Redefining Aging in HIV Infection Using Phenotypes

Purpose of review: This article critically reviews the utility of “phenotypes” as behavioral descriptors in aging/HIV research that inform biological underpinnings and treatment development. We adopt a phenotypic redefinition of aging conceptualized within a broader context of HIV infection and of aging. Phenotypes are defined as dimensions of behavior, closely related to fundamental mechanisms, and, thus, may be more informative than chronological age. Primary emphasis in this review is given to comorbid aging and cognitive aging, though other phenotypes (i.e., disability, frailty, accelerated aging, successful aging) are also discussed in relation to comorbid aging and cognitive aging. Recent findings: The main findings that emerged from this review are as follows: (1) the phenotypes, comorbid aging and cognitive aging, are distinct from each other, yet overlapping; (2) associative relationships are the rule in HIV for comorbid and cognitive aging phenotypes; and (3) HIV behavioral interventions for both comorbid aging and cognitive aging have been limited. Summary: Three paths for research progress are identified for phenotype-defined aging/HIV research (i.e., clinical and behavioral specification, biological mechanisms, intervention targets), and some important research questions are suggested within each of these research paths

Racial differences in neurocognitive outcomes post-stroke: The impact of healthcare variables

AbstractObjectives:The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke.Methods:One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age:M=56.4;SD=12.6; education:M=13.7;SD=2.5; 50% male; years post-stroke: 1–18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale.Results:An independent samplesttest indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score:M=37.63;SD=11.67) than Whites (Fluid T-score:M=42.59,SD=11.54;p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p&lt;.001 andp=.02, respectively) and significantly mediated racial differences on neurocognitive impairment.Conclusions:We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017,23, 640–652)</jats:p

Demographically-adjusted norms for the paced auditory serial addition test and letter number sequencing test in Spanish-speaking adults: Results from the neuropsychological norms for the U.S.-Mexico border region in Spanish (NP-NUMBRS) Project

ObjectiveThe Paced Auditory Serial Addition Test (PASAT) and Wechsler Adult Intelligence Scale Letter Number Sequencing subtest (LNS) are two commonly used measures of working memory. Demographic variables (age, education, ethnicity, etc.) can impact performance on these measures, underscoring the need for demographically adjusted norms. We aimed to develop normative data for the PASAT and LNS for Spanish-speaking adults living in the U.S.-Mexico border region as part of a larger normative effort.MethodParticipants were native Spanish-speakers from the Neuropsychological Norms for the U.S. Mexico Border Region in Spanish (NP-NUMBRS) project. Two hundred and forty-nine participants completed the PASAT and 202 participants completed LNS. Ages ranged from 19 to 60 and education from 0 to 20 years.ResultsOlder age was associated with lower scores on LNS (p &lt; .01) but not PASAT. Lower education was associated with lower scores on both tests (ps &lt; .001). Women obtained lower raw scores than men on PASAT (ps &lt; .003), and there were no significant main effects of gender on LNS raw scores. Raw-to-scaled score conversions were calculated, and fractional polynomial equations were developed to calculate demographically-adjusted T-scores accounting for age, education, and gender. Published norms for English-speaking non-Hispanic Whites substantially overestimated rates of impairment (defined as T-score &lt; 40) on both the PASAT and LNS.ConclusionsThe use of the population-specific normative data may improve detection of working memory dysfunction in U.S. Spanish-speaking adults and contribute to improved diagnostic accuracy and treatment planning in this population. Whether the norms generalize to U.S. Spanish-speakers from other countries remains to be determined

Panorama do Gerenciamento da Saúde por Idosos Residentes no Brasil: Impacto das Doenças Crônicas Não Transmissíveis no Gerenciamento da Saúde/Overview of Health Management by Elderly Residents in Brazil: Impact of Chronic Non-Communicable Diseases on Health Management

Introdução: As Doenças Crônicas Não Transmissíveis (DCNT) se encontram em crescente aumento na população idosa, sendo certo que a prevenção de seus fatores de risco é fundamental para evitar sua evolução. O gerenciamento da saúde é uma ocupação focada na capacidade do sujeito desenvolver, gerenciar e manter rotinas para promoção de saúde, contribuindo para prevenção, monitoramento e controle das DCNT. Objetivo: Identificar o panorama nacional do gerenciamento da saúde por pessoas idosas e compreender como realizam esta ocupação, comparando o grupo com e sem DCNT. Método: Estudo transversal, descritivo, exploratório e com abordagem quantitativa. Os dados foram coletados a partir da aplicação de um questionário. Para observar as possíveis associações entre as variáveis, foi utilizado o teste qui-quadrado. Resultados: A amostra foi composta por 222 idosos. As DCNT mais recorrentes foram: hipertensão, diabetes e doenças reumáticas. A maior parte da população estudada indicou que acompanhava sua saúde por meio da ida regular ao médico e da realização de exames periódicos. Os dispositivos mais utilizados para o gerenciamento da saúde foram o aferidor de pressão arterial e o aparelho celular. A maior parte das pessoas indicou acreditar que a prática do gerenciamento da saúde leva a um envelhecimento saudável e gera um aumento na qualidade de vida. Outrossim, 36,9% da amostra indicou possuir alguma dificuldade para realizar o gerenciamento da saúde. Conclusão: Foi possível delinear um panorama sobre como a população idosa gerencia sua saúde e observar as diferenças na realização desta ocupação pela população com e sem DCNT.Palavras-chave: Saúde do Idoso. Doenças não transmissíveis. Terapia Ocupacional. Abstract Introduction: Chronic Non-Communicable Diseases (NCDs) are increasing in the elderly population, and it is certain that the prevention of their risk factors is essential to prevent their evolution. Health management is an occupation focused on the subject's ability to develop, manage and maintain health promotion routines, contributing to the prevention, monitoring and control of NCDs. Objective: To identify the national panorama of health management by the elderly and understand how people perform this occupation, comparing the group with and without NCD. Method: Cross-sectional, descriptive, exploratory study with a quantitative approach. Data were collected from the application of a questionnaire. To observe possible associations between variables, the chi-square test was used. Results: The sample consisted of 222 elderly people. The most recurrent NCDs were: hypertension, diabetes and rheumatic diseases. Most of the population studied indicated that they monitored their health through regular visits to the doctor and periodic exams. The most used devices for health management were the blood pressure gauge and the cell phone. Most people indicated that they believe that the practice of health management leads to healthy aging and generates an increase in quality of life. Furthermore, 36.9% of the sample indicated having some difficulty in performing health management. Conclusions: It was possible to outline an overview of how the elderly population manages their health and observe the differences in the performance of this occupation by the population with and without NCD.Keywords: Health of the Elderly. Noncommunicable Diseases. Occupational Therapy. ResumenIntroducción: Las Enfermedades Crónicas No Transmisibles (ENT) están aumentando en la población anciana, y es cierto que la prevención de sus factores de riesgo es fundamental para prevenir su evolución. La gestión de la salud es una ocupación centrada en la capacidad del sujeto para desarrollar, gestionar y mantener rutinas de promoción de la salud, contribuyendo a la prevención, seguimiento y control de las ENT. Objetivo: Identificar el panorama nacional de la gestión en salud de los adultos mayores y comprender cómo las personas desempeñan esta ocupación, comparando el grupo con y sin ENT. Metodo: Estudio transversal, descriptivo, exploratorio con abordaje cuantitativo. Los datos se obtuvieron mediante la aplicación de un cuestionario. Para observar posibles asociaciones entre variables se utilizó la prueba de chi-cuadrado. Resultados: La muestra estuvo conformada por 222 ancianos. Las ENT más frecuentes fueron: hipertensión, diabetes y enfermedades reumáticas. La mayoría de la población indicó que monitoreaba su salud a través de visitas al médico y exámenes periódicos. Los dispositivos más utilizados fueron el medidor de presión arterial y el teléfono celular. La mayoría de las personas indicó que la práctica de la gestión de la salud conduce a un envejecimiento saludable y una mejor calidad de vida. Además, 36,9% de la muestra indicó tener alguna dificultad para realizar dicha actividad. Conclusiones: Fue posible esbozar un panorama de cómo la población anciana maneja su salud y observar las diferencias en el desempeño de esta ocupación por parte de la población con y sin ENT.Palabras clave: Salud del Anciano, Enfermedades no Transmisibles, Terapia Ocupacional

A inclusão digital de pessoas idosas em momento de pandemia: relato de experiência de um projeto de extensão

Objetivo: apresentar o desenvolvimento de um projeto de inclusão digital para idosos realizado em um ambiente virtual de aprendizagem. Métodos: Relato de experiência sobre o desenvolvimento de um projeto remoto de inclusão digital para idosos ofertado em Curitiba e Rio de Janeiro. Os participantes foram convidados por meio de grupos no WhatsApp® e divulgação nas redes sociais. Os critérios para participação foram: ter 60 anos ou mais, possuir Smartphone com acesso à internet, capacidade para baixar o aplicativo Google Meet® e habilidade para enviar mensagens pelo WhatsApp®. Foram realizadas quatro oficinas para o uso de Smartphones, entre abril de 2020 e janeiro de 2021, duas em Curitiba e duas no Rio de Janeiro. Os encontros foram conduzidos por 19 estudantes do curso de Terapia Ocupacional. Resultado: Participaram das oficinas 47 idosos, com idades entre 61 e 85 anos, a maioria do sexo feminino. Na análise dos relatos, as barreiras indicadas pelas monitoras que conduziram as oficinas estiveram relacionadas à própria tecnologia, ao ambiente, ao processo de ensino e aprendizagem e decorrentes de fatores pessoais. Como facilitadores, destacaram-se a confecção do material instrucional em vídeo, a troca da plataforma de ensino, a possibilidade de reagendamento dos encontros e a divisão de tarefas em duplas. Conclusão: Com o contexto da pandemia, o projeto de inclusão digital ocorreu no formato virtual e evidenciou a importância enquanto prática para promover o uso da tecnologia, o aprendizado e desenvolvimento de competências e, principalmente, favorecer a inclusão social dos idosos em momentos adversos

Repertório ocupacional de pessoas idosas em cenário pandêmico: olhares sobre trajetórias em (re)construção: Occupational repertoire of older people in a pandemic scenario: views on trajectories in (re)construction

Introdução: A pandemia do coronavírus impôs interrupções e/ou mudanças no modo de executar diversas ocupações. Muitas delas, fazem parte do cotidiano das pessoas idosas, e que podem repercutir na saúde e no bem-estar. Objetivo: Compreender as vivências das pessoas idosas na pandemia do coronavírus e suas repercussões no repertório ocupacional. Métodos: Trata-se de um estudo transversal descritivo, de abordagem qualitativa. Participaram da pesquisa 148 pessoas idosas, entrevistadas por chamada de vídeo. Desta forma, discorreram livremente sobre as vivências cotidianas na pandemia, seus significados e suas repercussões no repertório ocupacional. Os dados foram tratados pela técnica de análise de conteúdo. Resultados: Duas categorias temáticas representam as vivências das pessoas idosas: negativas e positivas. Nas vivências negativas, as alterações emocionais promoveram restrição à participação social ou até mesmo o desengajamento ocupacional. Por outro lado, a categoria das vivências positivas, mostrou pessoas idosas que utilizaram o cenário pandêmico para melhorar o autocuidado, se engajar em novos projetos de vida ou resgatar aqueles que estavam esquecidos, e reconhecer a importância da solidariedade e empatia diante das adversidades do adoecimento. Conclusão: As vivências foram ambivalentes. Os participantes declararam como a pandemia despertou afetos negativos que culminaram em interrupções de atividades rotineiras e significativas. No entanto, muitos demonstraram a capacidade de superar as adversidades, refletir sobre os aspectos positivos e se adaptar para se manter engajados em ocupações. Palavras-Chave: Idoso. Coronavírus. Participação Social. Terapia Ocupacional. Abstract Introduction: The coronavirus pandemic has imposed interruptions and/or changes in the way of performing various occupations that are part of the everyday life of older people and that can have repercussions on their health and well-being. Objective: To understand the experiences of the elderly in the coronavirus pandemic and its repercussions on the occupational repertoire. Methods: This is a cross-sectional descriptive study with a qualitative approach. A total of 148 older people participated in the research and were interviewed by video call. They were asked to talk freely about their daily experiences in the pandemic period, their meanings, and their repercussions on their occupational repertoire. The data were analyzed by the content analysis technique. Results: Two thematic categories represent the experiences of older people: negative and positive. In the negative experiences, the emotional changes promoted restricted social participation or even occupational disengagement. On the other hand, the category of positive experiences showed older people who used the pandemic scenario to improve self-care, engage in new life projects or rescue those that were forgotten, and recognize the importance of solidarity and empathy in the face of the adversities of illness. Conclusion: The experiences were ambivalent. The participants stated how the pandemic awakened negative affections that culminated in interruptions of routine and meaningful activities, however, many demonstrated the ability to overcome adversity, reflect on the positive aspects and adapt to stay engaged in occupations. Keywords: Aged. Coronavirus. Social Participation. Occupational therapy. Resumen Introducción: La pandemia de coronavirus ha impuesto interrupciones y/o cambios en la forma de realizar diversas ocupaciones que forman parte de la vida cotidiana de las personas mayores y que pueden repercutir en la salud y el bienestar. Objetivo: Conocer las experiencias de las personas mayores en la pandemia de coronavirus y sus repercusiones en el repertorio ocupacional. Métodos: Se trata de un estudio descriptivo transversal con un enfoque cualitativo. Un total de 148 personas mayores participaron en la encuesta y fueron entrevistadas por videollamada. Se les invitó a hablar libremente sobre sus experiencias cotidianas en la pandemia, sus significados y sus repercusiones en su repertorio ocupacional. Los datos se trataron mediante la técnica de análisis de contenido. Resultados: Dos categorías temáticas representan las experiencias de las personas mayores: negativas y positivas. En las experiencias negativas, las alteraciones emocionales promovían la restricción a la participación social o incluso la desvinculación ocupacional. Por otro lado, la categoría de experiencias positivas mostró a personas mayores que utilizaron el escenario pandémico para mejorar el autocuidado, emprender nuevos proyectos de vida o rescatar a los que estaban olvidados y reconocer la importancia de la solidaridad y la empatía ante las adversidades de la enfermedad. Conclusión: Las experiencias fueron ambivalentes. Los participantes declararon que la pandemia provocó un afecto negativo que culminó en la interrupción de las actividades rutinarias y significativas; sin embargo, muchos demostraron la capacidad de superar la adversidad, reflexionar sobre los aspectos positivos y adaptarse para seguir participando en sus ocupaciones. Palabras clave: Anciano. Coronavirus. Participación Social. Terapia ocupacional

Physical exercise is associated with less neurocognitive impairment among HIV-infected adults

Abstract Neurocognitive impairment (NCI) remains prevalent in HIV infection. Randomized trials have shown that physical exercise improves NCI in non-HIV-infected adults, but data on HIV-infected populations are limited. Communitydwelling HIV-infected participants (n=335) completed a comprehensive neurocognitive battery that was utilized to define both global and domain-specific NCI. Participants were divided into &quot;exercise&quot; (n=83) and &quot;no exercise&quot; (n=252) groups based on whether they self-reported engaging in any activity that increased heart rate in the last 72 h or not. We also measured and evaluated a series of potential confounding factors, including demographics, HIV disease characteristics, substance use and psychiatric comorbidities, and physical functioning. Lower rates of global NCI were observed among the exercise group (15.7 %) as compared to those in the no exercise group (31.0 %; p&lt;0.01). A multivariable logistic regression controlling for potential confounds (i.e., education, AIDS status, current CD4+ lymphocyte count, self-reported physical function, current depression) showed that being in the exercise group remained significantly associated with lower global NCI (odds ratio=2.63, p&lt;0.05). Similar models of domain-specific NCI showed that exercise was associated with reduced impairment in working memory (p&lt;0.05) and speed of information processing (p&lt;0.05). The present findings suggest that HIVinfected adults who exercise are approximately half as likely to show NCI as compared to those who do not. Future longitudinal studies might be best suited to address causality, and intervention trials in HIV-infected individuals will determine whether exercise can prevent or ameliorate NCI in this population

Adaptação transcultural do Mobile Proficiency Questionnaire (Questionário de Proficiência em Dispositivos Móveis) e validade de conteúdo para o português brasileiro

Resumo Objetivo Apresentar o processo de adaptação transcultural do Mobile Device Proficiency Questionnaire na população idosa brasileira e sua validade de conteúdo. Método Trata-se de um estudo de validação. Foram realizadas a tradução, retrotradução, análise do comitê de especialistas e pré-teste com 32 pessoas idosas para avaliar a equivalência semântica e cultural. Resultados A versão brasileira do instrumento manteve as categorias da versão original, avaliando de tarefas básicas a avançadas, divididas em oito subescalas avaliativas: funções básicas, comunicação, armazenamento de dados e arquivos, internet, calendário, entretenimento, privacidade e soluções de problemas e gerenciamento de software. Nesses domínios são investigadas a facilidade de uso e a experiência com as funções do dispositivo móvel. Conclusão A adaptação transcultural mostrou que o instrumento avaliativo é uma ferramenta útil e com alto potencial para a avaliação da proficiência de pessoas idosas no uso de dispositivos móveis. O instrumento permite estabelecer um panorama das competências digitais na população idosa, além de favorecer no processo de programação dos serviços de inclusão digital

Self-Knowledge and Self-Referential Processing in Memory Disorders: Implications for Neuropsychological Rehabilitation

Damage to the brain can affect the core of the individual, i.e. the self. Results from a small number of studies with amnesic individuals indicate that patients' ability to show preserved knowledge of self may vary. The present study explored self-knowledge in patients with memory impairment as a result of confabulation, mild cognitive impairment, Alzheimer's disease and acquired brain damage. We found that different memory disorders differentially affected patients' self-knowledge. At least some patients showed a preserved sense of self, and were able to acquire information about another person that they had met postmorbidly. Frontal function and stability of cognitive impairments over time appear to be two variables important in determining whether patients can have a consistent and updated sense of self. We also explored the extent to which self-referential and other-referential processing might enhance memory in individuals with memory-impairment. The self-reference effect (SRE) and other-reference effect (ORE) have been consistently found in normal adults. Results indicated that patients showed a normal SRE and ORE. The SRE and ORE appeared to be at least partly dependent on degree of knowledge of the person being referenced, and were also related to general memory and frontal function. Only the SRE, however, was also related to patients' ability to improve memory as a result of emotional processing. These findings may have important implications for caregivers and healthcare professionals working with memory-impaired patients, and may pave the way to novel memory rehabilitation methods