Javier Jerez-Roig

Prevalence of urinary incontinence and associated factors in nursing home residents

To determine the prevalence of urinary incontinence (UI) and associated factors in the institutionalized elderly.

Prevalence of fecal incontinence (FI) and associated factors in institutionalized older adults

The objective of this work is to determine the prevalence of FI and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December 2013, in 10 nursing homes (NHs) of the city of Natal (Northeast Brazil). Individuals over the age of 60 were included in the study, while those hospitalized or in terminal phase were excluded. Data collection included sociodemographic information, FI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). FI was verified through the Minimum Data Set (MDS) 3.0, which was also used to assess toileting programs. The Chi-square test and the linear Chi-square test were performed for bivariate analysis, as well as logistic regression for multivariate analysis. The final sample consisted of 321 elderly, mostly females, with mean age of 81.5 years. The prevalence of FI was 42.68% (CI 95%, 37.39-48.15). Most residents presenting FI were always incontinent (83.9%) and the most frequent incontinence type was total FI (solid and liquid stools). Incontinence control measures were applied only to 9.7% of the residents. The final model revealed a statistically significant association between FI and functional and cognitive impairments. It is concluded that FI is a health issue that affects almost half of the institutionalized elderly, and is associated with functional and cognitive disability.

Mortality trends and prediction of HPV-related cancers in Brazil.

Estimation of the size of a cancer group, either through number of cases or extrapolation of past observed trends, is indispensable to the planning of effective assistance measures. The aim of this study was to analyze the mortality trends of human papillomavirus-related cancers in Brazil by sex, in the period 1996–2010, and make predictions until the year 2025. All deaths registered as being a result of cervical cancer (ICD-10 code: C53), as well as those caused by vulvar and vaginal (C51 and C52), anal (C21), penile (C60), and oropharyngeal (C02, C09, C10) cancers, were registered. Adjusted rate calculations for each year were used to study the trends through the regression program ‘Joinpoint’. Predictions were made using the Nordpred program, utilizing the age–period–cohort model. When analyzing separately by location, it was observed that penile and anal cancers in men presented an increasing trend for the entire period with a statistically significant annual percentage change of 4% for anal cancer and 1.4% for penile cancer. Predictions indicate a reduction in the risk of death due to oropharyngeal cancer in men and cervical, vulvar, and vaginal cancers in women. It was observed that the increase in the number of deaths occurs mainly because of population changes (size and age structure). In terms of risk, an increase is predicted for anal and penile cancers in men and consequently an increase in mortality rates is observed for these types of cancers, unlike what is expected for human papillomavirus-related cancers in women.

Functional decline in nursing home residents: A prognostic study

Aim To verify the probability of maintaining functional capacity in basic activities of daily living and identify the prognostic factors of functional decline in institutionalized older adults. Methods A longitudinal study is presented herein, with 5 waves every 6 months, throughout 2 years (2013–2015), conducted with individuals ≥60 years old in 10 nursing homes in the city of Natal-RN (Brazil). Functional capacity was assessed by the items ‘eating’, ‘personal hygiene’, ‘dressing’, ‘bathing’, ‘transferring’, ‘toileting’ and ‘walking’, through a 5-item Likert scale. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time dependent variables included continence decline, cognitive decline, increase in the number of medication, and incidences of falls, hospitalizations and fractures. The actuarial method, the log-rank test and Coxs regression were applied as statistical methods. Results The cumulative probability of functional maintenance was 78.2% (CI 95%: 72.8–82.7%), 65.1% (CI 95%: 58.9–70.5%), 53.5% (CI 95%: 47.2–59.5%) and 44.0% (CI 95%: 37.7–50.2%) at 6, 12, 18 and 24 months, respectively. Predicting factors for functional decline were: severe cognitive impairment (HR = 1.96; p = 0.001), continence decline (HR = 1.85; p = 0.002) and incidence of hospitalizations (HR = 1.62; p = 0.020), adjusted by the incidence of depression, age, education level, presence of chronic diseases and low weight. Conclusions The cumulative probability of maintaining functional capacity in institutionalized older adults was only 44% at the 2-year follow-up. Prognostic factors for functional decline included severe cognitive impairment, continence decline and incidence of hospitalizations.

Future burden of prostate cancer mortality in Brazil: a population-based study

Prostate cancer mortality projections at the nationwide and regional levels to the year 2025 are carried out in this ecological study that is based on an analysis of Brazilian trends between 1996 and 2010. The predictions were made for the period 2011-2025 utilizing the Nordpred program based on the period of 1996-2010, using the age-period-cohort model. A significant increase was observed in the Brazilian rates between 1996 and 2006, followed by a non-significant decrease. The projections indicate a decrease in rates at a national level as well as for the Central, South and Southeast regions. Increases are expected for the North and Northeast regions. In conclusion, a reduction in the mortality rates for prostate cancer in Brazil is expected to the year 2025, as well as for the Central, South and Southeast regions. However, an increase in the absolute number of deaths in all regions is expected due to the anticipated aging of the population.

Depressive Symptoms and Associated Factors in Institutionalized Elderly

Background/Study Context: Depression is a common psychiatric disorder in the elderly that leads to a decrease in quality of life and functional impairment, among other health problems. The study of depressive symptoms in institutionalized elderly is scarce in Latin America and can contribute to plan prevention and treatment actions in order to improve health conditions for the residents as well as quality of life. Therefore, the aim of this study is to determine the prevalence of depressive symptoms and identify its associated factors in institutionalized elderly. Methods: A cross-sectional study is presented herein, carried out in 10 nursing homes of the municipality of Natal (Northeast Brazil). All individuals over the age of 60 were included. The Geriatric Depression Scale (GDS-15) was applied to verify the depressive symptoms, as well as sociodemographic variables related to the institution and health conditions (comorbidities, medication, body mass index, level of physical activity, mobility, and functional and cognitive capacities). Bivariate analysis was carried out using the chi-square Pearson’s test (or Fisher’s test) and the linear trend chi-square. Finally, logistic regression was utilized for multivariate analysis. Results: The final sample was constituted of 142 elderly, mostly of the female sex (78.9%), with an average age of 79.3 (SD: 8.2). Of these, 65 individuals presented depressive symptoms, with a 45.77% prevalence (95% confidence interval [CI]: 37.80–53.97%). The final model verified an association between the presence of depressive symptoms and functional impairment, prevalence ratio (PR) = 1.58 (95% CI: 1.04–2.42), and arterial hypertension, PR = 1.57 (95% CI: 1.07–2.31), adjusted by fecal incontinence, sex, and age. Conclusion: Depressive symptoms were present in almost half of the sample of institutionalized elderly, and this condition was associated with functional impairment and arterial hypertension. The results of this work indicate the importance of monitoring depression as well as intervening on these modifiable aspects, to avoid the cascade of negative outcomes associated with this disease and also improve the quality of life of this population group.

Autopercepção da saúde em idosos institucionalizados

This study aimed to verify health self-perception, its prevalence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted in 10 Long-Term care Institutions for the Elderly (LTIE) in the city of Natal (Northeast Brazil), between October and December 2013. Sociodemographic variables were analyzed, along with institution-related and health state variables. Descriptive and bivariate analyses were carried out (Chi-squared test, Fishers exact test or linear trend Chi-squared test), as well as multivariate analysis (logistic regression). The final sample consisted of 127 elderly. The prevalence of negative self-perceived health was 63.19% (CI 95%: 55.07-70.63), and was associated with weight loss (PR: 1.54; CI 95%: 1.19-1.99), rheumatic disease (PR: 1.46; CI 95%: 1.05-2.01) and not-for-profit LTIE (PR: 1.37; CI 95%: 1.03-1.83), adjusted by sex. More than half of the elderly reported negative self-perceived health, which was associated with weight loss, rheumatic disease and type of institution. Actions must be developed to promote better health conditions in LTIE, such as nutrition consulting and physical therapy, to improve quality of life.Resumo Este trabalho objetivou determinar a autopercepcao da saude em idosos institucionalizados, assim como verificar a prevalencia de percepcao negativa da saude e seus fatores associados. Trata-se de estudo transversal realizado em 10 instituicoes de longa permanencia para idosos (ILPI) da cidade de Natal, entre outubro e dezembro de 2013. Foram analisadas variaveis sociodemograficas, relacionadas a ILPI e as condicoes de saude. Realizou-se a analise descritiva, bivariada mediante os testes qui-quadrado, exato de Fisher ou qui-quadrado de tendencia linear, assim como multivariado mediante regressao logistica. A amostra foi de 127 idosos. A prevalencia de autopercepcao negativa da saude foi de 63,19% (IC 95%: 55,07-70,63), e esteve associada a perda de peso (RP: 1,54; IC 95%: 1,19-1,99), doenca reumatica (RP: 1,46; IC 95%: 1,05-2,01) e ILPI sem fins lucrativos (RP: 1,37; IC 95%: 1,03-1,83), ajustado por sexo. E fundamental desenvolver acoes de promocao da saude nas ILPI, como aquelas baseadas na nutricao e fisioterapia que atuem sobre esses agravos a saude, com vistas a melhorar a qualidade de vida.

Activity Limitations in Brazilian Institutionalized Older Adults.

Background and Purpose: Although functional assessments and programs to prevent activity limitations are fundamental for efficient geriatric evaluations and interventions, these procedures have not been satisfactorily explored at nursing homes in Brazil. Literature is scarce on the evaluation of disability in Brazilian institutionalized older people. Methods: A cross-sectional study was conducted in 10 nursing homes in the city of Natal (Northeast Brazil). Sociodemographic and health data were collected and activity limitations were assessed by the Katz Index. Results and Discussion: The prevalence of activity limitations was 72.9% (95% confidence interval: 67.8-77.5) and the most affected activity was “bathing” (71.6%), followed by “dressing” (65.4%) and “toileting” (62.0%). The final model revealed associations with private (for-profit) institutions (odds ratio [OR] = 3.33; P < .001), age ≥ 83 years (OR = 2.34; P = .003), institutionalization due to lack of caregiver (OR = 1.80; P = .033), and presence of osteoporosis (OR = 2.94; P = .045), adjusted by sex. Conclusions: Activity limitations affected almost 73% of institutionalized older people in this sample and were associated with private nursing homes, age, osteoporosis, and institutionalization due to lack of caregiver. Activity limitations exact high socioeconomic impacts and affect the quality of life of older people. The results obtained herein emphasized the importance of planning strategies for their prevention and treatment, directed to reduce the prevalence of this health issue.

Análise da produção científica da Revista Brasileira de Geriatria e Gerontologia: uma revisão bibliométrica

OBJECTIVE: To describe and analyze the profile of publications of the Brazilian Journal of Geriatrics and Gerontology (RBGG) between years 2006 to 2013. METHOD: This is a survey of literature review, descriptive type with bibliometric analysis of scientific production of RBGG. Data collection was performed by three trained investigators. The editorial staff was contacted via e-mail to get information regarding the number of manuscripts received, rejected and accepted. RESULTS: It published a total of 400 articles, of which 301 (75.3%) were original articles and 42 (10.5%) reviews. Most studies (95.1%) were published by Brazilian authors, most of whom are from the Southeast (43.4%) and South (26.8%), concentrated in the states of Sao Paulo (19.8%), Rio Grande do Sul (15.6%) and Rio de Janeiro (12.0%). Most works had quantitative approach and the most frequent type of study is the cross-sectional (45.9%), followed by literature review (13.7%) and a number of observational cases (10.7%). There was an increase in time of publication between 2006 and 2011, followed by stability until 2013. The most common themes were related to the psychological aspects of aging, physical activity and nutrition. CONCLUSIONS: There has been observed continuing increase in the number of papers received and published in RBGG in this period. The production is focused mainly in the universities at the national scope in the Southeastern and Southern regions. A wide range of topics was also identified.

Cognitive impairment and associated factors among institutionalized elderly persons in Natal, Rio Grande do Norte, Brazil

Objetivo: Identificar a prevalencia de incapacidade cognitiva e seus fatores associados em idosos institucionalizados. Metodos: Estudo transversal, realizado entre Outubro a Dezembro de 2013, nas Instituicoes de Longa Permanencia para Idosos de Natal, Rio Grande do Norte, Brasil, com 326 idosos de ambos os sexos. A avaliacao do declinio cognitivo foi classificada por meio do teste de Pfeiffer. Foram aferidas informacoes sobre condicoes sociodemograficas e estado de saude. O estado nutricional foi avaliado mediante a aplicacao da Mini Avaliacao Nutricional e capacidade funcional por meio do Indice de Katz. Para identificacao dos fatores associados com a presenca de incapacidade cognitiva moderada ou severa foi realizada a analise multipla de regressao logistica das variaveis com valor de p>0,20, utilizando-se o metodo Stepwise Forward. Resultados: Observou-se que 83,6% (IC 95%: 78,9-87,3%) dos idosos possuiam incapacidade cognitiva. O modelo final, ajustado pelo tipo de ILPI, mostrou que ter 83 anos ou mais foi considerado fator de risco para a incapacidade cognitiva moderada ou severa. Todavia, ter Hipertensao Arterial Sistemica (HAS) e ter sido institucionalizado por opcao propria foram considerados fator de protecao para a incapacidade cognitiva moderada ou severa. Conclusao: As variaveis idade, ter HAS e ter sido institucionalizado por opcao estao associadas diretamente, seja como fator de risco ou protecao, a presenca de incapacidade cognitiva severa ou moderada da populacao idosa. O diagnostico precoce desses fatores acarreta em maior zelo para que sejam tracadas metas de prevencao e atencao a saude, melhorando, consequentemente, a qualidade de vida dessas pessoas.