Renato Peixoto Veras

Envelhecimento populacional contemporâneo: demandas, desafios e inovações

O estudo discute as consequencias sociais e, particularmente, da saude, decorrentes da ampliacao do numero de idosos no Brasil em um curto periodo. Foram utilizados dados da Pesquisa Nacional por Amostra de Domicilios, de 1998 e 2003, que indicam melhoria das condicoes de saude dos idosos e uma distribuicao de doenca cronica semelhante para todos os grupos de renda. Se, por um lado, os idosos apresentam maior carga de doencas e incapacidades, e usam mais os servicos de saude, por outro, os modelos vigentes de atencao a saude do idoso se mostram ineficientes e de alto custo, reclamando estruturas criativas e inovadoras, como os centros de convivencia com avaliacao e tratamento de saude. A agenda prioritaria da politica publica brasileira deveria priorizar a manutencao da capacidade funcional dos idosos, com monitoramento das condicoes de saude, com acoes preventivas e diferenciadas de saude e de educacao, com cuidados qualificados e atencao multidimensional e integral.The paper discusses the social and, particularly, the health consequences resulting from the expansion of the numbers of elderly people in Brazil over a short period. The data used were from the 1998 and 2003 Pesquisa Nacional por Amostra de Domicílios (PNAD, the national household sampling survey), and they express an improvement in elderly peoples health conditions and similar distribution of chronic diseases across all income groups. If, on the one hand, elderly people present greater disease burden and incapacities and they use healthcare services more, on the other hand, the current models for healthcare for the elderly are shown to be inefficient and high-cost. Creative and innovative structures are required, such as social centers with health assessments and treatment. Foremost on the agenda for Brazilian public policy, priority should be given to maintaining elderly peoples functional capacity, with monitoring of their health conditions; preventive and differentiated actions relating to health and education; and qualified care and multidimensional comprehensive attendance.

O envelhecimento da população mundial: um desafio novo

Demographic aging as a worldwide phenomenon is described with emphasis on the situation in Brazil up to the year 2025. The causes of demographic aging in developing countries are reviewed and attention is given to the consequences particularly for the provision of health services. The authors also examine concepts such as the quality of life in the context of demographic aging. (SUMMARY IN ENG) (ANNOTATION)

Validação da escala de depressão geriátrica em um ambulatório geral

OBJECTIVE The Geriatric Depression Scale for screening depressive symptoms in the elderly has not been assessed in elderly outpatients who seek primary health care in Brazil. The objective was to determine the validity of the Short Scale for Major Depressive Episode or Dysthymia (GDS-15) in elderly outpatients. METHODS The scale was applied in 302 subjects with 65 years and older and then examined by an independent geriatrician, blinded to the results. Major depression and dysthymia were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Sensitivity and specificity were calculated at several cutoff values and a Receiver Operating Characteristic curve was plotted. RESULTS The best equilibrium was at the cutoff value of 5/6 showing 81% sensitivity and 71% specificity; the area under the Receiver Operating Characteristic curve was 0.85 (95% CI: 0.79-0.91). CONCLUSIONS The GDS-15 can be used for screening depressive symptoms in Brazilian elderly outpatients. The previously suggested cutoff value of 5/6 is adequate.OBJETIVO: A Escala de Depressao Geriatrica, utilizada para o rastreamento de sintomas depressivos em idosos, ainda nao teve suas caracteristicas de medida avaliadas em ambulatorios gerais no Brasil. O objetivo foi estudar a validade da Escala, com 15 itens (EDG-15), na identificacao de episodio de Depressao Maior ou Distimia em idosos atendidos em ambulatorio geral. METODOS: A Escala foi aplicada em 302 individuos com 65 anos ou mais, que em seguida foram examinados, de maneira independente, por um geriatra que nao tinha conhecimento dos resultados da Escala. Os diagnosticos de Depressao Maior ou Distimia foram feitos utilizando-se os criterios do Diagnostic and Statistical Manual of Mental Disorders-IV. A sensibilidade e a especificidade nos varios pontos de corte foram expressas pela curva Receiver Operating Characteristic. RESULTADOS: O ponto de corte de melhor equilibrio foi 5/6, obteve sensibilidade de 81% e especificidade de 71%; e o valor da area sob a curva Receiver Operating Characteristic foi de 0,85 (IC 95%: 0,79-0,91). CONCLUSOES: A Escala de Depressao Geriatrica pode ser utilizada para o rastreamento de sintomas depressivos na populacao geriatrica ambulatorial brasileira. O ponto de corte 5/6, sugerido inicialmente por outros autores, mostrou-se adequado.

Incapacidade funcional entre as mulheres idosas no Brasil

OBJETIVO: Estimar as taxas de incapacidade funcional e identificar os fatores sociodemograficos associados com a prevalencia de incapacidade funcional entre as mulheres idosas. METODOS: As estimativas das taxas de incapacidade funcional foram produzidas com informacoes da Pesquisa Nacional por Amostra de Domicilios, de 1998, realizada pelo Instituto Brasileiro de Geografia e Estatistica. O estudo analisou a populacao de mulheres idosas, num total de 16.186. Foram elaborados modelos de regressao logistica, utilizando como variavel dependente a dificuldade para caminhar 100 metros. RESULTADOS: A prevalencia de incapacidade funcional leve, moderada e severa foi maior entre as mulheres, e aumentou com a idade. Na analise de regressao logistica, os indicadores mais fortemente associados com o aumento da prevalencia de incapacidade funcional foram baixo nivel de educacao e baixo rendimento familiar. Residencia rural foi tambem associada com reducao de prevalencia. CONCLUSOES: Os resultados sugerem possiveis fatores de risco para o desenvolvimento de declinio funcional em idosas, tendo em vista que as associacoes encontradas foram consistentes com aquelas reportadas por outros estudos.

Crescimento da população idosa no Brasil: transformações e conseqüências na sociedade

Sao discutidas as transformacoes sociais e economicas que incidem sobre a vida dos idosos decorrentes do aumento da populacao de 60 anos ou mais, no Brasil. O processo migratorio e a intensa urbanizacao (em 1940 a populacao rural era de 68,8% e em 1980 de 32,4%) afetaram particularmente a populacao idosa dos grandes centros, ou daqueles que envelheceram nestas cidades. Esta nova organizacao social acentuou os problemas de solidao e pobreza dos idosos. Alem desta perda de status social que exclui sua participacao na sociedade moderna, o idoso teve tambem reduzido o suporte emocional no interior de sua familia. Entre os fatores que concorrem para tal, destacam-se a mudanca do padrao do modelo familiar, de extensa para nuclear, a maior mobilidade e o aumento do numero de separacoes e divorcios. O maior periodo de vida da mulher e suas consequencias (reducao de renda, aumento do numero de viuvas e maior frequencia de longos periodos de doencas cronicas), como tambem a mudanca do papel social da mulher no mundo contemporâneo, fazem parte de uma discussao especifica relativa a mulher e a velhice. A questao do trabalho, da aposentadoria e do custo social (coeficiente de dependencia) e outro aspecto abordado.The social and economic transformation which has been occurring in the life of the elderly, and the increase of the Brazilian population aged 60 years or over is discussed. The migration process (in 1940 the rural population was 68.8% and in 1980, 32.4%) and the intense urbanisation in major Brazilian cities has been particularly evident for the elderly population, or for those growing older in these cities. This new social organization had increased the problems of loneliness and poverty among the elderly. Furthermore, as a consequence of the loss of social status which has reduced their participation in contemporary society, the elderly have been loosing the emotional suport within their own families. Traditionally, older people are viewed as an integral part of the family and enjoy high esteem and prestige. There are factors which play an important role in the family changes - these factors are the decrease in the number of children, their dispersion owing to migration and urbanisation, and the increase in the number of divorces between couples. The relatively longer life span of women has brought unique consequences such as a decrease of income, an increase in the number of widows and a longer period of chronic disease, as well as the changing role of women and their participation in the labour force which further diminish the chances of family support. This paper also discusses certain aspects related to the issues of work, retirement and social expenditure (dependency ratio).

Fórum. Envelhecimento populacional e as informações de saúde do PNAD: demandas e desafios contemporâneos. Introdução

This article examines the new demographic and epidemiological reality in Brazil, based on data collected and organized in the Health Supplement of the National Household Sample Survey (PNAD-Health). It highlights the urgency of changes and innovations in health care paradigms for the elderly population with a preventive approach based on comprehensive education and care. As key concepts, the article emphasizes the need to preserve autonomy, participation, care, self-satisfaction, and the possibility of elder citizens being active in various social contexts. It also discusses the contribution by various authors to the discussion forum on Human Aging and the National Household Sample Surveys, coordinated by Cadernos de Saude Publica/Reports in Public Health, featuring studies on access to and utilization of health services by the elderly, the epidemiological pattern of breast cancer in elderly women, and the validity of using proxy respondents in research on self-perceived health status, concluding that the PNAD data are consistent and can be used by the scientific community.

Population aging today: demands, challenges and innovations.

O estudo discute as consequencias sociais e, particularmente, da saude, decorrentes da ampliacao do numero de idosos no Brasil em um curto periodo. Foram utilizados dados da Pesquisa Nacional por Amostra de Domicilios, de 1998 e 2003, que indicam melhoria das condicoes de saude dos idosos e uma distribuicao de doenca cronica semelhante para todos os grupos de renda. Se, por um lado, os idosos apresentam maior carga de doencas e incapacidades, e usam mais os servicos de saude, por outro, os modelos vigentes de atencao a saude do idoso se mostram ineficientes e de alto custo, reclamando estruturas criativas e inovadoras, como os centros de convivencia com avaliacao e tratamento de saude. A agenda prioritaria da politica publica brasileira deveria priorizar a manutencao da capacidade funcional dos idosos, com monitoramento das condicoes de saude, com acoes preventivas e diferenciadas de saude e de educacao, com cuidados qualificados e atencao multidimensional e integral.The paper discusses the social and, particularly, the health consequences resulting from the expansion of the numbers of elderly people in Brazil over a short period. The data used were from the 1998 and 2003 Pesquisa Nacional por Amostra de Domicílios (PNAD, the national household sampling survey), and they express an improvement in elderly peoples health conditions and similar distribution of chronic diseases across all income groups. If, on the one hand, elderly people present greater disease burden and incapacities and they use healthcare services more, on the other hand, the current models for healthcare for the elderly are shown to be inefficient and high-cost. Creative and innovative structures are required, such as social centers with health assessments and treatment. Foremost on the agenda for Brazilian public policy, priority should be given to maintaining elderly peoples functional capacity, with monitoring of their health conditions; preventive and differentiated actions relating to health and education; and qualified care and multidimensional comprehensive attendance.

Audiologia do envelhecimento: revisão da literatura e perspectivas atuais

AIM: to review the literature on aging-related hearing loss and its current impacts. LITERATURE REVIEW: In studies carried out in Brazil, presbycusis has been blamed for being the most frequent cause of hearing loss in the elderly, causing verbal communication impairment. International studies also show the high prevalence of hearing loss in the elderly. DISCUSSION: According to recent investigations, as the number of elderly people increase, the prevalence of presbycusis interfering in the life quality of this population also increases. Even among health care professionals, there is a huge lack of knowledge about the advantages and gains a specific hearing reeducation can bring about for the elderly with hearing impairment. CONCLUSIONS: the papers hereby analyzed showed that the public health care centers with physicians and speech and hearing therapists, should establish the guidelines for the development of diagnostic programs, purchase of hearing aids and, most specially, hearing reeducation for the elderly with presbycusis, so that they may enjoy their social relations, and thus enhance their life quality. However, in Brazil, studies and research in this area only beginning.

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.

A prevalência da perda auditiva em uma população de idosos da cidade do Rio de Janeiro: um estudo seccional

Hearing loss in the elderly is one of the most frequent chronic diseases. AIM: to estimate the prevalence of hearing loss in a representative sample of elderly people (aged 65 or over) in the city of Rio de Janeiro. MATERIAL AND METHOD: a prospective, cross-sectional population-based study with 238 elderly people aged 65 years or more (198 women and 40 men). RESULTS: the prevalence of hearing loss was 39.4% (better ear) and 61.6% (worse ear) in the female group, 60% (better ear) and 77.5% (worse ear) in the male group, and 42.9% and 64.3% in the study population. Mild hearing loss was the most prevalent level of hearing loss. CONCLUSION: the prevalence of hearing loss in the study population was significant and in accordance with others relevant international epidemiological studies. Longitudinal studies are needed to better understand age-related hearing loss.