Renata Cereda Cordeiro

Impacto funcional da internação hospitalar de pacientes idosos

OBJECTIVE: To describe functional capacity changes of elderly during hospitalization and to assess the correlation of these changes at the time of hospital discharge and sociodemographics and clinical variables. METHODS: There were studied 94 patients aged 65 to 94 years admitted to a geriatric-gerontological hospital unit of a school hospital. The first functional capacity evaluation (number of daily living activities impaired) of the elderly patients was carried out up to 24 hours after admission and the last one immediately after discharge. Routine therapeutic interventions were performed by an interdisciplinary health care team in the study period. Data was analyzed using Chi-square test (a£0.05). RESULTS: Of all patient studied, 25.6% improved their functional capacity, 34.0% had not had functional changes, 19.1% had worsened functionally, and 21.3% died during the study period. A significant correlation was seen between functional deterioration and cognitive deficits, delirium, and low functional capacity at admission. CONCLUSIONS: Functional capacity is an important marker of health in hospitalized elderly. Functional improvement during hospitalization is associated to lesser impairment in daily activities at the time of admission and better clinical conditions.

Factors associated to quality of life in active elderly

OBJECTIVE To analyze whether quality of life in active, healthy elderly individuals is influenced by functional status and sociodemographic characteristics, as well as psychological parameters. METHODS Study conducted in a sample of 120 active elderly subjects recruited from two open universities of the third age in the cities of São Paulo and São José dos Campos (Southeastern Brazil) between May 2005 and April 2006. Quality of life was measured using the abbreviated Brazilian version of the World Health Organization Quality of Live (WHOQOL-bref) questionnaire. Sociodemographic, clinical and functional variables were measured through crossculturally validated assessments by the Mini Mental State Examination, Geriatric Depression Scale, Functional Reach, One-Leg Balance Test, Timed Up and Go Test, Six-Minute Walk Test, Human Activity Profile and a complementary questionnaire. Simple descriptive analyses, Pearsons correlation coefficient, Students t-test for non-related samples, analyses of variance, linear regression analyses and variance inflation factor were performed. The significance level for all statistical tests was set at 0.05. RESULTS Linear regression analysis showed an independent correlation without colinearity between depressive symptoms measured by the Geriatric Depression Scale and four domains of the WHOQOL-bref. Not having a conjugal life implied greater perception in the social domain; developing leisure activities and having an income over five minimum wages implied greater perception in the environment domain. CONCLUSIONS Functional status had no influence on the Quality of Life variable in the analysis models in active elderly. In contrast, psychological factors, as assessed by the Geriatric Depression Scale, and sociodemographic characteristics, such as marital status, income and leisure activities, had an impact on quality of life.OBJETIVO: Analisar se a qualidade de vida de idosos ativos e saudaveis pode ser influenciada por estado funcional, caracteristicas sociodemograficas e por parâmetros psicologicos. METODOS: Estudo com amostra de 120 idosos ativos participantes de duas universidades abertas a terceira idade, nas cidades de Sao Paulo e Sao Jose dos Campos (SP), entre 2005 e 2006. A qualidade de vida foi mensurada utilizando a versao brasileira e reduzida do World Health Organization Quality Of Life (WHOQOL-bref). As variaveis sociodemograficas, clinicas e funcionais foram medidas por meio do Mini Mental State Examination, Geriatric Depression Scale, Functional Reach, One Leg Balance Test, Timed Up and Go Test, Six-Minute Walking Test, Human Activity Profile e questionario complementar. Foi realizada a analise descritiva simples, o coeficiente de correlacao de Pearson, o teste T para amostras nao relacionadas, a analise de variância, a analise de regressao linear e o calculo do fator de inflacao da variância. O nivel de significância para todos os testes foi fixado em 0,05. RESULTADOS: A analise de regressao linear mostrou relacao independente e sem colinearidade entre os quatro dominios do WHOQOL-bref e sintomas depressivos avaliados pela Geriatric Depression Scale. Nao possuir vida conjugal implicou melhor percepcao no dominio social; desenvolver atividades de lazer e possuir renda superior a cinco salarios minimos implicou melhor percepcao no dominio meio ambiente. CONCLUSOES: O estado funcional nao foi capaz de influenciar o comportamento da variavel qualidade de vida nos modelos de analise em idosos ativos, ao contrario dos fatores psicologicos avaliados pela Geriatric Depression Scale e das caracteristicas sociodemograficas como estado civil, renda e pratica de atividades de lazer.

Factors associated with functional balance and mobility among elderly diabetic outpatients.

OBJECTIVES To characterize balance and mobility among diabetic elderly outpatients and to estimate the extent to which functional balance and mobility abnormalities can be influenced by sociodemographic, clinical and other functional factors in a cross-sectional study. METHODS Ninety-one elderly (65+ years) outpatients were assessed. Mobility was evaluated by the Timed Up and Go Test (TUGT) and the balance, by the Berg Balance Scale (BS). RESULTS TUGT mean score was 15.65 +/- 5.9 seconds and BS mean score was 49.31 +/- 7.3 points. Using linear regression analysis (alpha < 0.05), significant and independent positive relationships were obtained between TUGT and age, daily activities (ADL/IADL), step strategy, and proprioceptive sensitivity. Factors negatively associated with BS were: ADL/IADL, step strategy, proprioceptive sensitivity, orthostatic hypotension (OH) and conflictive sensory conditions. CONCLUSION Elderly diabetic outpatients show abnormal balance and mobility related mainly to advanced age, disability, absence of step strategy, absence of proprioceptive sensitivity and presence of OH.

Fatores associados à qualidade de vida em idosos com osteoartrite de joelho

O estudo visou investigar se a qualidade de vida (QV) de idosos com osteoartrite (OA) de joelho pode ser influenciada por fatores sociodemograficos e/ou por parâmetros clinicos e funcionais gerados pela doenca. A uma amostra de 40 idosos atendidos em ambulatorio de reabilitacao gerontologica na cidade de Sao Paulo foi aplicado o questionario de QV 36-Item Short-Form Survey (SF-36). A funcionalidade, a rigidez articular e a dor foram medidas pelo Womac - Western Ontario and MacMaster Universities Osteoarthritis Index; os dados sociodemograficos, as variaveis clinicas e o uso de recursos fisicos e medicamentosos para controle da dor foram obtidos por questionario complementar. A analise de regressao linear mostrou relacao independente entre o dominio funcionalidade do Womac e seis dominios do SF-36 (p<0,05). Sao determinantes de pior QV na amostra estudada a dificuldade na realizacao de atividades funcionais, usar dispositivo de auxilio a marcha, apresentar comprometimento articular bilateral, o recurso a diversos meios para alivio da dor, bem como a baixa escolaridade e o fato de morar com outro de sua geracao (r=0,3; p<0,05). As atividades funcionais mais comprometidas foram as que envolvem a flexo-extensao de joelho e descarga de peso na articulacao afetada. Fatores tanto sociodemograficos como clinicos e funcionais gerados pela OA influenciaram negativamente a QV de idosos com OA de joelho.

Capacidade Funcional: estudo prospectivo em idosos residentes em uma instituição de longa permanência

A Short Physical Performance Balance - SPPB vem sendo utilizada largamente em pesquisas sobre o envelhecimento, como instrumento pratico e eficaz na avaliacao do desempenho fisico e rastreamento de idosos com riscos futuros de incapacidades. Ela avalia o desempenho de membros inferiores em tres aspectos: forca muscular, marcha e equilibrio, reconhecidos como componentes fundamentais para a qualidade de vida, sendo aceitos como indicadores universais do estado de saude em idosos. OBJETIVO: Analisar a eficacia da SPPB em detectar alteracoes na capacidade funcional do idoso institucionalizado e como esta e influenciada pelas variaveis cognitivas, clinicas e funcionais globais. METODOLOGIA: estudo prospectivo do qual participaram 30 residentes de uma instituicao de longa permanencia, filantropica, em Sao Paulo (17 mulheres e 13 homens), com idades acima de 60 anos ou mais (43% maiores de 80 anos) e media de sete anos de residencia. Apos 18 meses, estes idosos foram reavaliados e os dados, comparados. RESULTADOS: Dos idosos avaliados que obtiveram bom desempenho (17%), todos apresentaram perda de forca ao longo do seguimento. Quanto ao equilibrio e marcha, notou-se melhora de 16% e 1%, respectivamente. Apresentaram uma ou mais quedas, 47% dos sujeitos. Quando comparada com o Index de Independencia nas Atividades de Vida Diaria de Katz, a SPPB se mostrou mais sensivel em relacao ao declinio funcional, apontando 39% em comparacao aos 14% de perda identificada pelo Katz. CONCLUSAO: os dados corroboram estudos anteriores, que apontam para o declinio da capacidade funcional de idosos institucionalizados e para a aplicabilidade da SPPB na rotina de acompanhamento funcional dessa populacao.

A modalidade de assistência Centro-Dia Geriátrico: efeitos funcionais em seis meses de acompanhamento multiprofissional

O objetivo deste artigo e descrever os efeitos da assistencia multiprofissional na capacidade funcional de idosos atendidos em Centro-Dia Geriatrico apos seis meses de acompanhamento. O metodo usado foi o estudo clinico observacional de seguimento. Catorze pacientes com idade superior a 80 anos foram avaliados na admissao ao servico e apos seis meses de acompanhamento, segundo os seguintes instrumentos: atividades diarias pelo Brazilian OARS Multidimensional Functional Assessment Questionnaire; estado cognitivo por meio do Mini-Mental State Exam, equilibrio funcional pela Berg Balance Scale e mobilidade pelo Timed Up and Go Test. Foi realizada analise descritiva simples e, para comparacao entre os dois momentos de avaliacao, os testes Wilcoxon e T-pareado, a=0,05. Observou-se diferenca significativa entre a avaliacao e a reavaliacao com melhora no decorrer do tempo para a capacidade funcional global (p=0,019) e equilibrio funcional pelas tarefas de transferencias posturais (p=0,041). As demais variaveis mostraram manutencao de seus valores no seguimento. Conclusao: a assistencia multiprofissional em Centro-Dia potencializou melhora ou manutencao da capacidade funcional dos participantes, revelando ser uma alternativa promissora de modalidade de servico para a saude do idoso.

Declínio funcional de idosa institucionalizada: aplicabilidade do modelo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde

The purpose of this study was to analyse the clinical functional evolution of an elderly institutionalized woman, focussing on the way socioeconomic context and family-related conditions influenced her health, as well as to discuss the probable relationship between contextual events and the patients functional decline, by following the conceptual model of the International Classification of Functioning, Disability, and Health (ICF). ICF was created by the World Health Organization to address different areas of health and to establish a common language in health description, allowing a multidimensional description of direct and indirect factors related to the clinical-functional framework, targeting interprofessional interventions both in outpatient clinics and in institutional environment. The patient went through distinct stages in the long-term care facility, and deceased after 12 months. The discussion of the case allows for planning better strategies that can be used to deal with similar events.

Fatores associados à qualidade de vida em idosos ativos

OBJECTIVE To analyze whether quality of life in active, healthy elderly individuals is influenced by functional status and sociodemographic characteristics, as well as psychological parameters. METHODS Study conducted in a sample of 120 active elderly subjects recruited from two open universities of the third age in the cities of São Paulo and São José dos Campos (Southeastern Brazil) between May 2005 and April 2006. Quality of life was measured using the abbreviated Brazilian version of the World Health Organization Quality of Live (WHOQOL-bref) questionnaire. Sociodemographic, clinical and functional variables were measured through crossculturally validated assessments by the Mini Mental State Examination, Geriatric Depression Scale, Functional Reach, One-Leg Balance Test, Timed Up and Go Test, Six-Minute Walk Test, Human Activity Profile and a complementary questionnaire. Simple descriptive analyses, Pearsons correlation coefficient, Students t-test for non-related samples, analyses of variance, linear regression analyses and variance inflation factor were performed. The significance level for all statistical tests was set at 0.05. RESULTS Linear regression analysis showed an independent correlation without colinearity between depressive symptoms measured by the Geriatric Depression Scale and four domains of the WHOQOL-bref. Not having a conjugal life implied greater perception in the social domain; developing leisure activities and having an income over five minimum wages implied greater perception in the environment domain. CONCLUSIONS Functional status had no influence on the Quality of Life variable in the analysis models in active elderly. In contrast, psychological factors, as assessed by the Geriatric Depression Scale, and sociodemographic characteristics, such as marital status, income and leisure activities, had an impact on quality of life.OBJETIVO: Analisar se a qualidade de vida de idosos ativos e saudaveis pode ser influenciada por estado funcional, caracteristicas sociodemograficas e por parâmetros psicologicos. METODOS: Estudo com amostra de 120 idosos ativos participantes de duas universidades abertas a terceira idade, nas cidades de Sao Paulo e Sao Jose dos Campos (SP), entre 2005 e 2006. A qualidade de vida foi mensurada utilizando a versao brasileira e reduzida do World Health Organization Quality Of Life (WHOQOL-bref). As variaveis sociodemograficas, clinicas e funcionais foram medidas por meio do Mini Mental State Examination, Geriatric Depression Scale, Functional Reach, One Leg Balance Test, Timed Up and Go Test, Six-Minute Walking Test, Human Activity Profile e questionario complementar. Foi realizada a analise descritiva simples, o coeficiente de correlacao de Pearson, o teste T para amostras nao relacionadas, a analise de variância, a analise de regressao linear e o calculo do fator de inflacao da variância. O nivel de significância para todos os testes foi fixado em 0,05. RESULTADOS: A analise de regressao linear mostrou relacao independente e sem colinearidade entre os quatro dominios do WHOQOL-bref e sintomas depressivos avaliados pela Geriatric Depression Scale. Nao possuir vida conjugal implicou melhor percepcao no dominio social; desenvolver atividades de lazer e possuir renda superior a cinco salarios minimos implicou melhor percepcao no dominio meio ambiente. CONCLUSOES: O estado funcional nao foi capaz de influenciar o comportamento da variavel qualidade de vida nos modelos de analise em idosos ativos, ao contrario dos fatores psicologicos avaliados pela Geriatric Depression Scale e das caracteristicas sociodemograficas como estado civil, renda e pratica de atividades de lazer.

Effects of functional physical activity on the maintenance of motor function in Alzheimer's disease

It is widely known that older adults, even frail individuals, can improve their physical function using appropriately targeted exercise. Nevertheless, older adults with Alzheimer’s disease (AD) have been excluded from the majority of studies on exercise. The functional-task physical activity program is based on activities of daily living, and may be suited for elderly people with AD because it focuses on the maintenance and stimulation of preserved abilities. In addition, session costs are substantially reduced by adopting a group approach. Furthermore, the group approach may improve the social interaction of the demented patient. Objectives To determine whether a functional-task physical activity program in groups can maintain motor function in elderly with AD. Methods 10 elderly diagnosed with mild or moderate AD were assigned into one of two groups: subjects with and without intervention. The intervention consisted of a 12-week function-task physical activity program in groups. Measurements: activities of daily living (Katz and Lawton & Brody questionnaires), mobility (Timed Up and Go Test, Timed Up and Go manual Test and Timed Up and Go Cognitive Test), cognition (Mini-Mental State Examination), behavioral disturbances (Neuropsychiatric Inventory I-brief) and functional balance (Berg Balance Scale). Results A statistically significant difference between the two groups was found regarding the functional balance mean change measured by Berg scale score (p=0.046). A significant improvement of 1.60 points (95%CI[0.22;2.98]) was observed in the intervention group on this scale, while the non-intervention group showed –0.40 points (95%CI[–1.78;0.98], no change). Conclusions It is possible to treat mild and moderate Alzheimer’s patients using a group approach. The functional task physical activity program was efficient in functional balance improvement and also appeared to prevent mobility decline.

Survival Analysis and Factors Associated With Mortality Among Elderly in a Home Care Program

Home care (HC) is directed at older people with high risk of mortality due to clinical, social, and functional vulnerability. The purpose of this study is to analyze the likelihood of survival in a 2-year follow-up of elderly in HC and determine associations between the patient outcome (death/survival) and baseline data. The medical records of 38 elderly in a HC program were analyzed with regard to sociodemographic and clinical data and by the Functional Independence Measure (FIM). After a 2-year period, the records were reanalyzed to determine the patient outcome (death/survival). To determine the mortality rate in the follow-up period, the Kaplan-Meier survival analysis model was used. The Chi square, Fisher exact tests, the Student t and Mann-Whitney tests were used to analyze associations between the baseline variables and program status. The probability of survival was 75.36% and 56.14%, after 1 and 2 years of HC follow-up, respectively. Age, gender, marital status and FIM had no influence on mortality. The elderly who died showed a shorter time of assistance in the HC program, greater number of comorbidities and skin diseases compared to the survivors. Frail and socially vulnerable elderly may benefit from early intervention that focuses on the maintenance of function and the control of clinical complications.