Vera Elizabeth Closs

A evolução do índice de envelhecimento no Brasil, nas suas regiões e unidades federativas no período de 1970 a 2010

Introduction: The aging index (AI) assesses the process of the broadening of the elderly portion of the total population in relation to the relative variation in the young age group, where it is determined by the ratio of the elderly population to the young population. This indicator allows the observation of the evolution of the aging rhythm of the population, comparing geographic areas and social groups, and can thus help in the formulation, management and evaluation of public policies in the areas of health and social welfare. Palavras-chave: Envelhecimento da populacao. Envelhecimento Demografico. Indices. Censo Demografico. Transicao demografica. Brasil.

Importância atribuída ao sexo por idosos do município de Porto Alegre e associação com a autopercepção de saúde e o sentimento de felicidade

INTRODUCTION: Ageing has brought many modifications into the life of elderly people revealing the necessity of a close assistance to their needs and among them there is the very special one focusing their sexual activity. Sexual aspects about brasilian elderly are still little known, involving myths and prejudice to be overcome. OBJECTIVE: verify the degree of importance given to sex by the elderly in Porto Alegre city, RS, Brazil and analyze the association between self-health perception and the feeling of happiness. METHODS: Research was done through the analysis of the Multidimensional Study of the Elderly Database of Porto Alegre (EMIPOA) involving 1,078 individuals aged 60 and over. RESULTS: Study conducted with 938 elderly people aged 60-95 years; 542 (57,8%) considered sex very important and important. There was a significant difference (p<0,001) in the importance given to sex by men and women and no significant association between the importance given to sex and the feeling of happiness (p=0,299) was observed. CONCLUSION: Sex is considered important by a great number of old people that is open to a more profound study for sure.

Altura do joelho como medida alternativa confiável na avaliação nutricional de idosos

Objective:To evaluate the use of knee-height as a reliable alternative measure for nutritional evaluation in older adults in a geriatrics outpatient clinic.Methods:Cross-sectional study with elderly patients being treated in a geriatrics outpatient clinic of a University Hospital between November 2009 and November 2010. Variables investigated: gender, age, weight, stature, kneeheight, estimated stature using Chumlea equations, body mass index based on measured and estimated stature and classified according to Lipschitz, and socio-demographic characteristics. Measures of central tendency, dispersion, and proportion were used in the descriptive data analysis. Homogeneity between these measures was verified using intraclass correlation coefficient and Bland and Altman plot, and the correlation between the nutritional assessment concerning the body mass index calculated based on the measured stature and the nutritional assessment calculated based on the estimated stature was established using the quadratic weighted Kappa coefficient.Results:One hundred eight-six elderly patients with average age of 74.3±7.1 years were evaluated. The average body mass index calculated and estimated were, respectively, 28.96±5.86 kgm2, 27.95±5.47 kgm2, and the prevalence of overweight was 59.7% for body mass index calculated and 53.2% for body mass index estimated. A good agreement between the evaluations was observed (Kappa=0.79; p<0.001).Conclusion:Results showed that it is possible to use the knee-height for the estimation of stature to determine the body mass index in elderly patients in a geriatric outpatient clinic. It proved a useful alternative especially when it is difficult to obtain accurate measures in older adults, suggesting that knee-height is an important alternative measure for the nutritional status evaluation in elderly patients.

Comparative study of anthropometric and body composition variables, and functionality between elderly that perform regular or irregular physical activity

Introducao: o impacto da atividade fisica regular e/ou irregular na composicao corporal, massa e forca muscular e funcionalidade em idosos e ainda pouco estudado. Objetivo: comparar variaveis antropometricas, espessura muscular e de gordura, mobilidade e forca de preensao palmar de membros inferiores entre idosos regular e irregularmente ativos classificados pelo International Phisical Activity Questionnnaire. Metodo: estudo transversal com 75 idosos (14 homens e 61 mulheres) que praticavam atividade fisica regular (AFR=10) ou irregular (AFI=65). Variaveis antropometricas (indice de massa corporal, circunferencias e dobras cutâneas), espessura muscular e de gordura (triceps braquial, vasto lateral e gastrocnemico medial [ultrassom]), forca de preensao palmar (dinamometro Crown), forca de membros inferiores (teste de senta e levanta) e mobilidade foram coletadas da amostra de idosos. A atividade fisica foi avaliada atraves do International Phisical Activity Questionnnaire. Resultados: nao foram encontradas diferencas significativas nas variaveis antropometricas, espessura muscular e de gordura e forca entre os dois grupos (p>0,05). No entanto, no grupo de idosos que praticavam atividade fisica irregular, foi obtido melhor desempenho no teste de mobilidade do que nos idosos que praticavam atividade fisica regular (p<0,008). Esse resultado foi independente de sexo e idade (p=0,017). Conclusao: o estudo nao encontrou diferencas significativas entre os idosos que praticam atividade fisica de forma regular ou irregular em relacao a composicao corporal e parâmetros de forca. Contudo, os resultados sugerem que a pratica de atividade fisica irregular pode ajudar a mobilidade dos idosos e prevenir quedas.

Anthropometric measurements in elderly assisted in primary health care and their association with gender, age and frailty syndrome: EMI-SUS data

Objetivos: Descrever medidas antropometricas em idosos assistidos na atencao basica e analisar sua associacao com genero, idade e sindrome da fragilidade. Metodos: Este estudo transversal e parte do Estudo Epidemiologico e Clinico dos Idosos Atendidos pela Estrategia Saude da Familia de Porto Alegre-RS-Brasil (EMI-SUS). Foram obtidas dos idosos 27 medidas antropometricas (analisadas de forma isolada ou em equacoes, totalizando 41 dados de medidas antropometricas) e dados para determinacao da sindrome de fragilidade (Fenotipo de Fried). Foram utilizados o teste de Kolmogorov-Smirnov, o teste t de Student e o teste de analise de variância (ANOVA). Considerou-se o nivel de confianca de 95%. Resultados: A amostra incluiu 583 idosos, sendo 371 (63,6%) mulheres. Homens apresentaram medias significativamente superiores de peso, estatura, altura do joelho, circunferencias (antebraco, muscular do braco, pescoco, punho), area muscular do braco, relacoes (cintura/quadril, cintura/coxa, dobras tronco/extremidades) e indices (sagital, de conicidade). Mulheres apresentaram medias superiores do indice de massa corporal, circunferencias (braco, cintura, coxa, quadril), dobras cutâneas (bicipital, tricipital, subescapular, suprailiaca, peitoral, coxa, panturrilha, media seis dobras), area de gordura do braco, relacao cintura/estatura e relacao diâmetro abdominal sagital/estatura. Idosos mais jovens apresentaram medidas superiores das circunferencias do antebraco, braco, musculo do braco, coxa e area muscular do braco em relacao aos mais velhos. Idosos robustos tinham estatura, altura do joelho, circunferencia muscular do braco e area muscular do braco superiores e area de gordura do braco, dobras cutâneas da coxa, peitoral, bicipital, tricipital, panturrilha e relacao diâmetro abdominal sagital/estatura inferiores aos frageis e pre-frageis. Idosos frageis tinham circunferencias da panturrilha e antebraco menores e relacoes cintura/estatura, cintura/coxa, cintura/panturrilha e indices de conicidade e sagital, maiores que os robustos. Conclusoes: As medidas antropometricas mostraram-se associadas com genero, idade e fragilidade. Nos homens, as medias das medidas de tamanho, compleicao e de reserva de massa muscular foram maiores. Nas mulheres, as medias das medidas de reserva adiposa foram maiores e a associacao das medidas com a faixa etaria foi mais frequente. Fragilidade mostrou-se associada com perda de massa muscular. Idosos frageis apresentaram medidas inferiores de tamanho e compleicao.

Crosstalk Between Gut Microbiota and the Central Nervous System: A Focus for Alzheimer's Disease.

The role of diet and gut microbiota in the pathophysiology of neurodegenerative diseases, such as Alzheimers, has recently come under intense investigation. Studies suggest that human gut microbiota may contribute to the modulation of several neurochemical and neurometabolic pathways, through complex systems that interact and interconnect with the central nervous system. The brain and intestine form a bidirectional communication axis, or vice versa, they form an axis through bi-directional communication between endocrine and complex immune systems, involving neurotransmitters and hormones. Above all, studies suggest that dysbiotic and poorly diversified microbiota may interfere with the synthesis and secretion of neurotrophic factors, such as brain-derived neurotrophic factor, gammaaminobutyric acid and N-methyl D-Aspartate receptors, widely associated with cognitive decline and dementia. In this context, the present article provides a review of the literature on the role of the gutbrain axis in Alzheimers disease.

Indication of Bariatric Surgery (Roux-en-Y Gastric Bypass Surgery and Vertical Gastrectomy) in The Older Individuals and implications For Gut Microbiota

Life expectancy and the obesity epidemic have considerably increased in different regions of the world, especially in developing countries. Various strategies exist for the treatment of obesity, although diet therapy, physical activity and lifestyle modification programs form the pillars of this treatment [1]. However, if these strategies fail to treat obesity and its comorbidities, combination with pharmacological therapy becomes necessary, and as a last resort, bariatric surgery should be indicated. Obesity is considered a risk factor that reduces quality of life and life expectancy, and bariatric/metabolic surgery has been found the most effective treatment for morbid obesity [2]. The efficacy of bariatric procedures in inducing and maintaining weight loss is, for the most part, superior to that achieved by drug therapies or lifestyle modification [2]. Surgery results in greater weight loss and improvement in weight-related comorbidities in comparison to non-surgical interventions, regardless of the type of procedure adopted [2, 3]. Nonetheless, the indication of bariatric surgery in people aged over 65 years is still controversial and subject Abstract

Anthropometric Measures and Frailty Prediction in the Elderly: An Easy-to-Use Tool

Purpose Anthropometry is a useful tool for assessing some risk factors for frailty. Thus, the aim of this study was to verify the discriminatory performance of anthropometric measures in identifying frailty in the elderly and to create an easy-to-use tool. Methods Cross-sectional study: a subset from the Multidimensional Study of the Elderly in the Family Health Strategy (EMI-SUS) evaluating 538 older adults. Individuals were classified using the Fried Phenotype criteria, and 26 anthropometric measures were obtained. The predictive ability of anthropometric measures in identifying frailty was identified through logistic regression and an artificial neural network. The accuracy of the final models was assessed with an ROC curve. Results The final model comprised the following predictors: weight, waist circumference, bicipital skinfold, sagittal abdominal diameter, and age. The final neural network models presented a higher ROC curve of 0.78 (CI 95% 0.74–0.82) (P < 0.001) than the logistic regression model, with an ROC curve of 0.71 (CI 95% 0.66–0.77) (P < 0.001). Conclusion The neural network model provides a reliable tool for identifying prefrailty/frailty in the elderly, with the advantage of being easy to apply in the primary health care. It may help to provide timely interventions to ameliorate the risk of adverse events.

Síndrome metabólica em idosos da atenção terciária em Porto Alegre, Rio Grande do Sul: associação com o Índice de Alimentação Saudável

Objetivos : Avaliar a associacao entre sindrome metabolica e Indice de Alimentacao Saudavel em idosos atendidos em um servico de atencao terciaria pelo Sistema Unico de Saude. Metodos : Estudo transversal, realizado no ambulatorio do Servico de Geriatria do Hospital Sao Lucas da Pontificia Universidade Catolica do Rio Grande do Sul, em Porto Alegre, RS, entre novembro de 2009 e novembro de 2010. Foram convidados a participar do estudo todos os idosos atendidos no periodo, sendo excluidos aqueles com declinio cognitivo, transtornos psiquiatricos severos, grande restricao de mobilidade ou deficiencia auditiva severa que comprometessem a avaliacao nutricional. O diagnostico de sindrome metabolica foi estabelecido pelo Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults revisado e o padrao alimentar foi avaliado por meio do Indice de Alimentacao Saudavel adaptado para a populacao brasileira. Resultados : A amostra incluiu 186 idosos, a maioria mulheres (81,7%). A frequencia de sindrome metabolica foi de 58,6%. Nao houve diferenca entre os escores do Indice de Alimentacao Saudavel de idosos com e sem sindrome metabolica. Na maioria dos idosos a dieta necessitava de adequacoes. Idosos com sindrome metabolica tinham escore inferior somente para legumes e verduras (p=0,026). Na amostra total, o escore de cereais, paes, tuberculos e raizes foi diretamente associado com obesidade central (p=0,005); o de legumes e verduras inversamente com triglicerideos (p=0,002) e diretamente com colesterol ligado a lipoproteinas de alta densidade (HDL-c) (p=0,004); o de frutas, diretamente com obesidade central (p=0,048), glicemia (p=0,024), triglicerideos (p=0,001) e inversamente com HDL-c (p=0,015); o de leguminosas com glicemia (p=0,019); o de gordura total indiretamente com obesidade central (p=0,004) e glicemia (p=0,041); e variedade da dieta inversamente com glicemia (p=0,002) e pressao arterial diastolica (p=0,031). Conclusoes : A dieta dessa amostra de idosos da atencao terciaria necessitava de adequacao. Nao se observou associacao entre o escore total do Indice de Alimentacao Saudavel e sindrome metabolica. Contudo, entre dez componentes do indice, seis mostraram-se associados com os criterios diagnosticos da sindrome metabolica. Assim, destaca-se a necessidade de intensificar o cuidado em relacao a adequacao nutricional em todos os niveis da atencao a saude, uma vez que a nutricao e um fator importante na modulacao da sindrome metabolica e de seus componentes.

Perfil do paciente obeso e portador de síndrome metabólica candidato à cirurgia bariátrica em uma clínica particular de Porto Alegre, Rio Grande do Sul

Aims: To describe the sociodemographic and biochemical profiles, presence of comorbidities, lifestyles, and drug utilization of obese patients with metabolic syndrome eligible for bariatric surgery.Methods: This retrospective cross-sectional study included metabolic syndrome patients with class I, II, and III obesity treated at a specialized clinic in Porto Alegre, Rio Grande do Sul, Brazil, who were candidates for bariatric surgery. The patients were seen between January 2007 and March 2014 and the data for the study were collected from medical records. The following variables were investigated: age, sex, education, marital status, comorbidities, biochemical markers, drug utilization, smoking history, history of childhood overweight, and sleep quality. Patients were classified as class I obesity (BMI = 30 to 34.9), class II obesity (BMI = 35 to 39.9), and class III, or severe, obesity (BMI≥40). The diagnosis of metabolic syndrome was established according to the International Diabetes Federation.Results: A total of 198 subjects (83.8% of whom were women and 68.7% were married) with a mean age of 40.5±11.1 years (range of 21-69 years) were evaluated. Most of the patients (37.4%) were 30 to 39 years old. With regard to health, 77.3% of the patients had hypertension, 75.8% had dyslipidemia, and 75.3% had gastritis, and it should be noted that 67.2% of the patients were on antihypertensive medications and 42.9% on psychiatric drugs. A median of 0.81 (0.70-0.97mg/dL) was obtained for C-reactive protein levels. One hundred and thirteen patients (57%) reported having had excessive weight in childhood. Poor sleep quality was mentioned by 61 (31%) of individuals.Conclusions: Most individuals with class I, II, and III obesity and metabolic syndrome who sought care at the bariatric surgery clinic were young, adult, and married women with a college degree or higher education presenting with several comorbidities in addition to excess weight and inflammatory conditions. Other common findings included sleep disorders, excessive weight in childhood, and use of more than one type of medication.