Assessment and comparison of anticholinergic exposure in older adults at a Basic Health Unit in Porto Alegre

OBJECTIVES: To estimate the anticholinergic burden in geriatric patients using two scales and to assess the degree of agreement between them. METHODS: Data from an observational study conducted in a primary health care service were used. Anticholinergic burden was assessed using the Belgian Scale Muscarinic Acetylcholinergic Receptor ANTagonist Exposure Scale and the Brazilian Scale of Medicines with Anticholinergic Activity. The cumulative anticholinergic burden score was classified using a categorical approach: Brazilian scale (0: none; 1 - 2: low; &ge; 3: high) and Belgian scale (0: none; 0.5 - 1.5: low; &ge; 2: high). The degree of agreement between the two instruments was obtained through Cohen's kappa coefficient. RESULTS: A total of 374 older people were included, most of them female and aged between 60 and 69 years. At least one potentially inappropriate drug with anticholinergic activity was used by 60.70% of patients according to the Brazilian scale and 32.89% by the Belgian scale. On average, 20.85% were under high anticholinergic exposure. Overall, on both scales, the most commonly recurrent medications were those indicated for the treatment of psychiatric disorders. Agreement between the scales was moderate (Kappa = 0.43). CONCLUSIONS: A high percentage of older adults was exposed to drugs with an anticholinergic burden, posing risks to health and quality of life. Consensus is needed on how anticholinergic burden is calculated by these scores, as well as standardization of the list of included drugs.</p

The orthogeriatric cycle and orthogeriatric taxonomy: definitions, classifications, and conceptual elements for a better clinical practice

The incidence of fragility fractures is increasing. This group of diseases, mainly hip fractures, has enormous clinical, social, organizational, epidemiological, and economic impact. Orthogeriatrics emerged in the 1960s as a response to the impact of hip fractures on health systems. Since then, the cost-effectiveness of co-management models has been demonstrated, and the field of orthogeriatrics has expanded from acute care to prevention, rehabilitation, and follow-up, including involvement from clinical, academic, administrative, and political sectors. This has made associated indicators and standards increasingly complex. Moreover, orthogeriatrics initiatives are quite diverse throughout the world, since they arise due to varied local circumstances. Thus, it is necessary to review the foundations of the specialty to facilitate decision-making, comparison between models, and continuous improvement. In this article, we review current definitions and concepts in orthogeriatrics based on classic publications. We also reviewed the classifications of care models and carried out an evolutionary analysis of the field. Finally, we propose a taxonomic system that considers clinical, evolutionary, and functional aspects.</p

A simplified technique for fabricating complete dentures for patients with Parkinson&rsquo;s disease: a case report

BACKGROUND AND OBJECTIVE: Parkinson&rsquo;s disease is a neurological disorder that affects 1% of individuals aged 60 years and older. The associated symptoms can impose limitations on the available dental treatment options. CASE DESCRIPTION: This case report follows the CARE guidelines and presents an adapted and simplified technique to fabricate complete dentures for a 74-year-old male edentulous patient with Parkinson&rsquo;s disease. This modified technique enabled the fabrication of complete dentures in 4 clinical sessions of approximately 40 minutes. The first session involved manufacturing a preliminary impression with fast-setting alginate. The base plates and occlusal rims were then adjusted for artificial teeth arrangement during the second session. The final prosthesis was completed in the third session, which involved a teeth try-in and fabrication of a functional impression with low-melting thermoplastic material and polyether. Finally, denture installation was performed in the fourth session and follow-up consisted of 3 weekly sessions. DISCUSSION: Considering that the treatment provided satisfactory aesthetics and function, mastication and socialization benefits, and improved the self-esteem and well-being of the older patient with Parkinson&rsquo;s disease, the authors suggest this adapted and simplified technique for fabricating complete dentures.</p

Are quality of life, functional capacity, and urinary incontinence associated with fecal incontinence? The Fibra-BR Study

OBJECTIVE: To assess the prevalence of fecal incontinence and its association with clinical, functional, and cognitive-behavioral variables, medication use, frailty, falls, and quality of life in community-dwelling older adults (aged 65 years or older). METHODS: Cross-sectional, multicenter study carried out across 16 Brazilian cities. The question "In the last 12 months, did you experience fecal incontinence or involuntary passage of stool?" was defined as the indicator variable for fecal incontinence. Bivariate analyses were carried out to assess the prevalence of fecal incontinence and sociodemographic characteristics, comorbidities, cognition, functional capacity, depression, frailty, quality of life, and falls. Logistic regression analysis was also performed, with fecal incontinence as the dependent variable. RESULTS: Overall, 6855 subjects were evaluated; 66.56% were female, 52.93% white, and the mean age was 73.51 years. The prevalence of fecal incontinence was 5.93%. It was associated with worse self-care (OR 1.78 [1.08&ndash;2.96]), dependence for basic activities of daily living (OR 1.29 [1.01&ndash;1.95]), and urinary incontinence (OR 4.22 [3.28&ndash;5.41]). Furthermore, the absence of polypharmacy was identified as a protective factor (OR 0.61 [0.44&ndash;0.85]). CONCLUSION: The overall prevalence of fecal incontinence was 5.93%. On logistic regression, one quality of life variable, dependence for basic activities of daily living, and polypharmacy were significantly associated with fecal incontinence.</p

The use of ChatGPT in scientific publishing

The use of Generative Pretrained Transformer (ChatGPT), an artificial intelligence tool, for writing scientific articles has been reason for discussion by the academic community ever since its launch in late 2022. This artificial intelligence technology is becoming capable of generating fluent language, and distinguishing between text produced by ChatGPT and that written by people is becoming increasingly difficult. Here, we will present some topics to be discussed: (1) ensuring human verification; (2) establishing accountability rules; (3) avoiding the automatization of scientific production; (4) favoring truly open-source large language models (LLMs); (5) embracing the benefits of artificial intelligence; and (6) broadening the debate. With the emergence of these technologies, it is crucial to regulate, with continuous updates, the development and responsible use of LLMs with integrity, transparency, and honesty in research, along with scientists from various areas of knowledge, technology companies, large research funding bodies, science academies and universities, editors, non-governmental organizations, and law experts.</p

Videoconference assessment of functional and cognitive measures in Brazilian older adults: a reliability and feasibility study

OBJECTIVE: We aimed to determine the feasibility and reliability of videoconference assessment of functional and cognitive status among older adults in the context of the COVID-19 pandemic. METHODS: Thirty community-dwelling older adults (86.70% women) with a mean age of 69.77 (SD = 6.60) years who were physically independent and had no signs of cognitive impairment were included in the sample. An independent and experienced researcher assessed functional (chair rise test, chair stand test, sitting and rising test) and cognitive (Montreal Cognitive Assessment, parts A and B of the Trail Making Test, the Stroop test, the verbal fluency test) performance in real-time on the Google Meet platform on 2 non-consecutive days. The reliability of the measures was analyzed using the intraclass correlation coefficient (ICC), a paired t-test, or Wilcoxon and Bland-Altman analysis. The feasibility of the assessment was investigated using a standardized 14-item questionnaire. RESULTS: All functional performance measures showed excellent intra-rater reliability, with ICCs from 0.90 (95%CI 0.78 – 0.95) for the sitting and rising test to 0.98 (95%CI 0.96 – 0.99) for the chair rise test. Our analysis also showed mixed levels of reliability across measures, including good ICC (ranging from 0.79 – 0.91) for the Montreal Cognitive Assessment, part B of the Trail Making Test, and the congruent and neutral trials in the Stroop test, but poor-to-moderate ICC (ranging from 0.42 – 0.58) for the other cognitive assessments. In general, the participants reported good feasibility for the assessment format. CONCLUSION: In healthy and highly educated older adults, videoconferencing is a feasible method of determining functional and cognitive performance. Functional measures showed excellent reliability indexes, whereas cognitive data should be interpreted carefully, since the reliability varied from poor to moderate.</p

Cognition, functionality, and life space in older adults: the mediating role of perceived control and autonomy

OBJECTIVES: To examine a model of associations between cognition, functionality, and life-space mobility, and the mediating role of perceived control and autonomy. METHODS: This is a cross-sectional study with a sample of older adults aged over 72 years, which used data from the FIBRA study. We used the structural equation modeling technique. Variables in this model were cognition, functionality, perceived control and autonomy, and life-space mobility, with sociodemographic and health covariables. Data imputation was done through the expected maximization method aiming at more effective data utilization. This study was funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. RESULTS: The mediation model reached good fit indices. Cognition, functionality, and perceived control and autonomy demonstrated a predictive capacity for life space. Functionality and perceived control and autonomy mediated the relationship between cognition and life space; therefore, cognition influences life space, given its associations with the mediating variables. There was a mediating effect of perceived control and autonomy on the relationship between functionality and life space. CONCLUSIONS: Perceived control and autonomy have an adaptive role when considering changes in personal competencies. This adaptation is reflected on life spaces, indicating an adjustment between competence and environment. Studies aimed at promoting a good relationship between an individual and his or her context maintaining life space should consider perceived control and autonomy as important mechanisms in this relationship.</p