Sérgio Márcio Pacheco Paschoal

Quality of life and multimorbidity of elderly outpatients.

INTRODUCTION: Substantial medical research has established an inverse relationship between quality of life and illness. However, there exists minimal evidence for such a connection in the context of stable and controlled diseases. OBJECTIVE: We wished to correlate multimorbidity with quality of life for elderly patients who suffer from stable chronic diseases. METHODS: We used a tool to evaluate quality of life, namely World Health Organization quality of life-BRIEF, together with a scale of multimorbidity known as the Cumulative Illness Rating Scale - Geriatric Version. Furthermore, the quality of life data were correlated with scores recorded on the Cumulative Illness Rating Scale - Geriatric Version, the number of drugs used, and individual perceptions of health and age. RESULTS: We studied 104 elderly patients who suffered from chronic diseases. The patients had exhibited neither acute events nor secondary complications, their cognition was intact, and they were functionally independent. The Cumulative Illness Rating Scale - Geriatric Version showed an inverse correlation with the physical domain (p= 0.008) and a tendency toward an inverse correlation with the psychological domain (p= 0.052). Self-perception of health showed a high correlation with the physical domain (p= 0.000), psychological domain (p= 0.000) and environmental domain (p= 0.000). The number of drugs used correlated only with the physical domain (p= 0.004). Age and social domain showed a tendency toward a positive correlation (p= 0.054). DISCUSSION: We uncovered an inverse relationship between quality of life and multimorbidity in a group of patients who suffered from stable chronic diseases, with no functional limitations, pain or complications. Our data suggest that a patient’s knowledge that they have a certain clinical condition changes their subjective assessment of quality of life in the related domain. CONCLUSION: The perceived quality of life of the sample was affected by multimorbidity in the physical domain, with a tendency toward commensurate effects in the psychological domain.

Development of Elderly Quality of Life Index - EqoLI: item reduction and distribution into dimensions

OBJECTIVE To describe item reduction and its distribution into dimensions in the construction process of a quality of life evaluation instrument for the elderly. METHODS The sampling method was chosen by convenience through quotas, with selection of elderly subjects from four programs to achieve heterogeneity in the “health status”, “functional capacity”, “gender”, and “age” variables. The Clinical Impact Method was used, consisting of the spontaneous and elicited selection by the respondents of relevant items to the construct Quality of Life in Old Age from a previously elaborated item pool. The respondents rated each item’s importance using a 5-point Likert scale. The product of the proportion of elderly selecting the item as relevant (frequency) and the mean importance score they attributed to it (importance) represented the overall impact of that item in their quality of life (impact). The items were ordered according to their impact scores and the top 46 scoring items were grouped in dimensions by three experts. A review of the negative items was performed. RESULTS One hundred and ninety three people (122 women and 71 men) were interviewed. Experts distributed the 46 items into eight dimensions. Closely related items were grouped and dimensions not reaching the minimum expected number of items received additional items resulting in eight dimensions and 43 items. DISCUSSION The sample was heterogeneous and similar to what was expected. The dimensions and items demonstrated the multidimensionality of the construct. The Clinical Impact Method was appropriate to construct the instrument, which was named Elderly Quality of Life Index - EQoLI. An accuracy process will be examined in the future.

Impact of a program to promote health and quality of life of elderly.

OBJECTIVE To evaluate the effect on quality of life of elderly people enrolled in GAMIA - Multidisciplinary Care Group to Outpatient Elderly Subjects (Grupo de Assistência Multidisciplinar ao Idoso Ambulatorial) of the Geriatric Department, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo. METHODS Between 2000 and 2002, 83 elderly participants of GAMIA were assessed by the World Health Organization Quality of Life scale (WHOQOL-bref) at the beginning and the end of the program. Functionality was assessed by Katz and Lawton scales and sociodemographic data were obtained from medical charts. RESULTS Females predominated (79.5%) and overall mean age was 69.30 years. Data analysis showed a reduction in the physical domain of WHOQOL-bref (p = 0.014) and increased psychological health and environment domains (p = 0.029 and p = 0.007, respectively), detecting a trend of increase in social relationships and in general domains (p = 0.062 and p = 0.052, respectively). CONCLUSIONS The clinical evaluation of the elderly detected previously unknown diseases and determination of the use of new drugs, which might have been the predominant factor for the deterioration of their perception in the physical domain. Improvement in psychological health and the environment can be related to psychological and social support that the elderly received from peers and professionals and the benefits of group activities, as well as the upward trend observed in social relationships and general domains. Participation in a program to promote healthy aging was effective in improving the quality of life of the elderly.

Development of elderly quality of life index - EQOLI: theoretical-conceptual framework, chosen methodology, and relevant items generation

OBJETIVO: Descrever os passos iniciais do processo de construcao de um instrumento de avaliacao de qualidade de vida de idosos: a base teorico-conceitual do constructo Qualidade de Vida na Velhice, a metodologia escolhida para a construcao e a geracao dos itens relevantes. METODOS: O primeiro passo foi conceituar e definir o constructo, evidenciando o quanto os idosos realizam do que consideram importante para suas vidas e se estao satisfeitos com o que foi possivel concretizar. O segundo, escolher e descrever a metodologia de construcao (Metodo do Impacto Clinico) e a fase de geracao de itens relevantes ao objeto de estudo. Atraves de estudo piloto, foram delineados os procedimentos necessarios, estabelecendo-se todas as fases da metodologia. Demonstrou-se a viabilidade de seu emprego na construcao de um instrumento de avaliacao de qualidade de vida de idosos, com as adaptacoes necessarias. RESULTADOS: A geracao de itens selecionou, de 1032 respostas de idosos, 138 itens relevantes ao constructo. O estudo-piloto mostrou a viabilidade de aplicacao da metodologia e estabeleceu modificacoes na lista preliminar de itens, resultando nova lista (139 itens). DISCUSSAO: Estabelecida a base teorico-conceitual do constructo e a metodologia de construcao, selecionados os itens e realizado o piloto, a etapa seguinte consistira em submeter a lista a uma amostra de idosos, para reducao dos itens e distribuicao em dimensoes.PURPOSE To describe the initial steps of the construction process of a quality of life evaluation instrument for the elderly - the theoretic-conceptual framework for the construct, Quality of Life in Old Age; the construction methodology; and the generation of relevant items. METHODS The first step was to conceptualize and define the construct, determining how much the elderly are able to perform of what they believe to be important in their lives and whether they are satisfied with what was possible to perform. The next step was to select and describe the construction methodology (the Clinical Impact Method) and the phase of generation of relevant items for the research object. The necessary procedures were delineated through a pilot study, which helped to establish all phases of the used methodology. The viability of the construction of the Quality of Life in Old Age evaluation instrument was demonstrated along with the needed adaptations. RESULTS From 1032 answers by older people, 138 relevant items for the construct were identified by the items generation process. The pilot study demonstrated the suitability of the application of the methodology and established modifications to the preliminary items list, resulting in a new 139-item list. DISCUSSION Now that the theoretical-conceptual framework of the construct as well as the construction methodology and the items generation are established, the next step will consist of administering the resulting list to a sample of elderly people for item reduction and distribution of items into dimensions.

Serviços de atenção ao idoso e estratégias de cuidado domiciliares e institucionais

INTRODUCTION: Health care networks are critical in assisting the elderly population in several aspects. Home care, the Senior Companion Program [Programa Acompanhante de Idosos] of Sao Paulo Municipal Health Departament and institutions for the aged compose networks to assist the elderly. It is necessary to analyze how the network is established between these services and features that demand care. OBJECTIVE: To describe and compare home care services, the Senior Companion Program, and institutions for the aged as to possible differences and similarities, users demand, flow and care management services. METHODS: We carried out a non-exhaustive literature review of national literature published in electronic databases SciELO and LILACS in literary and electronic references in the period from 1997 to 2012. RESULTS: In total, 32 studies were included in the review. It was observed that the served population is predominantly female, with advanced age, and receive multidisciplinary care. Home care services and the Senior Companion Program value the maintenance of family and community as a setting, delaying institutionalization. The presence of the caregiver showed up as one of the most influential factors for the permanence of home care. CONCLUSION: It is concluded that the revised services have objectives that address the needs of the elderly. It is expected that the integration of health facilities establish their actions according to the profile of the elderly and characteristics of care offered at each service.

Risk factors for atherosclerosis in an elderly out patient population in the City of São Paulo

OBJECTIVE To analyze in out clinic elderly patients of both sexes for the prevalence of risk factors for atherosclerosis and study their association with the complications of atherosclerosis. METHODS Five hundred and sixteen outpatients, 152 men and 364 women, 60 years or older, were studied. The prevalences of hypertension, dyslipidemia, diabetes mellitus, cigarette smoking and obesity were determined in both sexes and compared using the chi-square test. The association between these factors and the presence of atherosclerotic complications was analyzed by logistic regression. RESULTS The comparative analysis of the factors in both sexes showed that hypertension, total cholesterol > or = 240 mg/dL, LDL-cholesterol > or = 160 mg/dL, and body mass index > 27.5 were more frequent among women, but HDL-cholesterol < 35 mg/dL and cigarette smoking were more frequent among men, and no difference occurred between sexes in relation to the frequency of triglycerides > or = 250 mg/dL and diabetes mellitus. After adjustment of the variables in the regression model, we observed that in the total of elderly patients, risk factors for complications of atherosclerosis were: triglycerides > or = 250 mg/dL, hypertension, and male sex. Among men, the risk factors were: LDL-cholesterol > or = 160 mg/dL, diabetes mellitus, HDL-cholesterol < 35 mg/dL and hypertension. Among women, the risk factors were: triglycerides > or = 250 mg/dL and hypertension. CONCLUSION The results showed that, in the elderly, the risk factors for atherosclerosis persist, but with different behaviors between men and women. The study suggests that the relative importance of the risk factors can change with the aging process.

Revisão de dois instrumentos clínicos de avaliação para predizer risco de quedas em idosos

Introduction: Fall is a common problem in the elderly and it can reduce their mobility and independence. The use of simple tools to detect risk of falls is essential to prevent and treat such events. However, there is no consensus about the most appropriate tools for each situation. Objective: To review studies about efficacy, sensitivity and specificity of Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS) in order to ascertain which is the most appropriate to predict falls in the elderly. Methods: We performed a literature review from MEDLINE, PubMed, ISI, LILACS and Portal de Periodicos CAPES databases, between 2001 and 2011. Results: We selected 17 different articles about BBS and 20 articles about TUGT. The review showed the two tools can be good predictors of falls. However, the articles differed in definition of fall and faller, type of study, quantity and characteristics of sample and assessment of falls, leading to different results as cutoff scores, sensitivity, specificity and prediction of fall. There is controversy about the ability of tools to predict falls in specific samples, such as active elderly. Conclusion: TUGT and BBS are effective to predict falls, provided they are adapted to each sample. Further studies should be performed using articles with homogeneous methods in order to support comparison of results about the effectiveness of tools.

Comprehensive geriatric assessment in elderly outpatients with dementia

Dementia is a common disabling disease in the elderly. In such patients, general health conditions may worsen the functional decline and loss of autonomy. The Comprehensive Geriatric Assessment (CGA) is a validated and recommended instrument for multidimensional evaluation of the aged. Nonetheless, it has yet to be assessed in demented patients. Objectives To analyze the functional, emotional and clinical status in elderly with dementia measured by the CGA. We also compared the results obtained in the same patients stratified for severity of dementia. Methods Transversal study with demented elderly outpatients. Subjects were evaluated by the CGA consisting of clinical data, Clinical Dementia Rating, performance-oriented mobility assessment of gait and balance (POMA), Cornell scale for depression, activities of daily living, Mini Mental Status Examination (MMSE), Mini Nutritional Assessment, Whispered and Snellen Test. Results Fifty-two patients with mean age of 77 years were evaluated. Majority of patients had Alzheimer disease (77%). Depression was the most prevalent comorbidity. The POMA score was related to the number of falls in the previous year. Also, there was correlation between complaints of visual and hearing impairment and the results on the Snellen and Whispered Tests. Regarding severity, 56% presented mild, 33% moderate and 11% severe condition. Patients with moderate/severe dementia had less leisure activities, greater risk of falls, along with worse performance on the MMSE, POMA and activities of daily living. Conclusions The CGA was applied in demented elderly with the help of their caregivers, and was able to better characterize patient state of health. Subjects with moderate/severe dementia obtained poor results in several assessed criteria.