Contribuição da reabilitação na saúde e na qualidade de vida do idoso no Brasil: reflexões para a assistência multidisciplinar

Resumo: O progressivo crescimento da população no Brasil tem causado, no âmbito sócio-econômico principalmente, preocupação aos sistemas de saúde, os quais ainda não estão preparados para atender as diversificadas demandas deste seguimento etário. Cuidar do idoso como uma pessoa integral e não apenas como um organismo biológico, protegendo-o e integrando-o dentro do contexto psicossocial do momento, deve ser o maior objetivo dos profissionais da saúde. Devemos estar tão preparados para lidar com especificidades do processo de envelhecimento quanto para tratar seus distúrbios. Há profunda inter-relação entre a qualidade de vida percebida e a saúde física e mental. Esta reflexão analisa a importância da reabilitação preventiva na promoção da qualidade de vida do idoso e de seus familiares conduzindo à conseqüente prevenção e postergação da manifestação de sintomas e de doenças crônicas. Palavras-chave: Envelhecimento. Reabilitação. Ensino. Abstract: The progressive populational growth in Brazil has caused, in the social-demographical scope mainly, much worry to the health systems, wich are not prepared to attend the different demands of this age segment. Caring for the elderly people as an integral person and not only as a biological organism, protecting them and integrating them into the psychosocial context of the moment should be the main objective of the health field professionals. We must be as well prepared to deal with the specificities of the aging process as to treat their disturbances. There is a deep inter-relation between the perceived quality of life and the mental and physical health. This reflexion analyzes the importance of the preventive rehabilitation in the elderly’s and their family’s life quality promotion, leading to the consequent prevention and postponement of the symptoms and chronical diceases manifestation. Keywords: Elderly. Rehabilitation. Teaching

ATIVIDADE FÍSICA, MANUTENÇÃO DA CAPACIDADE FUNCIONAL E DA AUTONOMIA EM IDOSOS: REVISÃO DE LITERATURA E INTERFACES DO CUIDADO

A capacidade funcional dos sistemas do organismo diminui gradualmente desde a juventude favorecendo a ocorrência de doenças crônicas, quedas e diminuição da capacidade funcional. O sedentarismo contribui significativamente na aceleração do ritmo do declínio, de modo que a eficácia da prática de atividade física na prevenção e controle dessas condições vem sendo progressivamente estudada. O objetivo deste estudo foi conhecer a produção do conhecimento, na forma de artigo, voltada para a manutenção da capacidade funcional e da autonomia em idosos por meio da atividade física, discutindo sobre as abordagens propostas para essa finalidade. Através de estudo exploratório, foi realizada uma revisão no período entre 2004 e 2008, das bases de dados Medline, Pubmed, Lilacs, Cinahal e Scielo, de onde foram selecionados artigos que verificaram as varia  das abordagens propostas em programas de atividade física. Os artigos demonstraram, em sua maioria, os benefícios da atividade física regular e adaptada aos diversos momentos e condições do idoso, na manutenção da capacidade funcional e da autonomia em idosos, confirmando inclusive a importância do incentivo à prática de atividade física em qualquer idade e principalmente ao idoso, dentro de suas amplas possibilidades e contextos.   PHYSICAL ACTIVITY, MAINTENANCE OF FUNCTIONAL CAPACITY AND AUTONOMY: LITERATURE REVIEW AND INTERFACES  OF CARE abstract The functional capacity of the body systems gradually decreases since the youth, favoring the occurrence of chronic diseases, falls and decreased functional capacity. The sedentary lifestyle contributes significantly in accelerating the pace of decline, so that the effectiveness of physical activity in the prevention and control of these conditions has been increasingly studied. The aim of this study was to know about the production of knowledge, in the form of articles, devoted to the maintenance of functional capacity and autonomy in older people through physical activity, discussing on the approaches proposed for this purpose. Through a exploratory study, a review was conducted in the period between 2004 and 2008, on the databases Medline, Pubmed, Lilacs, and Scielo Cinahal, from where were selected articles that were found in the various approaches proposed programs of physical activity. Most of the articles demonstrated the benefits of regular physical activity and adapted to different times and conditions of the elderly, the maintenance of functional capa  city and autonomy in the elderly, inclusively confirming the impor  tance of fostering physical activity at any age and especially for the elderly, within their broad scope and contexts. 

Effects of Topically Administered Neuroprotective Drugs in Early Stages of Diabetic Retinopathy:Results of the EUROCONDOR Clinical Trial

The primary objective of this study was to assess whether the topical administration of two neuroprotective drugs (brimonidine and somatostatin) could prevent or arrest retinal neurodysfunction in patients with type 2 diabetes. For this purpose, adults aged between 45 and 75 years with a diabetes duration ≥5 years and an Early Treatment of Diabetic Retinopathy Study (ETDRS) level of ≤35 were randomly assigned to one of three arms: placebo, somatostatin, or brimonidine. The primary outcome was the change in implicit time (IT) assessed by multifocal electroretinography between baseline and at the end of follow-up (96 weeks). There were 449 eligible patients allocated to brimonidine (n = 152), somatostatin (n = 145), or placebo (n = 152). When the primary end point was evaluated in the whole population, we did not find any neuroprotective effect of brimonidine or somatostatin. However, in the subset of patients (34.7%) with preexisting retinal neurodysfunction, IT worsened in the placebo group (P < 0.001) but remained unchanged in the brimonidine and somatostatin groups. In conclusion, the topical administration of the selected neuroprotective agents appears useful in preventing the worsening of preexisting retinal neurodysfunction. This finding points to screening retinal neurodysfunction as a critical issue to identify a subset of patients in whom neuroprotective treatment might be of benefit

Torpedo maculopathy: a morphofunctional evaluation.

To describe the optical coherence tomography (OCT), the standard short-wavelength fundus autofluorescence (SW-FAF) and near-infrared fundus autofluorescence (NIR-FAF), and the microperimetric findings in a child with a unique unilateral lesion of the temporal macula previously called torpedo maculopathy. A 4-year-old female with torpedo maculopathy was evaluated with spectral-domain OCT (SD-OCT), standard SW-FAF (excitation 488 nm, emission >500 nm) and NIR-FAF (excitation 787 nm, emission >800 nm). Microperimetry was performed to assess retinal sensitivity changes correlated to the macular lesion. SD-OCT showed an abnormally thin retinal pigment epithelium signal and an increased signal transmission in the choroid corresponding to the torpedo lesion with no neuroretinal changes. SW-FAF resulted in normal fluorescence of the lesion except for a small hyperfluorescent area at the tail level. NIR-FAF showed hypofluorescence corresponding to the lesion. Macular microperimetry showed reduced retinal sensitivity along the pigmented margins of the lesion with normal values over the lesion. The patient was re-evaluated 12 months later and no change was documented with all diagnostic techniques. This case supports a congenital defect of retinal pigment epithelium. The absence of both functional changes at lesion level and neuroretinal changes at OCT may depend on the very early detection of this lesion

Subthreshold transpupillary thermotherapy for subfoveal occult choroidal neovascularization secondary to age-related macular degeneration

PURPOSE: To describe the long term outcome of patients with subfoveal, occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with subthreshold transpupillary thermotherapy.METHODS: 82 eyes of 82 consecutive patients with subfoveal occult CNV secondary to AMD were treated with subthreshold transpupillary thermotherapy. Best corrected visual acuity, fundus photography, fluorescein and indocyanine green angiography were performed.RESULTS: All patients have been followed for at least 24 months. At the final follow-up visit, 75.6% of patients had stable or improved visual acuity and 24.4% had worsened visual acuity. No overtreatment side effects were found.CONCLUSION: Subthreshold transpupillary thermotherapy seems effective in stabilizing visual acuity in patients affected by occult, subfoveal CNV even on a long-term basis

Macular automatic fundus perimetry threshold versus standard perimetry threshold

Macular automatic fundus perimetry threshold versus standard perimetry threshold. Midena E, Radin PP, Convento E, Cavarzeran F. SourceDepartment of Ophthalmology, University of Padova, Padova; G.B. Bietti Eye Foundation, IRCCS, Roma, Italy. [email protected] Abstract PURPOSE: To evaluate if retinal sensitivity threshold obtained with an automatic fundus perimeter may be compared with a standard perimeter retinal threshold. METHODS: Automatic full-threshold fundus perimetry (microperimetry) of the macular area (10 degrees grid, 37 stimulated points) was quantified with a new automatic fundus perimeter (MP1 microperimeter) in nine normal subjects (18 eyes). Retinal threshold was also quantified using an identical grid projected with a standard Octopus 101 perimeter. RESULTS: Mean threshold registered by MP1 microperimeter was 19.7+/-0.8 dB (range 16-20 dB; 4.38+/-0.96 asb, range 4-10 asb) versus 33.1+/-1.7 dB (range 27-38 dB; 0.53+/-0.22 asb, range 0.16-2 asb) obtained with Octopus perimeter. Mean SD of intraindividual variation was 0.74 dB in MP1 and 1.51 dB in Octopus. No statistically significant differences were documented between right and left eye with both instruments (p=0.64). No reliable mathematical relationship between retinal thresholds could be obtained with the two perimeters. CONCLUSIONS: Fundus perimetry is a precise, functional fundus-related technique which allows threshold determination at selected retinal points even if fixation is unstable and visual acuity is low. This is beyond the possibility of any static standard perimetry. Normal threshold values obtained with MP1 automatic microperimeter cannot be currently compared with those obtained with standard Octopus perimeter. PMID: 17294384 [PubMed - indexed for MEDLINE

Mesopic Pelli-Robson contrast sensitivity and MP-1 microperimetry in healthy ageing and age-related macular degeneration

<b>Purpose</b>\ud \ud - To determine whether decreasing illumination of the Pelli-Robson contrast sensitivity (CS) chart and MP-1 microperimeter to low mesopic conditions is more sensitive to vision changes occurring with healthy ageing and in early and intermediate age-related macular degeneration (AMD) and whether these mesopic tests can differentiate visual function between healthy older participants with and without AMD risk genotypes.\ud \ud <b>Methods</b>\ud \ud - Retinal sensitivity was measured in 98 healthy participants (19-85 years) and 21 AMD (AREDS Grade 2/3) patients (73.9±6.5 years) using the Pelli-Robson CS chart and MP-1 microperimeter under low mesopic and standard illumination. The effect of ageing and AMD on retinal sensitivity was estimated using regression analysis. Healthy older participants (>50 years; <i>n</i>=24) were genotyped for AMD risk genes <i>CFH</i> and/or <i>ARMS2</i> and retinal sensitivity was compared between genotypes. \ud \ud <b>Results</b>\ud \ud - With healthy ageing, photopic and mesopic Pelli-Robson CS showed a similar decline (-0.004 log CS/year). In AMD, photopic CS showed a similar decline to healthy ageing (-0.004 log CS/year) while mesopic CS was significantly reduced (-0.007 log CS/year). Both standard and low mesopic microperimetry showed a significant decline (-0.51 and -0.73 % contrast/year) with healthy ageing and greater decline (-0.73 and -0.99 % contrast/year) with AMD onset. Pelli-Robson CS and microperimetry sensitivity did not differ between AMD risk genotypes. \ud \ud <b>Conclusions</b>\ud \ud - Mesopic Pelli-Robson CS detects functional deficits before photopic CS in early and intermediate AMD that can be differentiated from normal ageing. This test can be easily administered in clinical practice and may provide a means for early detection of retinal dysfunction