Angelo José Gonçalves Bós

Gerontology-Specific Graduate Programs in Brazil and Colombia

Abstract Every year the proportion of elderly people increases at a greater rate compared with other age groups, changing the population structure of most countries. Latin America has been internationally known for its higher percentage of young compared with elderly persons. The United Nations predicts that the proportion of elderly persons in Latin America and the Caribbean will be more similar to world figures in 2020 and even higher in 2040. The increasing elderly population in Latin America has increased the demand for advanced degree professionals with gerontology training. Nevertheless, in spite of training efforts during the last decade, the number of gerontology professionals is still insufficient. In total, the authors were able to locate only ten gerontology programs in Latin America (four in Brazil, two in Argentina, and one each in Uruguay, Peru, Cuba, and Colombia). The programs currently available in Brazil and Colombia are described in an effort to share information on the common characteristics of Masters and PhD degree programs in gerontology in Latin America. The authors concluded that, in Latin America, programs focused exclusively on gerontology are scarce.

Alterações de linguagem em pacientes idosos portadores de demência avaliados com a Bateria MAC

OBJETIVO: Identificar as alteracoes de linguagem em um grupo de pacientes idosos portadores de demencia nas tarefas de evocacao lexical livre, com criterio ortografico e com criterio semântico, interpretacao de metaforas e discurso narrativo da Bateria Montreal de Avaliacao da Comunicacao - Bateria MAC, bem como, verificar a frequencia de deficits. METODOS: Participaram do estudo 13 pacientes com demencia de grau leve a moderada, atendidos no Setor de Neurologia do Ambulatorio de Disturbios do Movimento e Demencias do Hospital Santa Clara da Irmandade Santa Casa de Misericordia de Porto Alegre (ISCMPA). O instrumento neuropsicologico de avaliacao foi a Bateria MAC e a aplicacao das tarefas seguiu a seguinte ordem: evocacao lexical livre, evocacao lexical com criterio ortografico, evocacao lexical com criterio semântico, interpretacao de metaforas e discurso narrativo. RESULTADOS: O grupo de pacientes com demencia apresentou desempenho deficitario em todas as tarefas da Bateria MAC que foram avaliadas, com diferenca significativa. Alem disso, os participantes apresentaram maior frequencia de deficits, em ordem decrescente, nas tarefas de reconto parcial do discurso narrativo (informacoes essenciais e presentes), seguidas pelas tarefas de evocacao lexical com criterio ortografico e com criterio semântico, e reconto integral do discurso narrativo. Pelo menos dois pacientes apresentaram alteracoes de desempenho em alguma das cinco tarefas realizadas da Bateria MAC. CONCLUSAO: A avaliacao de linguagem atraves da Bateria MAC permitiu a verificacao de alteracoes do processamento linguistico em idosos com demencia, o que caracteriza que tal instrumento tambem e aplicavel para esta populacao clinica.

Relationship between skin color, sun exposure, UV protection, fish intake and serum levels of vitamin D in Japanese older adults

Purpose This paper aims to observe the possible relationship between skin color, sun exposure level, UV protection and food intake and serum levels of 25(OH) D in Japanese older adults. Design/methodology/approach Elderly (n = 131; 65-93 years old), followed by the Tokyo Metropolitan Institute of Gerontology in the Kusatsu (36°N) received a self-applicable questionnaire about the quantity and quality of the daily sun exposure and behavior to avoid the sun. A color analyzer measured each red (R), green (G) and blue (B) component of skin color, and dietary vitamin D was estimated by food frequency questionnaire. Serum 25(OH) D levels were collected and categorized as sufficiency (>30 ng/mL), insufficiency (between 20 and 30 ng/mL) and deficiency (<20 ng/mL). Findings High proportion of participants had insufficiency (53 per cent) and deficiency (25 per cent) levels of 25(OH) D. Insufficiency levels were more prevalent in women (57 per cent, p = 0.048) and in participants that use gloves (49 per cent, p = 0.054) and sunscreen on face (76 per cent, p = 0.003) as a sun protection way. Participants with sufficiency levels of 25(OH) D presented lower values of R (p = 0.067), G (p = 0. 007) and B (p = 0.001) of skin color (what is meaning darker skin) and a higher fish intake (12 times per week). Research limitations/implications The study is a cross-sectional design and brings a potential for measurement error in the recorded subjective variables. There is a memory bias in self-reported sun exposure and food consumption; however, in the multivariate analysis, it was demonstrated a significant association. Second, although the authors have sought to evaluate a number of variables that could affect the skin’s ability to synthesize vitamin D, there are many other factors that may affect this ability that could not be accounted for. Another limitation was the assessment of self-reported ultraviolet exposure data rather than direct measurement of exposure. Practical implications It was also concluded that darker skin color (a surrogate of longer-term sun exposure) participants had a lower prevalence of vitamin D insufficiency in this ethnic homogeneous population. When accessing patients’ skin color, the clinician must account for his or her ethnicity. Social implications Governments should regulate supplementation or food fortification with vitamin D, with special focus in countries with geographical location of insufficient solar radiation for skin synthesis of this vitamin. With this, it becomes a priority that a safe sun exposure ensures the sufficient serum levels of 25 (OH) D without the use of supplements. Originality/value This report was the first to analyze skin color components associated to vitamin D levels, finding that blue and green colors were significant. The clinical implication of this find is yet to understand. It was also concluded that darker skin color (a surrogate of longer-term sun exposure) participants had a lower prevalence of vitamin D insufficiency in this ethnic homogeneous population. When accessing patients’ skin color, the clinician must account for his or her ethnicity.

Poor Food Consumption in Middle Aged and Elderly Indigenous People in Southern Brazil

Introduction: Considering the food as one of the basics for healthy aging, we identified important gaps in the knowledge of food habits and nutrition of southern Brazilian indigenous people. Objective: This study evaluated the dietary intake of Kaingang and Guarani ethnic indigenous living in Porto Alegre and Planalto, Brazil. Methodology: A cross-sectional, descriptive and analytical study, with the participation of 150 indigenous people, aged between 40 and 104 years. Dietary intake was estimated by a 24-hour recall, conducted between July and August 2009. Results: There was excessive consumption of foods rich in simple carbohydrates (candy and soda), and high intake of lipids of animal origin (lard as a base for some preparations), which is related to the increase risk of heart diseases. There was a low consumption of fruits and vegetables (sources of vitamins, minerals, fiber and bioactive compounds), foods that can reduce the risk of diseases. Conclusions: The lack of one or more nutrients, called hidden hunger, is considered an important nutritional problem, as the stage prior to the appearance of detectable clinical diseases. Thus, the poor food choices or lack of access to good quality of food may be influencing the health status of these indigenous. It is noteworthy that food as a source of pleasure and cultural identity and family also may be necessary to approach health promotion respecting the food culture of this population.

Aging and frailty or frailty and aging

Sewo-Sampaio et al. present us with a very interesting comparison of frail and robust elderly women in Southeast Brazil. The study sample is a group of older women who participate in diverse activities in community centers. They applied a very comprehensive, but easy to use, heath examination instrument and found important differences in two groups of participants: frail and robust. What is interesting about this sample is the fact that one would not expect to have frail participants in this group, as they are active participants of community activities. However, there were quite a few frail older women. The comprehensive assessment also allowed the authors to discuss what frailty syndrome actually is. The authors mentioned sensibly: “surprisingly, differences between the robust and frail groups were found in all investigated (clinical) domains, reinforcing the multidimensional nature of the aging process.” Is frailty a measurement of aging? Do frail older adults age faster than those robust ones? What makes this discussion important is the fact that when talking about frailty, we are not dealing with a single disease. When we check for a patient’s frailty status, we are actually accessing his or her health, by the means of a comprehensive (physical, nutritional, social and psychological) function. First described by Linda Fried as a clinical syndrome at the beginning of this century, frailty could not be described or linked to a single known disease. The frailty concept also agrees with the knowledge that aging is not linked to a single known disease. When the retired medical doctor, William W Peter MD, called Nathan W Shock PhD in February 1958, he offered his cadaver to science. Dr Peter wanted Dr Shock to find out why, at his age (76 years ), he had no known disease and was therefore healthy. The answer Dr Peter received from the visionary Dr Shock was not less unexpected: “we don’t need to wait until you die, we can research you know.” This single call led to the first step in creating the famous Baltimore Longitudinal Study of Aging in March of that same year. In the beginning, the Baltimore Longitudinal Study of Aging focused on understanding the factors that would prevent the development of diseases, although Dr Shock had the clear notion that “Aging was not a disease.” He was more concerned with the impairment that is found in older adults, but his concept was not so easy to “sell” to the scientific community at that time. It was not until 2003 that Dr Luigi Ferrucci MD included the concept of frailty in the Baltimore Longitudinal Study of Aging, introducing this new way to study aging. Thus, frailty, as a manifestation of the aging process, brings us a novel way to study aging. Understanding the factors related to frailty might help us to understand the aging process per se.

Anthropometric profile and self esteem of a physical activity group on Health Unit

Aims: to compare, socio-demographic and anthropometric profile, presence of chronic diseases, and self-esteem index of a Physical activity Group (PaG) and a sedentary group (Control Group – CG) linked to a Family Health Unit (FHU) in Porto alegre, Brazil. Methods: The study consisted of 15 participants from the P aG and 15 from the CG, using a convenience sample, since all PG available were included. Both groups were matched by sex and age. Both groups consisted of only women. Results: The mean age of P aG was 62±8 years and CG was 61±10 years, not been statistically different. anthropometrically both evaluated groups were similar. Most commonly found diseases were Hypertension (66%) and Diabetes (25%). The level of self-esteem was high in 67% of participants in both groups, with no difference between groups. Conclusions: Current evidence indicates that physically active people have better self-esteem and a lower risk of developing Coronary Heart Disease, Type 2 Diabetes Mellitus, and Hypertension. Several protocols recommend the expansion of health actions, motivating physical activity in primary care. Based on the data, we emphasize the importance of studies that characterize the real life of group participants in FHU users, especially in physical activity, since the population has a high prevalence of chronic degenerative diseases. We emphasize the importance of Public Policies that offer users exercise programs within the community and encourage them to this practice, with the activeness of the healthcare team.