Maria Angélica dos Santos Sanchez

Assistência ambulatorial geriátrica: hierarquização da demanda

In Brazil, the rapid growth of the elderly population has been causing a great impact on the healthcare system, with increased costs and service utilization. The inefficiency of traditional models for geriatric healthcare has made it essential to change the healthcare concepts for this population. This can take place through the development of new healthcare models that include the means to identify, assess and treat elderly patients with a variety of morbid and functional conditions, and which can be applied diverse healthcare scenarios. An outpatient model is proposed, with two stages that differ in the depth and coverage of their actions. These stages are organized as increasing levels of complexity and are capable of selecting subgroups of individuals that, because of their risk characteristics, should follow different paths through the healthcare structure. This paper discusses the first stage of this model, which involves risk identification among large groups of elderly people, by means of structuring a hierarchical flow of actions and using assessment tools of adequate sensitivity and specificity. Individuals aged 65 years or over who are detected through walk-in outpatient consultation, home visits or telephone interview are classified using a rapid screening risk evaluation instrument composed of eight items. Depending upon the level of risk presented, the individual will either be referred to another level of functional evaluation (medium-high and high risk levels), or to normal clinical care and old peoples community centers (low and medium risk levels). The second stage will be the subject of a subsequent paper.No Brasil, o rapido crescimento da populacao de idosos vem produzindo grande impacto no sistema de saude, com elevacao dos custos e da utilizacao dos servicos. A ineficiencia dos modelos tradicionais de assistencia ao idoso torna imprescindivel a mudanca no paradigma de atencao a saude dessa populacao, por meio do desenvolvimento de novos modelos de atencao que incorporem a identificacao, a avaliacao e o tratamento de idosos com perfis morbidos e funcionais variados, passiveis de serem aplicados nas diversas modalidades assistenciais. Propoe-se um modelo ambulatorial, em duas etapas, que se diferencia pela profundidade e abrangencia das acoes, organizadas em niveis crescentes de complexidade e capazes de selecionar subgrupos de individuos que, por suas caracteristicas de risco, devem progredir, diferenciadamente, na estrutura de atencao. Descreve-se a primeira etapa, que pressupoe a captacao e identificacao de risco de grandes grupos de idosos, por meio de um fluxo hierarquizado de acoes e o uso de instrumentos de avaliacao com sensibilidades e especificidades adequadas. O individuo com 65 anos ou mais, captado por demanda espontânea ambulatorial, captacao domiciliar ou busca telefonica, e classificado segundo avaliacao de risco, denominada Triagem Rapida, composta de oito itens. Dependendo do risco encontrado, o individuo sera encaminhado para acompanhamento clinico usual e atividades em centros de convivencia de idosos (risco baixo e medio) ou para outra etapa da avaliacao funcional (riscos medio-alto e alto). A segunda etapa sera tema de artigo posterior.

Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): adaptação transcultural para uso no Brasil

This article presents the results of the translation and cross-cultural adaptation of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the test-retest reliability of a version to be used in Brazil. An instrument review committee analyzed the conceptual and item equivalence. In order to analyze semantic equivalences, three translations and three back-translations were performed; a summary version was devised and pre-tested, and a test version elaborated. The Cronbachs +/- coefficient and intraclass correlation coefficient (ICC) were used to measure the internal consistency and test-retest reliability, respectively. Of the 169 informants assessed, 97 were retested. A Cronbachs +/- of 0.94 and an ICC of 0.92 were found. The reliability levels lead to the conclusion that the IQCODE-BR version is easy to comprehend. Satisfactory equivalence to the original version was observed.

Cross-cultural Adaptation of the "Functional Activities Questionnaire - FAQ" for use in Brazil

Objective The aim of this paper was to present the results of the first stage of cross-cultural adaptation of the Functional Activities Questionnaire (FAQ). Methods The tool was subjected to translation and re-translation, and the test-retest reliability of a proposed version for use in Brazil was analyzed. Results Of the 548 questionnaire respondents, a convenience sample of 68 informants was selected for retesting. Internal consistency was measured by Cronbachs alpha (0.95) while test-retest reliability was assessed using intra-class correlation (0.97). The findings have shown that FAQ is brief - averaging seven minutes to apply, easily understood and has good intra-rater test-retest reliability. Conclusion Our results suggest this adapted version of the FAQ is a reliable and stable tool which may be useful for assessing function in Brazilian elderly. Notwithstanding, the version should be subjected to further analysis with the aim of reaching functional equivalence.

Accuracy of the Brazilian Version of the Informant Questionnaire on Cognitive Decline in the Elderly at Screening for Dementia in Community-Dwelling Elderly Participants Findings From FIBRA-RJ Study

Objectives: To determine the accuracy of the Brazilian version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-BR) for screening for dementia and to analyze the association of sociodemographic variables of the elderly participants and informant, as well as the mental health of the informant, in the scores of the questionnaire. Methods: A cross-sectional study was carried out with 417 elderly participants and their informants from the sample of the Frailty in the Brazilian Elderly Study, Rio de Janeiro, Brazil. The older individuals were assessed by clinical, functional, and neurocognitive evaluation, and the diagnosis of dementia was established according to Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition) criteria. The informants were evaluated by Mini-Mental State Examination (MMSE), Center of Epidemiologic Studies—Depression Scale, and Burden Interview Scale. The Cambridge Cognitive Examination Test—Revised (CAMCOG-R) was used for convergent validity analysis. The association between IQCODE-BR and the study variables was determined by multivariate logistic regression analysis. Results: The best cutoff point was 3.26; the sensitivity, specificity, and area under the receiver–operating characteristic curve were 89%, 72%, and 0.88 (95% confidence interval: 0.837-0.917), respectively. The CAMCOG-R and the MMSE showed a moderate and negative association with IQCODE-BR. Conclusion: The IQCODE-BR is an instrument with good accuracy for the detection of dementia syndrome in Brazilian older person.

Screening for dementia: Brazilian version of the Informant Questionnaire on Cognitive Decline on the Elderly and its psychometric properties.

To assess the criterion validity of the Brazilian version of the Informant Questionnaire on Cognitive Decline on the Elderly (IQCODE‐BR), and analyze the influence of educational level and age of both the elderly and the informants on the questionnaire scores.

High‐Calorie Supplements for Treatment of Anorexia or Cachexia in Older Adults

The authors are grateful to Mr. Philip Bastable. Conflict of Interest: None. Author Contributions: Aline Ramanantsoa: study concept, acquisition of subject and data, interpretation of data, preparation of manuscript. Mamy Ramanantsoa: acquisition of subject and data, interpretation of data, preparation of manuscript. Elodie Bertrand: interpretation of data, preparation of manuscript. Dominique Valeyre, Christian Spiekermann: interpretation of data. Henri Patouraux: acquisition of subject and data, interpretation of data. Patrick Manckoundia: study concept, interpretation of data, preparation of manuscript. Sponsor’s Role: There was no sponsor for this study.

A entrevista social no processo de avaliação geriátrica ampla

The new guidelines of the pledge management strengthen actions towards the elderly care now that it has become one of the Health Ministerys priorities. Furthermore, the National Policy of Elderly prescribes a thorough and integrated care with emphasis on the multidimensional approaches that aim at rescuing or preserving both the autonomy and independence of the aging subject. A new paragon in the care appears bringing the comprehensive geriatric assessment, which is accomplished by a multidisciplinary team, as an essential praxis of both tracking and identifying the numerous illnesses to which the elderly is susceptible to. In this kind of assessment, it is fundamental to look into the social issues that might either retard the elderlys recuperation or bring about new maladies. The social interview is a technical instrument that will provide the professional with resources for an assessment that will entail an adequate intervention from the knowledge of the possibilities and limitations of the patients coming to geriatric facilities. This work aims at taking under consideration the social assessment withing the range of the comprehensive geriatric assessment. It is also an effort to contribute to the praxis of the social worker, given that theory in this field is rare and social issues are central to the establishment of efficient therapeutic procedures.

The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country

Previous studies have indicated that dementia and depression have a considerable impact on the functional capacity of older adults, also influencing awareness about ability. The purpose of the current study was to investigate the impact of dementia, depression and awareness on activities of daily living (ADL) in a sample from a middle‐income country.