Aplicação de instrumentos breves de rastreio de avaliação geriátrica na atenção primária: Application of brief geriatric assessment screening instruments in primary care

Objetivo: Avaliar a capacidade intrínseca e presença de síndromes geriátricas, para sugerir melhor estratégia de abordagem da pessoa idosa frágil na atenção primária. Método: Estudo observacional, transversal e analítico, em uma amostra por conveniência de pessoas idosas atendidas no Serviço de Geriatria do Hospital Santa Casa de Misericórdia de Vitória. A aplicação e avaliação dos instrumentos breves (fenótipos de fragilidade, sarcopenia, cognição e nutrição) foi realizada por pesquisadores previamente capacitados, no período precedente às consultas desses pacientes no ambulatório de geriatria. Os pesquisadores cronometraram o tempo de execução dos instrumentos. Houve também a colaboração, quando necessário, dos familiares ou cuidadores. O projeto de pesquisa foi aprovado no Comitê de Ética e Pesquisa com parecer consubstanciado de número 4.128.709.  Resultado: Foram analisados 62 pacientes durante a pré-consulta que apresentavam um índice de massa corporal de 26±4 Kg/m2. Entre os pacientes estudados, 32,3% (n = 20) foram considerados frágeis, 35,5% (n = 22) apresentaram sarcopenia, 69,4% (n = 43) com declínio cognitivo e 41,9% (n = 26) com risco de desnutrição. O tempo médio para aplicar os quatro questionários foi de 6,63±060 (4-7) minutos. Conclusão: O emprego de instrumentos de rastreamento rápido se mostra com importância na avaliação geriátrica abrangente que pode ser empregada por profissionais da atenção primária

Hipertensão arterial em idosos acima de 80 anos: um desafio terapêutico / Hypertension in the elderly over 80 years: a therapeutic challenge

OBJETIVO: Avaliar a frequência dos fenótipos de hipertensos tratados com anti-hipertensivos em pacientes com 80 anos ou mais de idade em acompanhamento regular em atendimento ambulatorial.MÉTODOS: Estudo transversal, em amostra de pacientes com idade superior a 80 anos, portadores de Hipertensão Arterial (HA) em acompanhamento ambulatorial regular no programa de geriatria. Foi orientado ao familiar-cuidador realizar a Monitoração Residencial da Pressão Arterial (MRPA) com aparelho digital e manguito adequado em antebraço. Os fenótipos de meta terapêutica hipertensão arterial sustentada não controlada, hipertensão arterial controlada em consultório e domicílio, hipertensão do avental branco não controlada e hipertensão mascarada não controlada foram avaliados.RESULTADOS: Foram analisados cinquenta e oito pacientes com 85±3 (80-92) anos de idade, destes 67,2 % (n = 39) pertenciam ao sexo feminino; 19% (n=11) dos pacientes apresentaram hipertensão arterial sustentada não controlada; 13,8% (n=8) hipertensão do avental branco não controlada e 24,1% (n=14) apresentaram hipertensão arterial mascarada não controlada. Vinte e cinco pacientes (43,1%) apresentavam-se com pressão arterial controlada na consulta ambulatorial e no domicílio.CONCLUSÃO: Pessoas com 80 anos ou mais de idade apresentaram uma alta frequência de hipertensão do avental branco não controlada e hipertensão mascarada não controlada, e a MRPA apresentou-se como um método importante na otimização terapêutica anti-hipertensiva

Prevalence of orthostatic hypotension in elderly patients from ambulatory and institutionalized

OBJECTIVES: To study the relationship of orthostatic hypotension in outpatients and institutionalized ones. METHODS: Cross-sectional study of elderly aged 65 or older, who were attended in a geriatric ambulatory and residents in long-stay institutions (ILPI). RESULTS: They were evaluated 135 individuals, 38 of ILPI with 78±9 years of age (50% men) and 97 geriatric outpatient clinic with 78±7 years (78.4% women). The frequency of hypertension was 55.3% in ILPI and 78.4% in the community (p=0.01). Orthostatic hypotension was observed in 7.9% in ILPI and 3.1% in elderly in the community. The drugs associated with orthostatic hypotension were: antidepressants - odds ratio (OR=10.18 (95%CI 1.30-79.52), p=0.02 - and anticonvulsants - OR=251 (95%CI 1.55-67.44), p=0.01, 01. The presence of falls in the last six months was 26.3% in the ILPI and 27.8% of outpatients. No association between falls and orthostatic hypotension, OR=1.34 (95%CI 0.23-7.66). CONCLUSION: The orthostatic hypotension was more frequent in elderly in institutions; it was associated with antidepressants and anticonvulsants, and was not associated with falls in this population.</p

Disability after stroke: a systematic review

Introduction: Stroke is the most common cause of disability in Western countries, yet there is no consensus in the literature on how to measure and describe disability from stroke. Objective: To conduct a systematic literature review on disability in stroke survivors. Method: Observational studies published in the PubMed, LILACS and SciELO online databases were selected, to evaluate disability in adults and in the elderly after stroke in the period 20022012. The Downs and Black checklist for non-randomized studies was used to assess the quality of the articles. Results: 212 articles were found from which 16 were selected to compose the study. The mean age of participants was 67 years, and disability affected 24% to 49% of the population evaluated. With regard to measurement instruments, 31% of the studies analyzed presented results of disability by means of the modified Rankin Scale; 19% by means of the World Health Organizations International Classification of Functioning, Disability and Health; 19% by means of Katz Index of Independence in Activities of Daily Living; 12.5% by means of the London Handicap Scale; 12.5 % by means of the Barthel Index; and 6.25% by means of the Functional Independence Measure. Conclusion: Literature is not uniform as regards means of measuring disability after stroke, but considering the preference of articles in assessing physical performance in activities of daily living, it can be concluded that a quarter to half of the population that survives stroke has some degree of disability

Disability after stroke: a systematic review

Introduction Stroke is the most common cause of disability in Western countries, yet there is no consensus in the literature on how to measure and describe disability from stroke. Objective To conduct a systematic literature review on disability in stroke survivors. Method Observational studies published in the PubMed, LILACS and SciELO online databases were selected, to evaluate disability in adults and in the elderly after stroke in the period 2002–2012. The Downs and Black checklist for non-randomized studies was used to assess the quality of the articles. Results 212 articles were found from which 16 were selected to compose the study. The mean age of participants was 67 years, and disability affected 24% to 49% of the population evaluated. With regard to measurement instruments, 31% of the studies analyzed presented results of disability by means of the modified Rankin Scale; 19% by means of the World Health Organization’s International Classification of Functioning, Disability and Health; 19% by means of Katz’ Index of Independence in Activities of Daily Living; 12.5% by means of the London Handicap Scale; 12.5 % by means of the Barthel Index; and 6.25% by means of the Functional Independence Measure. Conclusion Literature is not uniform as regards means of measuring disability after stroke, but considering the preference of articles in assessing physical performance in activities of daily living, it can be concluded that a quarter to half of the population that survives stroke has some degree of disability

Functionality and 25-hydroxyvitamin D levels in institutionalized older adults

OBJECTIVES: To evaluate the frequency of hypovitaminosis D among older adults and its association with the level of functionality. METHODS: This cross-sectional observational study of older adults residing in a non-profit long-term care facility assessed functionality with the Katz Index of Independence in Activities of Daily Living. Vitamin D levels were classified as: deficient (&lt; 20 ng/mL), insufficient (21-29 ng/mL), or normal (&ge; 30 ng/mL). We used the chi-square test and Student's t-test to compare dichotomous and continuous variables, respectively. Analysis of variance with Tukey's post hoc test was used to assess differences between groups. RESULTS: The sample consisted of 63 individuals whose mean age was 81 (61-113) years: 36 (55.4%) women and 27 (44.6%) men. The mean vitamin D level was 18.6 ng/mL, being &lt; 30 ng/mL in 84.1%. The level was normal in 10 (15.9%), insufficient in 17 (27%), and deficient in 36 (57.1%). Vitamin D deficiency was present in 76.5% of those with total functional dependence (Katz = 5-6). CONCLUSIONS: We observed a high frequency of hypovitaminosis D, especially vitamin D deficiency, which was very common among those with significant functional dependence.</p

Human immunodeficiency virus infection and its association with sarcopenia

AbstractPresarcopenia and sarcopenia were evaluated in HIV-infected individuals and in healthy elderly controls according to the consensus definitions of the European Working Group on Sarcopenia in Older People. Bioelectrical impedance, a hydraulic hand dynamometer, and gait speed were used to evaluate muscle mass, muscle strength, and physical performance, respectively. Adjusted and unadjusted binary logistic regression predicted the risk of sarcopenia. Predictor contribution was assessed by the Wald test. Significance was established at p≤0.05. The HIV-infected group consisted of 33 patients on treatment (42.4% women; mean age 59±7 years; mean BMI 25±6kg/m2; viral load undetectable in 30 cases). The HIV-uninfected group consisted of 60 individuals (71.7% women; mean age 70±7 years; mean BMI 28±6kg/m2). Of the controls, 4 (6.7%) individuals had presarcopenia and 4 (6.7%) sarcopenia compared to 4 (12.1%) and 8 (24.2%), respectively, in the HIV-infected group. The HIV-infected patients had a 4.95 higher risk (95% CI: 1.34–18.23) for sarcopenia compared to the controls. It should be pointed out that the control group was on average 10 years older. This risk increased further (RR=5.20; 95% CI: 1.40–19.20) after adjusting for age and BMI. HIV-infected patients were shown to be at a greater risk of sarcopenia, an indicator of frailty, even following adjustment for age and BMI

Avaliação de fatores associados à mortalidade em pacientes com 80 anos ou mais de idade internados em unidade de terapia intensiva geral / Evaluation of factors associated with mortality in patients aged 80 years or older hospitalized in a general intensive care unit

Estudos demonstram que pacientes com 80 anos ou mais de idade apresentam uma alta frequência de mortalidade durante internação em unidades de terapia intensiva. O objetivo foi avaliar pacientes com idade superior a 80 anos no ambiente de Unidade de Terapia Intensiva geral (UTI), analisando escores prognósticos APACHE II e SOFA e os dados clínicos-laboratoriais durante a internação na UTI e associá-los com mortalidade. Coorte histórica analítica e observacional, em uma amostra por conveniência de um hospital-escola. O estudo contou com um número de 173 pacientes, sendo destes 65,3% do sexo feminino com 86±4 (80-99) anos de idade. Durante a internação, observamos um total de 87 óbitos totais (50,3%), sendo 70,11% no período de permanência na UTI. O estudo evidenciou que os pacientes com 80 anos de idade ou mais, apresentam uma alta mortalidade em UTI geral, e os escores de prognóstico APACHE II e SOFA não apresentaram associação com mortalidade.