Adriana Nunes Machado

Quality of life and multimorbidity of elderly outpatients.

INTRODUCTION: Substantial medical research has established an inverse relationship between quality of life and illness. However, there exists minimal evidence for such a connection in the context of stable and controlled diseases. OBJECTIVE: We wished to correlate multimorbidity with quality of life for elderly patients who suffer from stable chronic diseases. METHODS: We used a tool to evaluate quality of life, namely World Health Organization quality of life-BRIEF, together with a scale of multimorbidity known as the Cumulative Illness Rating Scale - Geriatric Version. Furthermore, the quality of life data were correlated with scores recorded on the Cumulative Illness Rating Scale - Geriatric Version, the number of drugs used, and individual perceptions of health and age. RESULTS: We studied 104 elderly patients who suffered from chronic diseases. The patients had exhibited neither acute events nor secondary complications, their cognition was intact, and they were functionally independent. The Cumulative Illness Rating Scale - Geriatric Version showed an inverse correlation with the physical domain (p= 0.008) and a tendency toward an inverse correlation with the psychological domain (p= 0.052). Self-perception of health showed a high correlation with the physical domain (p= 0.000), psychological domain (p= 0.000) and environmental domain (p= 0.000). The number of drugs used correlated only with the physical domain (p= 0.004). Age and social domain showed a tendency toward a positive correlation (p= 0.054). DISCUSSION: We uncovered an inverse relationship between quality of life and multimorbidity in a group of patients who suffered from stable chronic diseases, with no functional limitations, pain or complications. Our data suggest that a patient’s knowledge that they have a certain clinical condition changes their subjective assessment of quality of life in the related domain. CONCLUSION: The perceived quality of life of the sample was affected by multimorbidity in the physical domain, with a tendency toward commensurate effects in the psychological domain.

Prognostic factors for mortality among patients above the 6th decade undergoing non-cardiac surgery: cares - clinical assessment and research in elderly surgical patients

PURPOSE To ascertain perioperative morbimortality and identify prognostic factors for mortality among patients ≥55 years who undergo non-cardiac surgery. METHODS A retrospective cohort of 403 patients relating to perioperative morbidity-mortality. Data were collected from a standardized protocol on gender, age, comorbidities, medications used, smoking, alcohol abuse, chronic use of benzodiazepine, nutritional status, presence of anemia, activities of daily living, American Society of Anesthesiology classification, Detsky’s modified cardiac risk index - American College of Physicians, renal function evaluation, pulmonary risk according to the Torrington scale, risk of thromboembolic events, presence of malignant disease and complementary examinations. RESULTS The mean age of the subjects was 70.8 ± 8.1 years. The “very old” (≥80 years) represented 14%. The mortality rate was 8.2%, and the complication rate was 15.8%. Multiple logistic regression showed that a history of coronary heart disease (OR: 3.75; p=0.02) and/or valvular heart disease (OR: 31.79; p=0.006) were predictors of mortality. The American Society of Anesthesiology classification was shown to be the best scale to mark risk (OR: 3.01; p=0.016). Nutritional status was a protective factor, in which serum albumin increases of 1 mg/dl decreased risk by 63%. DISCUSSION The results indicate that serum albumin, coronary heart disease, valvular heart disease and the American Society of Anesthesiology classification could be prognostic predictors for aged patients in a perioperative setting. In this sample, provided that pulmonary, cardiac and thromboembolic risks were properly controlled, they did not constitute risk factors for mortality. Furthermore, continuous effort to learn more about the preoperative assessment of elderly patients could yield intervention possibilities and minimize morbimortality.

Identification and treatment of osteoporosis among elderly patients with hip fractures

OBJECTIVE: To evaluate the profile of osteoporosis treatment among patients hospitalized due to hip fractures at a tertiary-level university hospital. To compare the impact of hospitalization on approaches toward treating bone mass losses. METHOD: The medical records of 123 hip fracture patients aged 60 years and over at the Institute of Orthopedics, Hospital das Clínicas, University of São Paulo School of Medicine, between 2004 and 2006 were reviewed and analyzed with respect to approaches towards investigating osteoporosis and treatments before and after fracture. RESULTS: The patients’ mean age was 78 ± 8.3 years, and the majority were women (71.54%). The patients had a mean of 2.72 comorbidities and used 3.26 medications on average. Among these patients, 12.3% reported a previous diagnosis of osteoporosis, and 5.83% were on medication for this. The mean waiting time for surgery was 6.3 ± 7.54 days, and seven patients (5.7%) died during the hospitalization. There were no investigations using bone densitometry, no changes in osteoporosis therapy between admission and discharge (p = 0.375), and no reports of referrals for the patient to have access to treatment. CONCLUSIONS: Investigations and treatments of osteoporosis and strategies for preventing new fractures were not implemented during the hospitalization of these elderly patients with hip fractures, even though this is the most feared complication of osteoporosis. These data need to be disseminated so that professionals dealing with elderly patients are attentive to the need for primary and secondary prevention of osteoporosis because of the impact of fractures on these patients’ quality of life, independence, morbidities, and mortality.

Impact of a program to promote health and quality of life of elderly.

OBJECTIVE To evaluate the effect on quality of life of elderly people enrolled in GAMIA - Multidisciplinary Care Group to Outpatient Elderly Subjects (Grupo de Assistência Multidisciplinar ao Idoso Ambulatorial) of the Geriatric Department, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo. METHODS Between 2000 and 2002, 83 elderly participants of GAMIA were assessed by the World Health Organization Quality of Life scale (WHOQOL-bref) at the beginning and the end of the program. Functionality was assessed by Katz and Lawton scales and sociodemographic data were obtained from medical charts. RESULTS Females predominated (79.5%) and overall mean age was 69.30 years. Data analysis showed a reduction in the physical domain of WHOQOL-bref (p = 0.014) and increased psychological health and environment domains (p = 0.029 and p = 0.007, respectively), detecting a trend of increase in social relationships and in general domains (p = 0.062 and p = 0.052, respectively). CONCLUSIONS The clinical evaluation of the elderly detected previously unknown diseases and determination of the use of new drugs, which might have been the predominant factor for the deterioration of their perception in the physical domain. Improvement in psychological health and the environment can be related to psychological and social support that the elderly received from peers and professionals and the benefits of group activities, as well as the upward trend observed in social relationships and general domains. Participation in a program to promote healthy aging was effective in improving the quality of life of the elderly.

Comparison between ability and performance: a study on the functionality of dependent elderly individuals

OBJETIVO: comparar la capacidad y el desempeno para la realizacion de las Actividades Basicas de la Vida Diaria en ancianos dependientes atendidos por el Centro de Referencia del Anciano. METODO: se trata de un estudio transversal, observacional, con abordaje cuantitativo. La Medida de Independencia Funcional (MIF) fue aplicada en 109 ancianos atendidos en un Centro de Referencia del Anciano. De estos, 60 ancianos fueron clasificados como dependientes para las actividades basicas de la vida diaria y fueron descritos de acuerdo con la Clasificacion Internacional de Funcionalidad Incapacidad y Salud (CIF). El proceso de triangulacion reforzo la confiabilidad de los datos obtenidos, en el cual consideramos las informaciones de pacientes y acompanantes en conjunto con la ficha medica y evaluacion objetiva. RESULTADOS: el promedio de edad fue de 81,0±7,1, con predominancia del genero femenino. La diferencia entre la capacidad y el desempeno fue estadisticamente significativa (p<0,05) en la mayoria de las tareas de lo cotidiano. CONCLUSION: la contribucion de este estudio en la utilizacion de la CIF fue la interpretacion de sus calificadores de manera semicuantitativa, lo que permitio comparaciones e inferencias mas objetivas y evidencio una clara distancia entre el desempeno y la capacidad de esos ancianos en gran parte de las actividades evaluadas.OBJECTIVE to compare the ability and performance of Basic Activities of Daily Living of dependent elderly individuals cared for in a geriatric healthcare center. METHOD cross-sectional, observational study with quantitative approach. The Functional Independence Measure (FIM) was applied in 109 elderly individuals cared for in a geriatric healthcare center. Of these, 60 individuals were classified as dependent in the case of basic activities of daily living described according to the International Classification of Functionality, Disability and Health (ICF). The process of triangulation reinforced reliability of data, which included information provided by patients and caregivers and that contained in medical files and objective assessment. RESULTS the average age was 81.0±7.1 with a predominance of women. The difference between ability and performance was statistically significant (p<0.05) in most daily tasks. CONCLUSION the contribution of this study in using ICF was semi-quantitatively interpreting its qualifiers, which enabled more objective comparisons and inferences, and revealed a clear distance between the performance and ability of these individuals in most of the assessed activities.

Comparação entre a capacidade e desempenho: um estudo sobre a funcionalidade de idosos dependentes

OBJETIVO: comparar la capacidad y el desempeno para la realizacion de las Actividades Basicas de la Vida Diaria en ancianos dependientes atendidos por el Centro de Referencia del Anciano. METODO: se trata de un estudio transversal, observacional, con abordaje cuantitativo. La Medida de Independencia Funcional (MIF) fue aplicada en 109 ancianos atendidos en un Centro de Referencia del Anciano. De estos, 60 ancianos fueron clasificados como dependientes para las actividades basicas de la vida diaria y fueron descritos de acuerdo con la Clasificacion Internacional de Funcionalidad Incapacidad y Salud (CIF). El proceso de triangulacion reforzo la confiabilidad de los datos obtenidos, en el cual consideramos las informaciones de pacientes y acompanantes en conjunto con la ficha medica y evaluacion objetiva. RESULTADOS: el promedio de edad fue de 81,0±7,1, con predominancia del genero femenino. La diferencia entre la capacidad y el desempeno fue estadisticamente significativa (p<0,05) en la mayoria de las tareas de lo cotidiano. CONCLUSION: la contribucion de este estudio en la utilizacion de la CIF fue la interpretacion de sus calificadores de manera semicuantitativa, lo que permitio comparaciones e inferencias mas objetivas y evidencio una clara distancia entre el desempeno y la capacidad de esos ancianos en gran parte de las actividades evaluadas.OBJECTIVE to compare the ability and performance of Basic Activities of Daily Living of dependent elderly individuals cared for in a geriatric healthcare center. METHOD cross-sectional, observational study with quantitative approach. The Functional Independence Measure (FIM) was applied in 109 elderly individuals cared for in a geriatric healthcare center. Of these, 60 individuals were classified as dependent in the case of basic activities of daily living described according to the International Classification of Functionality, Disability and Health (ICF). The process of triangulation reinforced reliability of data, which included information provided by patients and caregivers and that contained in medical files and objective assessment. RESULTS the average age was 81.0±7.1 with a predominance of women. The difference between ability and performance was statistically significant (p<0.05) in most daily tasks. CONCLUSION the contribution of this study in using ICF was semi-quantitatively interpreting its qualifiers, which enabled more objective comparisons and inferences, and revealed a clear distance between the performance and ability of these individuals in most of the assessed activities.

A atividade física e o enfrentamento do estresse em idosos

OBJECTIVE To analyze the value of a physical activity program on stress coping of the elderly. METHODS Intervention study with a group of 18 elderly people referred by the Geriatric Service of the Hospital das Clinicas of the Universidade de Sao Paulo, who attended a supervised exercise program, evaluated by the human activity profile and the coping questionnaire. RESULTS In the coping and functional performance scales, increased stress coping capacity and improvement of daily activities were found after exposure to a physical activity program. CONCLUSIONS The practice of supervised and regular physical activity, combining aerobic, resistance, stretching, and respiratory exercises, yields positive effects in the coping capacity and in the accomplishment of the daily activities.

O efeito do consumo crônico de etanol na absorção duodenal de ferro em camundongos

CONTEXT Alcoholists present an increase of iron hepatic concentration, although the responsible mechanisms for this deposition are still unknown. Despite the extensive literature related on the iron absorption in different pathological conditions, the effect of chronic ethanol consumption are still not conclusive and not completely understood. OBJECTIVE To verify the effect of chronic ethanol ingestion on duodenal absorption of iron. METHODS Ten male Swiss mice were divided into two groups: group 1 (n = 5) - control, and group 2 (n = 5) - water consumption with ethanol, as only water source. The animals were followed during 120 days. After this period, the duodenum was isolated and saline solution containing ascorbate of iron II in the 0,016 concentration of mg of iron element was infused. The effluent was collected in times 20, 40, 60, 80, 100 and 120 minutes. The results were analyzed by Mann-Whitney and Kruskal-Wallis tests. The significance was set for P<0.05. RESULTS No difference was found between iron absorption as well as iron absorption curves in groups 1 and 2. CONCLUSION The chronic consumption of ethanol did not alter iron absorption.

Comparación entre capacidad y desempeño: un estudio sobre la funcionalidad de ancianos dependientes

OBJETIVO: comparar la capacidad y el desempeno para la realizacion de las Actividades Basicas de la Vida Diaria en ancianos dependientes atendidos por el Centro de Referencia del Anciano. METODO: se trata de un estudio transversal, observacional, con abordaje cuantitativo. La Medida de Independencia Funcional (MIF) fue aplicada en 109 ancianos atendidos en un Centro de Referencia del Anciano. De estos, 60 ancianos fueron clasificados como dependientes para las actividades basicas de la vida diaria y fueron descritos de acuerdo con la Clasificacion Internacional de Funcionalidad Incapacidad y Salud (CIF). El proceso de triangulacion reforzo la confiabilidad de los datos obtenidos, en el cual consideramos las informaciones de pacientes y acompanantes en conjunto con la ficha medica y evaluacion objetiva. RESULTADOS: el promedio de edad fue de 81,0±7,1, con predominancia del genero femenino. La diferencia entre la capacidad y el desempeno fue estadisticamente significativa (p<0,05) en la mayoria de las tareas de lo cotidiano. CONCLUSION: la contribucion de este estudio en la utilizacion de la CIF fue la interpretacion de sus calificadores de manera semicuantitativa, lo que permitio comparaciones e inferencias mas objetivas y evidencio una clara distancia entre el desempeno y la capacidad de esos ancianos en gran parte de las actividades evaluadas.OBJECTIVE to compare the ability and performance of Basic Activities of Daily Living of dependent elderly individuals cared for in a geriatric healthcare center. METHOD cross-sectional, observational study with quantitative approach. The Functional Independence Measure (FIM) was applied in 109 elderly individuals cared for in a geriatric healthcare center. Of these, 60 individuals were classified as dependent in the case of basic activities of daily living described according to the International Classification of Functionality, Disability and Health (ICF). The process of triangulation reinforced reliability of data, which included information provided by patients and caregivers and that contained in medical files and objective assessment. RESULTS the average age was 81.0±7.1 with a predominance of women. The difference between ability and performance was statistically significant (p<0.05) in most daily tasks. CONCLUSION the contribution of this study in using ICF was semi-quantitatively interpreting its qualifiers, which enabled more objective comparisons and inferences, and revealed a clear distance between the performance and ability of these individuals in most of the assessed activities.

Testosterone profile in older men with Alzheimer’s disease

Evidence suggests low testosterone levels in Alzheimer’s disease. Objectives To compare testosterone levels between older men with and without Alzheimer’s disease. Methods Fourteen men with Alzheimer’s disease were compared with twenty eight men without dementia. Demographic variables and clinical profiles were analyzed. Within fifteen days before or after the described evaluation, measures of total testosterone and Sex Hormone Binding Globulin (SHBG) were performed. Free testosterone level was calculated based on total testosterone and SHBG. Quantitative variables were analyzed using Student’s t test or Kruskal-Wallis test, while qualitative variables were analyzed using chi-square or Fisher test. Results Mean age in the Control and Alzheimer’s disease groups were 72.0 (SD±4.8) years and 79.3(SD±5.9) years, respectively (p=0.001). Mean schooling between these two groups were 8.78 and (±5.86) years, respectively (p=0.022). There were no statistically significant differences between the two groups for testosterone levels, although a trend was observed for the Alzheimer’s disease group to present lower levels than the control group (p=0.066). There was no direct correlation between free testosterone and age, although a trend was evident (p=0.068). Conclusions There was no significant difference in testosterone between men with AD and those without dementia.