CORRELATION OF BODY MASS INDEX WITH THE HAND GRIP STRENGTH AND ADDUCTOR POLLICIS MUSCLE THICKNESS IN ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS AND SYSTEMIC LUPUS ERITEMATOSUS IN A BRAZIL NORTHEAST REFERENCE CENTER

Introduction: Rheumatoid arthritis and systemic lupus erythematosus are autoimmune, chronic and progressive diseases, which can be get worst in the presence of muscle mass loss due to physical inactivity and continuous inflammatory. Therefore, estimate body composition can assist in the treatment of these diseases. Objective: To evaluate the correlation of body mass index with handgrip strength and adductor pollicis muscle thickness in elderly patients with rheumatoid arthritis and systemic lupus erythematosus followed in a reference center in Brazil. Material and Methods: Cross-sectional study carried out in a rheumatology outpatient clinic in a reference center in Northeastern Brazil (Recife / PE). Elderly patients with rheumatoid arthritis and systemic lupus erythematosus. Anthropometric measurements of weight, height and Body Mass Index (BMI) were taken, in addition to the measurement of body composition: calf circumference (CC), arm circumference (MUAC), adductor pollicis muscle thickness (APMT) and strength of hand grip (HGS). The data were treated using the SPSS version 17.0 for Windows and Excel 2010. Pearson correlation and the Chi-square test were used for analysis. The level of significance was set at 5%. The IMIP Research Bioethics Committee approved the present study under No. 19163619.1.0000.5201 the participants’ guardians signed the Free and Informed Consent Form (ICF). Results: The study included 19 patients aged 60 to 85 years and a mean age of 70.05 years +/- 8.47 SD, 94.74% of whom were female. The BMI, MUAC, CC, APMT and HGS mean of (26.93g / m2 ± 5.75DP), (28.85 ± 4.06DP), (34.79 ± 3.62DP), (11.52 ± 4.437DP) and (10.81 ± 6.77DP) respectively. The BMI showed that 31.26 were overweight, while HGS showed that 66.7% had a deficit in handgrip strength justified by the high prevalence of depletion of the adductor pollicis muscle, which identified that 97.4% showed signs of depletion of this musculature. There was a moderate correlation between BMI, MUAC and CC (r = 0.453) and (r = 0.426), respectively, while for BMI and APMT the correlation was weak (r = 0.348), as well as the correlation between BMI and HGS was r = 0.005. Conclusions: There was a prevalence of eutrophic and overweight elderly people, however with loss of muscle mass and decreased hand grip strength. This may suggest a greater risk for the development of senile sarcopenia. &nbsp

Older Adults’ Engagement in Mindfulness Practices

There is substantial evidence to suggest that mindfulness practices positively affect older adults’ physical, emotional, and cognitive wellbeing. However, there is still little information available about the interest and inclination among older adults for performing mindfulness-related exercises. We conducted a survey study aimed at exploring the prevalence of older adults engaged in such activities. Data were collected from 174 older adults (Males: 48; Females:126) who responded using a self-constructed survey, and analyzed using SPSS. Results indicate that almost two-thirds of older adult respondents engage in at least one mindfulness practice and almost a third engage in more than one, with meditation, deep breathing, and yoga being the most prevalent

Predictors of in-hospital mortality in critically ill Geriatric patients

Objective: To determine the predictors of in-hospital mortality in critically ill older patients. Participants and Methods: A prospective cohort study including 305 critically ill older adults (age ?60 years) who were admitted to High Dependency Units (HDUs) in a tertiary care university hospital from March 22, 2019 to January 4, 2020. Demographic, clinical and laboratory data of participants were collected thought a review of medical records and clinical observation at HDUs till either death or discharge alive. Statistical analysis included univariate analysis of selected potential predictors such as various comorbidities, C- reactive protein / Albumin ratio (CAR), Neutrophil-lymphocyte ratio (NLR), Red cell distribution width (RDW), Po2/Fio2 ratio (PFR), Simplified acute physiology score II (SAPS II), Charlson comorbidity index (CCI) and multidrug-resistant Gram-negative bacterial (MDR-GNB) infection to ascertain their association with mortality, followed by multivariable logistic regression to derive the final prediction model. The discriminative ability of the model was evaluated by using the receiver operating characteristic (ROC) curve. RESULTS: Overall mortality was 53.1%. Multivariate regression analysis revealed independent predictors of mortality including dementia in clinical history with an odds ratio (OR) of 4.86 (95% CI: 1.28-18.34), total protein with an OR of .53 (95% CI: .30-.95) and the use of mechanical ventilation (MV) and/or intravenous cardiovascular support with an OR of 148.34 (95% CI: 34.28-641.77), formulating a novel prognostic model with an area under the ROC curve of .93 (95% CI: .89-.96, P.000). CONCLUSION: History of dementia, total protein and the use of MV and/or intravenous cardiovascular support are predictors of mortality in critically ill geriatric patients. It provides a novel prognostic model which needs validation in other multicenter prospective studies

NURSE ROLE AS NA EDUCATOR IN HIV PREVENTION IN THE ELDERLY: A NEW PERSPECTIVE FOR THE HEALTH CARE OF THE ELDERLY

Objective: Reflect the nurse role as an educator in HIV prevention in the elderly. Methods: This is a qualitative, descriptive and exploratory study. An online bibliographic survey was carried out in the databases of the Virtual Health Library (VHL), Latin American and Caribbean Literature in Health Sciences (Lilacs) and Scientific Electronic Library Online (SciELO). The descriptors were used: “Assistance to the Elderly”; “Nursing”; “HIV” and “Public Health”. The inclusion criteria defined for the selection of articles were: articles published in Portuguese, articles in full that portrayed the theme and articles published in the referred databases in the last ten years. Results: When reading the eleven selected articles, it was possible to observe the high rate of elderly people with HIV. The profile of sexual behavior is commonly described only in people up to 59 years of age, abstaining from the population above 60 years, which favors forgetting this age group. From the perspective of HIV in the health of the elderly, the multidisciplinary team has an importance, especially the nurse, as its role is directed to the maintenance and restoration of health, leading them to self-care with a focus on health education practices. Conclusion: In the studies that were analyzed, the relevance of the nurse’s role as an educator was explicit, because unfortunately there is still a “taboo” when sexuality is explained in the elderly, and the nurse exercising his / her health education function may be adding knowledge of prevention and treatment for this population that is neglected by society

Efficacy of Doll thErapy compared with standard treatment in the control of behavioral and psychologic Symptoms and CaRegIver Burden in dEmentia: DESCRIBE a randomized, controlled study

Behavioral and psychologic symptoms of dementia (BPSD) are frequent and represent a burden for patients and caregivers; in particular, the presence of agitation and aggression (A/A) has an important impact on patients’ quality of life. As psychotropic drugs can induce severe collateral effects, the use of a first line non-pharmacologic approach is highly recommended.Here we evaluate the effect of doll therapy (DT) on A/A in geriatric patients with moderate to severe dementia hospitalized in an acute geriatric unit.We enrolled fifty-two acute in-patients with dementia and A/A. Subjects were randomized to DT (26) or standard treatment (ST, 26), we measured agitation and caregiver burden with standard clinical scales at baseline and during treatment. In order to evaluate the effect of DT withdrawal, we carried out a telephonic follow-up interview after 1 and 4 weeks from hospital discharge.DT is more effective than ST in the control of agitation, but not in reducing the professional caregiver burden. The use of pro re nata psychotropic drugs was reduced in patients treated with DT. After DT withdrawal, A/A progressively increased.In conclusion we show that DT may be more effective than ST in the control of A/A in acute geriatric in-patients affected by dementia. Our results suggest that, in patients affected by severe to moderate forms of dementia with A/A, DT may be used as a first line treatment, not only in nursing home residents, but also in acute care geriatric in-patients

THE IMPACT OF COVID-19 ON INFORMAL CAREGIVERS IN THE US

Background: Caregiver burden has negative effects on mental and physical health along with quality of life. Meanwhile, social and physical distancing protocols during the COVID-19 pandemic have created additional impacts on informal caregiving in a rapidly changing environment. Early research over the past year suggests that the pandemic has caused increased caregiver burden as well as caregiving intensity among these individuals. Purpose: Our primary purpose in this informational literature review is to describe the impacts of the pandemic on informal caregiver burden and the sudden shift in roles and responsibilities as a result of pandemic-related changes in caregiving. This review will describe emerging effects on various aspects of health among informal caregivers and explore the growing need to support unpaid caregiving during this time. Methods: A streamlined search was conducted to fit the scope of this review, with key terms determined to identify relevant publications. Common research databases and up-to-date mainstream resources were utilized. Notably, we focused on research published or released since March 2020, primarily rapidly reviewed studies, to align with the timing of the COVID-19 pandemic in the US. Results: Early research suggests that the pandemic has worsened caregiver burden and increased caregiving intensity and hours of care among unpaid, informal family caregivers. Reported health impacts include higher stress, pain, and depression, along with decreased social connectedness and quality of life. Notably, however, COVID-related research generally does not focus on the positive aspects of caregiving, such as its role as a source of purpose in life, creating an opportunity to explore ways to boost certain valuable personal resources among caregivers. Conclusions: Informal family caregivers face their own negative health outcomes and distress as a result of greater caregiver burden, intensity, and the changing landscape of caregiving during the ongoing COVID-19 pandemic. Immediate policy and support recommendations should be considered to alleviate informal caregiver burden and provide ongoing resources over the longer term. In addition, future work should explore the potential of boosting positive resources such as resilience and purpose to ease caregiver burden

The Usefulness of Short Physical Performance Battery Score for Predicting the Ability of Toilet Activity in Hospitalized Older Patients

Background: It has been still unclear whether the cut-off value of the short physical performance battery for predicting the ability of the toilet activity in the hospitalized older patients. The aim of this study was to reveal the relationship between the short physical performance battery and the ability of toilet activity, and also to determine the cut-off value of the short physical performance battery score for the ability of toilet activity in the hospitalized older patients. Methods: In this cross-sectional study, 71 hospitalized older patients were recruited. The short physical performance battery and the ability of toilet activity using the Barthel index (BI) were measured. The patients were split into two groups, according to the ability of toilet activity (Group 1: 10 point; Group 2: 5 point or less in BI score). A multiple logistic regression analysis was used to assess the relationship between the two groups. Moreover, the cut-off value for dividing into two groups, (Group 1 and Group 2) using the short physical performance battery score, which was calculated by a receiver operating characteristic curve. Results: The short physical performance battery score was an independent explanator for the ability of toilet activity using multiple logistic regression analysis. Besides, the cut-off value of the short physical performance battery for the ability of toilet activity was set in this study. Conclusion: The findings of this study suggest that the cut-off value of the short physical performance battery score could be a useful index to predict the ability of toilet activity in the hospitalized older patients. &nbsp

THE EFFECTS OF A COGNITIVE TRAINING PROGRAM FOR OLDER ADULTS: A BRIEF PRELIMINARY REPORT

As one ages, some degree of cognitive decline is expected. Despite this, declines in cognitive abilities and the possibility of dementia is a common concern among older adults. In response to these concerns, a variety of cognitive training programs have been developed that aim to improve or maintain cognitive functioning. Prior literature has shown mixed or limited findings on cognitive changes after implementation of cognitive training. This study evaluated the effectiveness of a cognitive training program designed for older adults with no to minimal cognitive decline. The current study included 17 participants who engaged in two one-hour cognitive training sessions each week for 12 weeks. Each session required participants to complete activities that targeted the following cognitive domains: attention, visual and verbal memory, visual spatial skills, processing speed and executive functioning, and language. These cognitive domains, along with depression and memory self-efficacy, were assessed prior to and immediately after completion of the program. Small to large effect sizes on the majority of cognitive outcome measures were observed following participation in the program. Small reductions in depressive symptoms were also found. These findings provide preliminary support for the use of a comprehensive cognitive training program for cognitively-intact older adults

Potentially Inappropriate Medications for Older Adults in Dental Practice

Objective: The present study aimed to review the medications frequently prescribed in dental practice that are potentially inappropriate for the elderly population due to the risks presented. Methods: An integrative literature review was carried out, based on the Guidance Manual: Prescription and Dispensing of Medicines Used in Dentistry, which reports the main drugs prescribed in dental practice (2017). From this, medications described in the Beers list of the American Society of Geriatrics (2019) were extracted, in order to identify medications that are potentially inappropriate in the elderly, what are the main consequences of use and appropriate management in view of the need for prescription. Results: The prescription and dispensing guidance manual for medicines used in dentistry has a list of 142 medicines, containing anti-inflammatories, antibacterials, opioids, benzodiazepines and other types of drugs. Of the drugs listed, 27 are considered inadequate and the most common therapeutic class among the drugs was anti-inflammatory drugs, being equivalent to 44.5% of the inadequacies found. Conclusion: Despite the risks associated with medications, it appears that they are widely prescribed in dental practice, making these groups worthy of special attention due to their potential for serious adverse events and negative impacts on the elderly and the health system, in addition to to emphasize the importance of the professional regarding the best indications and pharmacotherapeutic follow-up by the clinical pharmacist in caring for the elderly

Development of Estimate Formulas for Waist Circumference Using Body Mass Index and Limb Circumferences in Hospitalized Older Adults

Background: Little research has been conducted on the estimate formulas for waist circumference using body mass index and limb circumferences in hospitalized older adults. Thus, we conducted the present study to develop estimate formulas of waist circumference using body mass index and limb circumferences in hospitalized older adults. Methods: Forty hospitalized older patients were recruited in this cross-sectional study. We measured waist circumference, body mass index, upper arm circumference, forearm circumference, thigh circumference, and calf circumference. The estimate formulas for waist circumference were developed using simple and multiple regression analysis. Results: Simple regression analysis indicated that body mass index, upper arm circumference, forearm circumference, thigh circumference, and calf circumference were independent explanators for waist circumference (p < 0.05 for all). In addition, body mass index, upper arm circumference, and forearm circumference but not thigh circumference and calf circumference were extracted as independent explanators for waist circumference in multiple regression analysis (p < 0.05). We were able to develop the estimate formulas using body mass index, upper arm circumference, forearm circumference, thigh circumference, and calf circumference. Conclusion: The results suggest that the estimate formulas for waist circumference may provide an opportunity to easily evaluate waist circumference, even in hospitalized older adults with kyphosis posture. However, future studies should be conducted to develop the estimate formulas for waist circumference with a lower error value