Envelhecimento bem sucedido e longevidade avançada

Partindo de uma análise realista mas positiva ao desafios e repercussões do envelhecimento da população idosa, esta revisão pretende explorar os paradigmas de envelhecimento ativo, saudável e bem sucedido e a sua aplicabilidade ao grupo dos muito idosos. Para isso, baseia-se em estudos que focaram a fase muito avançada de vida, com destaque para o estudo das pessoas com 80 e mais anos no âmbito do Projeto DIA: Da Incapacidade à Atividade e dos casos “bem sucedidos” do PT100 – Estudo de Centenários do Porto, ambos desenvolvidos na Unidade de Investigação e Formação sobre Adultos e Idosos (UNIFAI-ICBAS.PT). Domínios alternativos de envelhecimento bem sucedido e a importância dos recursos individuais, designadamente psicológicos, são apresentados como importantes elementos para a compreensão do processo de adaptação à longevidade avançada

Perceived risk of institutionalization, hospitalization, and death in oldest old primary care patients

Objectives: This study aims to analyze the accuracy and predictive ability of the Risk Instrument for Screening in the Community (RISC) scored by general practitioners (GPs) in a sample of primary care patients aged 80+ with perceived mental health concerns. Method: GPs ranked the perceived risk of the three adverse outcomes (hospitalization, institutionalization and death) at 1 year in a five Likert scale (RISC score), where 1 is the lowest risk and 5 is the highest. Follow up contacts were conducted after 1 year of assessment in order to collect data on the three outcomes. Results: The 1-year proportion of institutionalization, hospitalization and death were 12.1 %, 25.2 % and 19.0 % respectively. Based upon the sensitivity and specificity from the Receiver Operating Characteristic (ROC) curves, we found an optimal cut-off point of ≥4 for the RISC. The RISC had fair accuracy for 1-year risk of in- stitutionalization (Area Under the ROC curve (AUC) = 0.75, 95% CI 0.43-0.68) and hospitalization (AUC = 0.65, 95% CI 0.52-0.78), but not for death (AUC = 0.55, 95% CI 0.43-0.68). Conclusions: The RISC as a short global subjective assessment is to be considered a reliable tool for use by GPs. Our results showed that RISC seems to be a good instrument to triage very old people at risk for in- stitutionalization but with poor accuracy at predicting hospitalization and limited predictive ability for death, suggesting further research and caution on this instrument’s use.publishe

Regional differences in morbidity profiles and health care use in the oldest old: findings from two Centenarian Studies in Portugal

Background: The worldwide increase of human life expectancy and the rapid aging of the population will contribute to an increasing prevalence of chronic illness. Even so, individuals who reach very advanced ages often postpone or escape age-related diseases that are common causes of death. Objective: This article aims to examine health-related characteristics of two distinct samples of Portuguese centenarians (one predominantly rural – PR vs. one predominantly urban - PU), and explore potential dissim- ilarities in their morbidity profiles and use of health care services. Methods: A total of 241 centenarians were considered. Sociodemographic characteristics, health status, and use of health care services were assessed by semi-structured interviews with the centenarians and their proxies (family or formal caregiver). Results: A higher average of 4.80 self-reported illnesses (sd = 2.01) were found in the PU sample (vs. 2.96; sd = 1.77 in the PR sample); in overall the PR sample presented a better health condition with lower levels of physical and mental impairments, and a greater number of centenarians who did not succumb to the three most common lethal diseases (heart disease, non-skin cancer and stroke) in the elderly population (85.4% vs. 60% in the PU sample). Conclusions: Portuguese centenarians experienced a substantial number of illnesses, but an overall better health status was found in centenarians from the PR area. By providing distinctive health-related profiles, our findings suggest the importance of contextual factors in shaping how very advanced ages may be achieved.publishe

Risk perception in subjects at-risk for Familial Amyloidotic Polyneuropathy: Percepción del riesgo en sujetos con riesgo de Polineuropatía Amiloide Familiar

http://sherpa.ac.uk/romeo/issn/2011-2777/The aims of this study are to know if subjects at-risk were aware of their 50% risk for Familial Amyloidotic Polyneuropathy (FAP); to know the value of the subjective risk; to understand the association between sociodemographic characteristics and risk perception, and between the risk status and the subjective perception of risk. 174 subjects 50% atrisk for FAP were tested. 52.9% subjects at-risk were aware of their 50% risk condition. The mean value of the subjective risk was higher and closer to 50% when the subjects were aware of their 50% risk condition. Education was associated to a higher awareness of being at 50% risk. It seems that information on previous knowledge before performing the genetic counselling increases the subjective risk.Los objetivos de este estudio son saber si los sujetos en riesgo eran conscientes de su riesgo del 50% para la polineuropatía amiloide familiar (PAF); conocer el valor del riesgo subjetivo; y comprender la asociación entre las características sociodemográficas y la percepción del riesgo y entre el riesgo real y la percepción subjetiva del riesgo. Se examinaron 174 sujetos con riesgo de PAF del 50%. 52,9% de los sujetos en riesgo eran conscientes de su condición de riesgo del 50%. El valor medio del riesgo subjetivo fue mayor y más cercano al 50% cuando los sujetos eran conscientes de su condición de riesgo del 50%. La educación se asoció a una mayor conciencia de estar al 50% de riesgo. Parece que la información sobre los conocimientos previos antes de realizar el asesoramiento genético aumenta el riesgo subjetivo.info:eu-repo/semantics/publishedVersio

Saúde percebida e "passagem à reforma"

A “passagem à reforma” é um processo complexo por meio do qual os indivíduos abandonam a vida profissional. Uma das formas possíveis de abordar a complexidade deste acontecimento é tomá-lo como uma transição de vida envolvendo mudança e adaptação e susceptível de produzir stresse. Na procura de uma compreensão mais apurada do impacto da “passagem à reforma” na saúde percebida dos indivíduos que se reformam, realizámos um estudo comparativo entre 50 indivíduos reformados e 50 indivíduos não reformados – em ambos os casos, 25 homens e 25 mulheres –, vivendo nas suas residências no norte e centro de Portugal. Os indivíduos reformados encontravam-se nessa situação há pouco tempo (menos de um ano) e os indivíduos não reformados eram trabalhadores a tempo inteiro. O instrumento usado para avaliação foi uma versão do “Questionário de Auto-Avaliação da Saúde e do Bem-Estar Físico”, retirado do “Protocolo Europeu de Avaliação do Envelhecimento”. Os resultados mostram não haver diferenças relevantes entre indivíduos reformados e não reformados acerca da percepção que têm da respectiva saúde. No entanto, os indivíduos reformados queixam-se mais acerca da saúde nos meses seguintes à “passagem à reforma”, enquanto as queixas dos indivíduos não reformados remontam a um período de tempo mais longo. ------ ABSTRACT ------ Abstract-Retirement is a complex process by which individuals withdraw from full-time participation in a job. We can approach the complexity of the retirement process taking it as a life transition involving change and adaptation that may produce stress. In search for a better understanding of retirement transition impact in perceived health, a comparative study was made between 50 retired persons and 50 non-retired persons – in both cases, 25 men and 25 women – residing in their home in the north and centre of Portugal. The retired individuals were recently retired (less than one year) and the non-retired individuals were full-time workers. The instrument used for evaluation was a version of the “Self-Reported Health Questionnaire”, taken from “The European Survey on Aging Protocol” (ESAP). The results show that there are no relevant differences between retired and non-retired concerning self-reported health. However, retired individuals complain more about health in the months after retirement (coincident with the new retirement condition), while full-time workers complain about health over a long period

Determinants of frailty: the added value of assessing medication

This study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0-4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8%, 25.3%, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of medications independently predicted an additional 2.5% of total frailty and 5.3% of physical frailty. The adverse effects of polymedication and its direct link with the amount of comorbidities could explain the independent contribution of this variable to frailty prediction. Furthermore, the consumption of drugs for cardiovascular diseases was particularly important for the prediction of frailty and of its physical domain. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains provided additional evidence of the integral model of frailty’s relevance. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty

La salud mental en los ancianos de la Región Autónoma de Madeira. Estudio piloto

La salud mental ha sido evaluada de acuerdo con la estructura propuesta por Ware & Veit (1), que incluye una dimensión positiva (el bienestar psicológico) y otra negativa (el distress psicológico). Este estudio piloto tiene como objetivo elaborar un protocolo para tipificar lasituación de la salud mental en la población anciana de la región. De los 63 ancianos seleccionados, a los que se les realizó el Mini Mental Health Examination, 47 integran la muestra. Todos tenían 65 años o más y residen en la comunidad. La casi totalidad era independiente en sus actividades básicas cotidianas. La puntuación media obtenida por los ancianos en el Inventario de Salud Mental fue superior a la obtenida por Ribeiro (2) en una muestra de jóvenes portugueses. El protocolo de investigación ha sido el adecuado. Los resultados nos han proporcionado una primera imagen de la salud mental en los ancianos de la RAM.Mental health was assessed in accordance with the structure proposed by Ware & Veit (1) which considers psychological well-being and distress. The purpose of this pilot study, carried out in Madeira Autonomous Region (RAM), was to validate the research protocol for characterising the mental health of the Region’s older people. Sixty three elders were chosen for the Mini Mental Health Examination and 47 of these were included in the sample. All of the people were aged 65 or older and lived in the community. Nearly all of the people could carry out basic daily life activities independently. The average points score found for the Mental Health Inventory shows that the mental health index of these older people is greater than that found by Ribeiro (2) in a sample of young Portuguese people. The research protocol was shown to be suitable. The results have provided us with an initial snap-shot of the mental health of the elders in Madeira.info:eu-repo/semantics/publishedVersio