Fernanda Loureiro

Patterns of chronic benzodiazepine use in the elderly

Background In several countries, prevalence studies demonstrate that chronic use of BZD in the elderly population is very high. This scenario has reached pandemic proportions for decades and is an important public health problem. Objectives To examine the independent association between chronic benzodiazepine use in depression, anxiety and bipolar disorder, as well as other clinical and sociodemographic factors. Methods This cross-sectional study was developed from a population-based survey and conducted from March, 2011 to December, 2012 using a random sample of 550 elderly people who were enrolled in the Family Health Strategy in Porto Alegre, Brazil. Data was collected from identifying epidemiological and health data (sociodemographic, self-perception health, self-reported diseases, smoking, alcohol and pharmacotherapeutic evaluation) and from the diagnoses of mood and anxiety disorders. Results Elderly patients diagnosed with depression, anxiety, concomitant depression/anxiety and bipolar disorders, and those who were using antidepressants have a higher risk of benzodiazepine use. Individuals who self-reported drinking alcohol had a lower risk of benzodiazepine use. Discussion Benzodiazepines are often used by the elderly for long periods, which has a direct impact on the treatment of mood and anxiety disorders and on vulnerable groups such as the elderly, who may be unnecessarily taking these drugs.

Abstracts from the 10th South-Brazilian Congress of Geriatrics and Gerontology and de 19th Winter Meeting of the Brazilian Society of Geriatrics and Gerontology – Rio Grande do Sul

PAJAR (Pan American Journal of Aging Research) presents to the scientific community its first supplement with the Abstracts from the 10th South-Brazilian Congress of Geriatrics and Gerontology and de 19th Winter Meeting of the Brazilian Society of Geriatrics and Gerontology – Rio Grande do Sul, held in the city of Bento Goncalves / RS in the period of July 6 to 8, 2017.

Prevalência de enteroparasitoses em idosos da Estratégia Saúde da Família de Porto Alegre, Brasil

132 Geriatr Gerontol Aging, Vol. 10, Num. 3, p.132-9 Engroff P, Ely LS, Silva AB, Viegas K, Loureiro F, Gomes I, DeCarli GA 133 Geriatr Gerontol Aging, Vol. 10, Num. 3, p.132-9 INTRODUCTION Intestinal parasites in the human intestinal tract are responsible for symptoms such as diarrhea, malnutrition, anemia, and psychosocial changes, among others.1 Intestinal parasitic infections are common in children, and therefore, this population is the primary focus of prevention and treatment campaigns. In the elderly population, little is known about the influence of parasites on aging. It is believed that intestinal parasite infections can be more severe in the elderly due to the aging of the immune system.2-4 Three epidemiological factors are required for the occurrence of parasitic disease: • suitable host conditions, including nutritional status; • cultural and behavioral factors; • the resistance of the parasite to the host immune system and the environment.5,6 Few epidemiological studies examine only elderly populations. Previous studies have reported cases in certain areas where the prevalence of intestinal parasitic infections in elderly population ranges from 9.5% to 72.8%.3,7-11 To understand the reality and needs of each region, the Family Health Strategy (FHS) team, which is part of the Unified Health System in Brazil, implements health surveillance, promotion, prevention, and disease control activities.12 The use of epidemiological tools and the collection of survey data by Community Health Workers (CHW) regarding the social and environmental factors that may affect human health enable closer proximity of health services to the population.13 Certain environmental factors may interfere with the disease process and increase the risk of contamination by intestinal parasites. Despite the development of new sanitation technologies, the health system in Brazil is not suitable, and deficiencies have been noted in the health education provided to the population, especially low-income individuals.14 Therefore, this study aimed to determine the prevalence of intestinal parasites and identify the association between this prevalence and the sociodemographic, environmental, and health factors of the FHS elderly residing in the city of Porto Alegre, RS, Brazil. METHOD This study is part of the “The multidimensional study of the elderly in the Family Health Strategy in Porto Alegre, Brazil (EMI-SUS)”, which occurred between March 2011 and December 2012. This prospective, randomized cross-sectional study was conducted on a sample of elderly individuals who were registered in the FHS in the municipality of Porto Alegre. To select the study participants, FHS teams were stratified by Health Districts (HD), and approximately 30% of the teams from each HD were selected; for the 30 FHS teams selected, 36 respondents were randomly selected from each FHS.15 The inclusion criteria for the study were as follows: older than 60 years of age and registered in the FHS. This project was approved by the Ethics Committees of PUCRS (protocol 10/04967) and of the Municipal Health Secretary of Porto Alegre (protocol 001.021434.10.7). Data collection was performed in two steps. First, during home visits, the CHW invited the elderly to participate in the study, obtained their consent and prepared a general questionnaire to collect the epidemiological variables. At this time, the CHW also informed each participant about the required fecal sample collection. Second, the project team collected blood and stool samples at the healthcare unit where each elderly individual was registered. Blood samples were collected into a tube containing EDTA, and fecal samples were collected into a plastic pot with screw top and stored in a refrigerator for no more than three days. Parasitological stool examinations (PSE) were conducted by the Biochemistry, Molecular Genetics and Parasitology Laboratory of the Institute of Geriatrics and Gerontology using the spontaneous sedimentation technique16 and the Baermann-Moraes method17 for all the samples. Hemograms were performed by the Clinical Pathology Laboratory of Hospital São Lucas by fluorescence flow cytometry (Sysmex XT 2000 – Kobe, Japan). Anemia was defined using the WHO hemoglobin values (< 13 g/dL for men and < 12 g/dL for women).18 Eosinophilia was considered present when the blood eosinophil value was above 400/uL. The following variables were used to test the correlation between the socioeconomic status of the 13 regions of Porto Alegre (Center, South, Center/South, Axis Baltazar, North, Humaitá/Navegantes, Restinga, East, Partenon, Lomba do Pinheiro, Glória, Cruzeiro and Northeast) with the prevalence of intestinal parasites: indicators of inadequate housing, water supply, sewage, and pavement. The georeferenced socioeconomic indicators, based on the 2010 Population Census of the Brazilian Institute of Geography and Statistics, were obtained from the Observatory of the City of Porto Alegre.19 The indicators for water supply and pavement, given originally as the number of houses with an adequate supply, were recalculated to show the number with an inadequate supply. The 30 FHS teams selected for the study were distributed across 13 of the 17 regions. Statistical analysis was performed in SPSS version 17. The variables were described as frequencies, means, and standard deviations. The χ2 Pearson test was used to compare the frequencies of the different variables. The χ2 test for linear Prevalence of intestinal parasites in the elderly 134 Geriatr Gerontol Aging, Vol. 10, Num. 3, p.132-9 trend was used to compare ordinal variables. If variables in the Pearson test had one or more cells with an expected value of less than five, they were analyzed using Fisher’s exact test. The significance level was p < 0.05. The multivariate analysis used binary logistic regression; the entry criterion for all variables was p < 0.300. In the final model, the variables were maintained if the independent p values were less than 5%. RESULTS Of the 1.080 randomly selected elderly individuals, 764 answered the epidemiological questionnaire, 608 provided fecal samples, and 581 provided blood samples. Therefore, after applying the exclusion criteria, a total of 581 elderly individuals participated in this study. The mean age was 68.2 ± 7.0 years, and 376 of the participants were female (64.7%). The overall prevalence of intestinal protozoans and helminthes was 10.8% (95%CI 8.6 – 13.6), and the prevalence of pathogenic parasites was 2.8% (Giardia lamblia, n = 6; Ascaris lumbricoides, n = 4; Strongyloides stercoralis, n = 3; Trichuris trichiura, n = 2; Iodamoeba bütschlii, n = 1) (95%CI 1.7 – 4.4). Co-infection was observed in only five individuals (Endolimax nana + Entamoeba coli, n = 3; Entamoeba coli + Giardia lamblia, n = 1; Entamoeba coli + Iodamoeba bütschlii, n = 1). The prevalence of intestinal parasites is described in Table 1. In the bivariate analysis, there were no statistically significant relationships between the prevalence of intestinal parasites and the socioeconomic and demographic variables (Table 2). Table 3 presents the hygienic and sanitary variables. The elderly who reported having other pets had a higher prevalence of intestinal parasites (27.8%) than those who had dogs and cats or who did not have pets (p = 0.041). The elderly who had animals that were bathed weekly showed a higher prevalence of intestinal parasites (16.0%) than those who were bathed less frequently (p = 0.024). Intestinal parasites N % Endolimax nana 29 42.7 Entamoeba coli 23 33.8 Giardia lamblia 6 8.8 Ascaris lumbricoides 4 5.9 Strongyloides stercoralis 3 4.4 Trichuris trichiura 2 2.9 Iodamoeba bütschlii 1 1.5 Total 68 100 Table 1. Description of intestinal parasites species Variable Population n (%) Prevalence of intestinal parasites % p Gender Female 376 (64.7) 10.1 0.439 Male 205 (35.3) 12.2 Race* White 374 (65.2) 9.9 0.479# Black 108 (18.8) 14.8 Mulatto 77 (13.4) 9.1 Others 15 (2.6) 6.7 Marital status* Married 226 (39.2) 13.7 0.230 Single 99 (17.2) 6.1 Separated 94 (16.3) 10.6 Widowed 157 (27.3) 10.2 Education* Illiterate 73 (12.6) 9.6 0.695Ɨ Incomplete primary school/school dropout 415 (71.6) 10.8 Primary school 56 (9.7) 12.5 High school or above 36 (6.2) 11.1 Age group (years) 60–69 376 (64.7) 11.4 0.404Ɨ 70–79 159 (27.4) 10.7 80 or above 46 (7.9) 6.5 Income* No income 45 (8.2) 6.7 0.572Ɨ Up to 1 BS 309 (56.3) 11.3 More than 2 BS 195 (35.5) 11.3 Cohabitants* Spouse and family 159 (27.6) 13.8 0.264 No spouse; others 194 (33.7) 9.8 Only spouse 118 (20.5) 12.7 Lives alone 105 (18.2) 6.7 Own professional activity?* Yes 118 (20.6) 13.6 0.286 No 454 (79.4) 10.1 Total 581 (100.0) 10.8 95CI% 8.6 – 13.6 BS: basic salary (~

Psychometric characteristics of the full and short versions of the IQCODE-BR among low income elderly persons with a low educational level

310.00) #p value calculated by Fisher’s exact test. Ɨp value calculated by Fisher’s exact test for linear trend. *Some individuals did not answer this question so were considered missing. Table 2. Description of socioeconomic and demographic variables according to the prevalence of intestinal parasites Engroff P, Ely LS, Silva AB, Viegas K, Loureiro F, Gomes I, DeCarli GA 135 Geriatr Gerontol Aging, Vol. 10, Num. 3, p.132-9 In the final multivariate analysis, the variables that were independently associated with seropositivity to intestinal parasites were the presence of animals other than dogs or cats (birds, chicken, sheep, and goats; OR = 0.208; p = 0.046) and having pets that were bathed weekly (OR = 11.31; p = 0.027). Evaluating the association with other health variables (Table 4), we observed that the elderly who did not have hypertension (15.4%) or did not have mental diseases (depression, mood disorders, cognitive impairment, and dementia; 12.8%) had a higher prevalence of intestinal parasites than #p value calculated by Fisher’s exact χ2 test. *Some individuals did not answer this question so were considered missing. Variable Population n (%) Prevalence of intestinal parasites

The Mental Health Research Protocol of the Multidimensional Study of the Elderly in the Family Health Strategy in Porto Alegre, Brazil (EMI-SUS)

Objective : To study the psychometric characteristics of the Brazilian Portuguese version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-BR) using a sample of low income elderly persons with a low educational level, and compare the full and short versions of the questionnaire. Method : A cross-sectional study of a convenience sample of a population with a low educational level was performed. The IQCODE-BR was applied to the informants of 87 elderly persons (60-90 years old), who were triaged by psychiatrists and neurologists for the diagnosis of depression, mild cognitive impairment (MCI), and dementia. Results : The median age of the sample was 72 and the majority were women (72.4%). A total of 31 (35.6%) were illiterate, 30 (34.5%) had dementia, 21 (24.1%) suffered from depression, 20 (23.0%) had MCI, and 16 (18.4%) were diagnosed with none of these conditions. The median IQCODE-BR was higher in the groups with depression and MCI than the normal group, and was highest of all in the group with dementia. The full and reduced versions of the IQCODE-BR had similar levels of accuracy. Conclusion : In this sample the IQCODE-BR was shown to be an effective tool for tracking MCI and dementia. The use of the short version with cut-off points of 3.22 for MCI excluding a diagnosis of depression, and 3.48 for dementia irrespective of the presence of symptoms of depression, is suggested.