Estudo de seguimento por dois anos de idosos residentes em São Paulo, Brasil: metodologia e resultados preliminares

INTRODUCTION: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil s rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO ( Epidemiologia do Idoso ) Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.INTRODUÇÃO: Estudos transversais recentes mostraram alta prevalência de doenças crônicas e incapacidades físicas entre idosos. Considerando o rápido processo de envelhecimento do Brasil e as conseqüências que esse aumento de idosos com doenças crônicas e incapacidades associadas acarretará para o sistema de saúde, fazia-se necessário estudo que pudesse superar as limitações dos dados transversais, permitindo determinar quais os fatores determinantes de uma vida longa e livre de doenças incapacitantes, o chamado envelhecimento bem sucedido. É apresentada a metodologia do primeiro estudo epidemiológico longitudinal com idosos residentes na comunidade, no Brasil. MÉTODO: O perfil do cohorte inicial é comparado com dados de estudos anteriores a com o perfil dos não respondentes para avaliar a validade de análises longitudinais futuras.O projeto EPIDOSO (Epidemiologia do Idoso) seguiu por dois anos 1.667 idosos (65+), residentes em São Paulo. Consistiu de duas ondas, cada qual com três inquéritos: domiciliar, clínico e laboratorial. RESULTADOS E CONCLUSÕES: O perfil da população não diferiu de estudos anteriores, mostrando maioria de mulheres, viúvas, vivendo em domicílios multigeracionais, com uma alta prevalência de doenças crônicas, distúrbios psiquiátricos e incapacidades físicas. A despeito de todas as dificuldades inerentes a um estudo longitudinal, o grupo de não-respondentes ao segundo inquérito domiciliar não diferiu significativamente dos respondentes, assegurando análises longitudinais livres desse tipo de viés. Em relação aos inquéritos clínico e laboratorial, os não-respondentes mostraram-se mais velhos e mais incapacitados que os respondentes, limitando o uso dos dados clínicos e laboratoriais a análises pertinentes a uma cohorte mais jovem e saudável. Sexo, educação, apoio familiar e nível socioeconômico não influenciaram de forma significativa a taxa de não - resposta, ao contrário do que se costuma verificar.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Scientific evidence for octogenarians and nonagenarians

OBJECTIVE: Evaluate the characteristics of scientific medical studies including patients over 80 years old, from january 2000 to october 2009. METHODS: We searched the eletronic database MEDLINE, and two regional databases (Scielo and Lilacs). We used search terms "octogenarians" or "nonagenarians" at the title, and filter to identify articles in english language, with abstracts and articles with patients over 80 years old. Data were extracted from articles and studies were classified according to level of evidence based on Oxford Center for Evidence-Based Medicine classification. RESULTS: Three hundred ninety-five studies were found at MEDLINE database, the number of studies increased fourfold from 2000 to 2008, 18 studies in 2000 and 63 studies in 2008. The majority of studies were classified as clinical research (291 studies, 73,7%), observational (339 studies, 85,8%) and retrospective (260 studies, 65,8%). Only 6 studies (1,5%) evaluate interventions. Cardiac surgery departments published more among the articles found (106 studies, 26,8%), followed by cardiology (62 studies, 15,7%). American studies wer the most common (128 studies, 32,4%). Only 6,7% were produced by Geriatric departments. CONCLUSION: The number of scientific evidence with very old patients increased in the last years. Clinical research, obsertational studies and retrospectives were the main characteristics found. The best level of evidence found was 1B. Cardiac surgery and cardiology produced more studies. In regional database we found more national studies.</p

Functional magnetic resonance imaging response as an early biomarker of cognitive decline in elderly patients with metabolic syndrome

Objectives: We assessed whether potential changes in brain activation patterns of elderly individuals with metabolic syndrome (MetS) who were cognitively healthy (without mild cognitive impairment or dementia) were associated with cognitive decline in executive function in the short-term. Method: We analyzed 43 individuals (23 MetS, 20 controls) using a global geriatric evaluation, a neuropsychological battery, and task-related (attention) fMRI exam. Correlation analysis between the fMRI signal at baseline and cognitive impairment after 1 year was based on the voxel-based Pearson coefficient, corrected for multiple comparisons. Results: At baseline, MetS patients showed reduced brain response in frontal and parietal regions compared to controls. After one year, the MetS group also showed a decline in verbal fluency performance. fMRI response in the right dorsolateral prefrontal cortex and bilateral parietal lobes was negatively correlated with verbal fluency decline in the MetS group. Discussion: Our results provide an early biomarker of the possible development of cognitive impairment, particularly in the executive function, of elderly individuals suffering from MetS. These findings also point to an up or down regulation which could be interpreted as compensatory mechanism for possible brain tissue burden caused by MetS.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)Ministry of Health which, via Technical Area of Health of Aged (PROADI)Hospital Israelita Albert Einstein under Support Program for Institutional Development of Brazilian Unified National Health System (SUS)Univ Fed Sao Paulo, Escola Paulista Med, Dept Psychiat, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, BrazilHosp Israelita Albert Einstein, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, BrazilHosp Israelita Albert Einstein, Ave Albert Einstein, Sao Paulo, BrazilHosp Israelita Albert Einstein, Rua Madre Cabrini 462, BR-04020001 Sao Paulo, SP, BrazilUniv Estadual Sao Paulo Julio de Mesquita Filho, Fac Med Botucatu, Dept Internal Med, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Internal Med, Div Geriatr, Rua Francisco de Castro 105, BR-04020050 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Psychiat, Rua Borges Lagoa 570, BR-04038030 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Internal Med, Div Geriatr, Rua Francisco de Castro 105, BR-04020050 Sao Paulo, SP, BrazilCAPES: 2009/12271-3Web of Scienc

Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results

INTRODUCTION: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil's rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO (`Epidemiologia do Idoso') Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case