Paula Engroff

Suicide risk in the elderly: Data from Brazilian public health care program

OBJECTIVE Examine prevalence and level of suicide risk, and its associations with sociodemographic factors and mood disorders. METHODS A cross-sectional study with a random sample of 530 individuals aged 60 years or more from Family Health Strategy of Porto Alegre, Brazil. Diagnosis was made by psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus). RESULTS Suicide risk was found in 15.7% of the sample. Female gender, elderly with no income or with no paid activity and those who have lost one or more of his sons presented association with suicide risk. Bipolar disorder shows association with suicide risk for those with or without current episode. For unipolar depression only elderly with a current episode shows association with suicide risk. LIMITATIONS The cross-sectional design limits the examination of causative relationships. The MINIplus questions are not broad enough to assess other important self-destructive behaviors. CONCLUSIONS A high rate of suicide risk was found. As expected an increased rate of mood disorders were related to the risk of suicide. The loss of sons may partly explain a subtype of late-life risk of suicide or mood disorders especially in the oldest-old. These findings can be a useful to generate other research hypothesis and for health professionals who care older persons. Detecting characteristics linked to suicide, therefore opening up the possibility of preventing tragic outcomes providing a proper treatment.

The Inverted CD4:CD8 Ratio Is Associated with Cytomegalovirus, Poor Cognitive and Functional States in Older Adults

Background: Some premature features of immunosenescence have been associated with persistent viral infections and altered populations of T cells. In particular, the inverted T CD4:CD8 ratio has been correlated with increased morbidity and mortality across different age groups. Objective: Here, we investigated the role of persistent viral infections, cognitive and functional states as predictors of inverted CD4:CD8 ratio of older adults in a developing country. Methods: Three hundred and sixty community-dwelling older adults (aged 60-103 years) were recruited. Cognitive function was evaluated by the Instrument of Brief Neuropsychological Assessment and Mini-Mental State Examination inventory. Functional Activities Questionnaire was used to determine activities of daily living. Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) serologies were determined by ELISAs. Peripheral blood was assessed for lymphocyte subsets by flow cytometry (CD4+, CD8+, NK, NKT, B and CD8+CD28-). Results: Fifty-nine individuals were identified with CD4:CD8 ratio <1, and had increased IgG titers to CMV (p < 0.01), but not to EBV, compared to subjects with CD4:CD8 ratio >1. The older adults with inverted CD4:CD8 ratio had impairments in some cognitive dimensions and had more functional disability and dependency (p = 0.01) than subjects with CD4:CD8 ratio >1. The lymphocyte subsets did not vary between groups. The increased CMV-IgG titers alone contributed to 8× higher chance to invert CD4:CD8 T cell ratio (OR 8.12, 95% CI 1.74-37.88, p < 0.01). Conclusion: Our data further indicate the role of CMV on circulating T cells, poor cognition and functional disability/dependency during aging.

Hematological parameters and prevalence of anemia among free-living elderly in south Brazil

Objective The aims of this study were to analyze the hematological parameters, the prevalence of anemia and the association between anemia and socioeconomic conditions in an elderly community-based population. Methods A population-based study was performed as part of the Multidimensional Study of the Elderly in Porto Alegre, Brazil (EMIPOA). An initial total of 1058 community residents aged 60 years and older were interviewed. Of these, 392 agreed to have a physical evaluation and a blood sample was taken from each. The hematological parameters analyzed in the blood samples included the hemoglobin concentration, mean cell volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW). The association between the variables and the diagnosis of anemia was assessed using the chi-squared test and a multiple logistic regression model. Results The overall prevalence of anemia was 12.8%. Anemia was present in 13.7% of women and in 10.4% of men. Normocytic normochromic anemia without anisocytosis was the most common type of anemia (46%). The assessment of erythrocyte morphology showed significant differences between anemic and non-anemic individuals (microcytosis = 12% vs. 1.5%, hypochromia = 40% vs. 8.8%, and anisocytosis = 26% vs. 7%). In the analysis of socioeconomic conditions, significant differences were found in respect to age and race. Conclusion The prevalence of anemia increases with age and is associated with race, microcytosis, hypochromia and anisocytosis. Anemia is not a condition that should be associated only with the aging process, as it may be due to pathological conditions that occur most frequently in this age group. As a result, a diagnosis of anemia warrants adequate clinical attention.

Tabagismo em idosos

Smoking cigarettes is an important accelerator of the aging process which compromises the life expectancy, and the quality of life. Smokers over 50 years old have a higher dependence on nicotine, smoke more cigarettes, smoke longer, have more health problems related to smoking and have more difficulty in quitting smoking. The main causes of death from smoking are cardiovascular diseases, chronic obstructive pulmonary disease and lung cancer. Nowadays, there are a number of strategies to stop smoking cigarettes, non-pharmacological and pharmacological, which are also advantageous for the elderly. This study aims to report data on smoking in Brazil and in the world, the pathology involved and the toxic effects of cigarette components as well as suggest treatment strategies, especially in the elderly. We examined published articles from the databases: Pubmed, Scielo, Portal Capes, Ministerio da Saude, Instituto Nacional do Cancer, IBGE and the World Health Organization. We concluded that smoking is a source of risk and major cause of numerous diseases. But the desire to quit is higher among those who recognize that this habit affects their health. While the benefits of stopping smoking are higher among younger, smoking cessation at any age reduces the risk of death and improves the general health condition.

Prevalência de enteroparasitos em idosos

OBJECTIVES: To evaluate the prevalence of intestinal parasites in elderly patients from a geriatric ambulatory in Porto Alegre, Rio Grande do Sul state, Brazil, and in elderly residents of two long-stay institutions in the same city, as well as to evaluate the presence of enteroparasites in the elderlys pets. METHODS: Stool samples from the elderly and the pets were analyzed through fecal parasitological examination. To evaluate the enteroparasites, macroscopic exam, concentration methods of Hoffman, Pons and Janer and the Baermann-Moraes method were used. Socioeconomic conditions and hygiene habits were evaluated, and for the elderly that had pets a questionnaire about their way of life was applied. RESULTS: 310 elderly were studied with mean age of 78.6±8.4 years old, 77.1% were women and 22.9% were man. The prevalence of intestinal parasites was 12.9% for the elderly from the geriatric ambulatory and 12.9% for the institutionalized elderly. The results showed no association between enteroparasites from pets and their owner, because no elder who had a pet with parasitic disease presented positive result in fecal examination. CONCLUSIONS: The prevalence of enteroparasites in the elderly from Porto Alegre was lower than in other studies. These results showed that each geographic area has its socioeconomic, environmental, and educational peculiarities. The studies should be continued in the elderly from different areas of Rio Grande do Sul and Brazil to identify particular situations. Sanitary measures and education can be proposed based on such studies to improve population health.

Consumo de nutrientes em idosos residentes em Porto Alegre (RS), Brasil: um estudo de base populacional

A cross-sectional, population-based study was conducted on a random sample of 427 elderly individuals living in Porto Alegre, Brazil, to establish the nutrient consumption profile and verify its association with sociodemographic and health variables. Dietary intake was assessed using the 24-hour Food Recall Survey and the Dietetic Research Investigation technique. Seventy percent of the elderly respondents were women: 48.5% were between 60 and 69 years old; 68.8% had less than 8 years of schooling; 39% had a family income of between 2 and 5 minimum wages and 58.4% took no physical exercise. Hypertension was the most prevalent disease among the elderly and 54.9% were underweight. Men consumed more calories, protein, fiber, minerals and vitamins than women. Carbohydrate and calcium intake increases with advancing age, while zinc intake decreases. Physical exercise increased the intake of calories, magnesium, potassium and phosphorus. The higher the schooling the greater the intake of vitamins B6 and B12; the higher the family income, the greater the consumption of vitamin B6 and folic acid. The results show that there are nutritional deficiencies in the daily diet of the Brazilian elderly population, especially among women and individuals over 80 years of age.A cross-sectional, population-based study was conducted on a random sample of 427 elderly individuals living in Porto Alegre, Brazil, to establish the nutrient consumption profile and verify its association with sociodemographic and health variables. Dietary intake was assessed using the 24-hour Food Recall Survey and the Dietetic Research Investigation technique. Seventy percent of the elderly respondents were women: 48.5% were between 60 and 69 years old; 68.8% had less than 8 years of schooling; 39% had a family income of between 2 and 5 minimum wages and 58.4% took no physical exercise. Hypertension was the most prevalent disease among the elderly and 54.9% were underweight. Men consumed more calories, protein, fiber, minerals and vitamins than women. Carbohydrate and calcium intake increases with advancing age, while zinc intake decreases. Physical exercise increased the intake of calories, magnesium, potassium and phosphorus. The higher the schooling the greater the intake of vitamins B6 and B12; the higher the family income, the greater the consumption of vitamin B6 and folic acid. The results show that there are nutritional deficiencies in the daily diet of the Brazilian elderly population, especially among women and individuals over 80 years of age.

Prevalência de obesidade associada à ingestão calórica, glicemia e perfil lipídico em uma amostra populacional de idosos do Sul do Brasil

OBJETIVO: Determinar a prevalencia de obesidade associada ao consumo de macronutrientes, as alteracoes do perfil lipidico, a glicemia e a pratica de atividade fisica em idosos. METODOS: Foi realizado estudo transversal com 304 idosos do municipio de Porto Alegre, RS, Brasil. Medidas antropometricas de peso e altura foram utilizadas para o calculo do indice de massa corporal (IMC) e foram analisados o perfil lipidico, a glicemia, a ingestao diaria de macronutrientes e a pratica de atividade fisica. RESULTADOS: A prevalencia de obesidade foi de 30,6%, sofrendo reducao com o aumento da idade. As idosas obesas apresentaram maior frequencia de hipertrigliceridemia, cujos valores aumentaram conforme o aumento do IMC. Nesse grupo, a pratica de atividade fisica foi menor. Entre os homens, houve maior consumo de proteina na dieta. CONCLUSAO: Os resultados mostraram que a obesidade e um importante problema de saude na Regiao Sul do Brasil, sofrendo influencia de fatores socioculturais e economicos que prejudicam a manutencao de uma alimentacao saudavel. Politicas publicas devem ser direcionadas a fim de controlar esse problema, ja que a obesidade e um fator limitante para a longevidade.

The Association Between the Chronic Use of Non-Steroidal Anti- Inflammatory Drugs and Oxidative and Inflammatory Markers in the Elderly

OBJECTIVES Investigate the association between the chronic or occasional use of nonsteroidal anti-inflammatory drugs (NSAIDs) and plasma levels of oxidative and inflammatory markers in elderly at the Family Health Strategy in Brazil. METHODS It was a cross-sectional study of data collected from random elderly volunteers. A questionnaire including sociodemographic, health and medicine use data was administered. The blood levels of FRAP (ferric reducing ability of plasma), AOPP (plasma advanced oxidation protein products), MDA (malondialdehyde) and insulin were measured. RESULTS The study sample comprised 758 elderly patients, of which 121 (15.96%) used NSAIDs. The mean age was 68.53 years and 68.41 for individuals who used NSAIDs occasionally and chronically, respectively. Gastric problems may be associated with the chronic or occasional use of NSAIDs (P = 0.042). Which indicates mean plasma levels of Insulin and HOMA-IR (Homeostasis Model Assessment Insulin Resistance) are increased in chronic use of NSAIDs and describes a statistical trend (P = 0.065) for the association of chronic NSAIDs use with the BMI (body mass index) of the subjects studied. CONCLUSION This study suggests that there is no association between the chronic or occasional use of NSAIDs and oxidative and inflammatory markers. It is known that NSAIDs have innumerable adverse effects, but they can have some benefits. So, additional studies are needed to clarify whether NSAIDs are associated with these markers and whether they are related with their real consequences.

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.

Uso de anti-inflamatórios e analgésicos por uma população de idosos atendida na Estratégia Saúde da Família

The aim of this study was to analyze the prevalence of the use of anti-inflammatory and analgesic drugs among elderly persons from the Family Health Program in Porto Alegre, Rio Grande do Sul, and investigate associated factors such as sociodemographic and health data; continuous or as needed use of drug, drug used subject to medical prescription or self-medicated. Data collection occurred between March 2011 and December 2012. Community health workers applied a questionnaire relating to sociodemographic and health data and medication use. Non-steroidal antiinflammatory drugs, glucocorticoids, non-opioid analgesics and opioids were evaluated. A total of 758 elderly persons were included and anti-inflammatory and analgesic drugs were used by 28.8% of the population. Acetaminophen and ibuprofen were the most frequently used drugs. Regarding self-perception of health, the worse the perception of health, the greater was the use of therapy ( p<0.001). Liver disease and osteoarthritis/ arthritis/rheumatism were found to be associated with anti-inflammatory and analgesic use ( p<0.001). The prevalence of anti-inflammatory and analgesic use was considered moderate when compared to previous studies (28.8%). In addition, most of the elderly persons used the drugs when only needed, most probably due to feeling minor to moderate pain or because they had suffered the adverse effects of these medications in the past and so chose to use them sporadically.