Desenvolvimento do índice de qualidade de vida do idoso - IQVI: base teórico-conceitual, metodologia escolhida e geração de itens relevantes

PURPOSE: To describe the initial steps of the construction process of a quality of life evaluation instrument for the elderlythe theoretic-conceptual framework for the construct, Quality of Life in Old Age; the construction methodology; and the generation of relevant items. METHODS: The first step was to conceptualize and define the construct, determining how much the elderly are able to perform of what they believe to be important in their lives and whether they are satisfied with what was possible to perform. The next step was to select and describe the construction methodology (the Clinical Impact Method) and the phase of generation of relevant items for the research object. The necessary procedures were delineated through a pilot study, which helped to establish all phases of the used methodology. The viability of the construction of the Quality of Life in Old Age evaluation instrument was demonstrated along with the needed adaptations. RESULTS: From 1032 answers by older people, 138 relevant items for the construct were identified by the items generation process. The pilot study demonstrated the suitability of the application of the methodology and established modifications to the preliminary items list, resulting in a new 139-item list. DISCUSSION: Now that the theoretical-conceptual framework of the construct as well as the construction methodology and the items generation are established, the next step will consist of administering the resulting list to a sample of elderly people for item reduction and distribution of items into dimensions.OBJETIVO: Descrever os passos iniciais do processo de construção de um instrumento de avaliação de qualidade de vida de idosos: a base teórico-conceitual do constructo Qualidade de Vida na Velhice, a metodologia escolhida para a construção e a geração dos itens relevantes. MÉTODOS: O primeiro passo foi conceituar e definir o constructo, evidenciando o quanto os idosos realizam do que consideram importante para suas vidas e se estão satisfeitos com o que foi possível concretizar. O segundo, escolher e descrever a metodologia de construção (Método do Impacto Clínico) e a fase de geração de itens relevantes ao objeto de estudo. Através de estudo piloto, foram delineados os procedimentos necessários, estabelecendo-se todas as fases da metodologia. Demonstrou-se a viabilidade de seu emprego na construção de um instrumento de avaliação de qualidade de vida de idosos, com as adaptações necessárias. RESULTADOS: A geração de itens selecionou, de 1032 respostas de idosos, 138 itens relevantes ao constructo. O estudo-piloto mostrou a viabilidade de aplicação da metodologia e estabeleceu modificações na lista preliminar de itens, resultando nova lista (139 itens). DISCUSSÃO: Estabelecida a base teórico-conceitual do constructo e a metodologia de construção, selecionados os itens e realizado o piloto, a etapa seguinte consistirá em submeter a lista a uma amostra de idosos, para redução dos itens e distribuição em dimensões

Development of Elderly Quality of Life Index – Eqoli: Item Reduction and Distribution into Dimensions

OBJECTIVE: To describe item reduction and its distribution into dimensions in the construction process of a quality of life evaluation instrument for the elderly. METHODS: The sampling method was chosen by convenience through quotas, with selection of elderly subjects from four programs to achieve heterogeneity in the "health status", "functional capacity", "gender", and "age" variables. The Clinical Impact Method was used, consisting of the spontaneous and elicited selection by the respondents of relevant items to the construct Quality of Life in Old Age from a previously elaborated item pool. The respondents rated each item’s importance using a 5-point Likert scale. The product of the proportion of elderly selecting the item as relevant (frequency) and the mean importance score they attributed to it (importance) represented the overall impact of that item in their quality of life (impact). The items were ordered according to their impact scores and the top 46 scoring items were grouped in dimensions by three experts. A review of the negative items was performed. RESULTS: One hundred and ninety three people (122 women and 71 men) were interviewed. Experts distributed the 46 items into eight dimensions. Closely related items were grouped and dimensions not reaching the minimum expected number of items received additional items resulting in eight dimensions and 43 items. DISCUSSION: The sample was heterogeneous and similar to what was expected. The dimensions and items demonstrated the multidimensionality of the construct. The Clinical Impact Method was appropriate to construct the instrument, which was named Elderly Quality of Life Index - EQoLI. An accuracy process will be examined in the future

Avaliação e comparação dos fatores intrínsecos dos riscos de quedas em idosos com diferentes estados funcionais

Falls in old people are multifactorials events that represent a large importance to the gerontologists because it appears with large morbidityand mortality in this age. This dissertation has the objective to trace the socio-functional and clinic profile of olders ambulatoriais with differentsgrades of performance and then, compare them, identify the factorsevaluated who have correlation with the risk and frequency of the fall. Forty nine olders were evaluated (with average age of 71.24, SD 5.47) of a screening ambulatory of Geriatric Service of a tertiary Hospital, in relation to their balance and gait (assessed by POMA), muscle strength (30's chair stand), gait velocity (Timed Up and Go), incidence of falls and others risks clinics; the olders were divided in to two groups of risks of falls, thrown thetest POMA: medium and low risk. Results: the group of medium risk related more falls (14 olders) than the low risk (3), proved statistically (qui- square 0,0052). Into the factors of risks evaluated, the presence of depression or antecedents was the most frequent in the medium risk (qui-square 0,0016), but it didn't present difference if the variable was thenumber of falls; the muscle weakness presented statistic correlation in the relation of risk (qui- square 0,0284) and the fall (qui-square 0,0013). These facts suggest that the POMA really evaluates the risk of falls and the treatment of risk factors like depression or antecedents and the muscle weakness can cooperate in the prevention of the occurrence of falls in olders of medium risk.As quedas em idosos são eventos multifatoriais de relevante importância para os gerontólogos, já que são causadoras de grande morbidade e mortalidade nessa faixa etária. O objetivo desta dissertação foi traçar o perfil sócio-funcional e clínico de idosos ambulatoriais em dois diferentes níveis de desempenho e assim compará-los, identificando os fatores avaliados que se correlacionassem com o risco e o relato de queda. Quarenta e nove idosos (média de idade de 71.24 anos, DP 5.47) foram avaliados (pelo teste POMA) num ambulatório de triagem do Serviço de Geriatria de um hospital terciário, em relação ao seu equilíbrio e marcha, força muscular (30 's chair stand), velocidade da marcha (Timed Up and Go), incidência de quedas e outros riscos clínicos. Os idosos foram divididos em dois grupos de risco para quedas através do POMA: médio e baixo risco. O resultado obtido foi: o grupo de médio risco relatou mais quedas (14 idosos) do que o de baixo risco (3), comprovado estatisticamente (qui-quadrado 0,0052). Dentre os fatores de risco avaliados, a presença de depressão ou antecedentes psiquiátricos foi mais freqüente no médio risco (qui-quadrado 0,0016), porém, não apresentou diferença quando a variável era o relato de quedas. A fraqueza muscular apresentou correlação estatística tanto em relação ao risco (qui-quadrado 0,0284) quanto à queda (qui-quadrado 0,0013). Estes dados sugerem que o POMA realmente avalia o risco de quedas e que o tratamento de fatores de risco, como depressão ou antecedentes e a fraqueza muscular, podem contribuir na prevenção da ocorrência de quedas em idosos de médio risco

Quedas em idosos: grupo de risco moderado

PURPOSE: To trace the socio-functional and clinical profiles of elders with moderate levels of movement functionality as determined by the Performance-Oriented Mobility Assessment (POMA Ia), and to compare the groups having high and moderate levels of functionality regarding the frequency of falls and identifiable risk factors. METHODS: The research involved 49 elders (with an average age of 71.24, SD 5.47) who were seeking medical care in the geriatric unit of a tertiary care hospital. Study participants were evaluated regarding their balance and gait (POMA Ia assessment), muscle strength (chair-stand test), gait velocity (timed up and go test), incidence of falls, and other clinical risk factors. RESULTS: The moderate functionality group reported significantly more falls (14) compared with the high functionality group (3). Of the risk factors evaluated, the presence of depression or of a psychiatric record was significantly more frequent in the moderate-functionality group but was not correlated with an increase in falls., Muscle weakness was found significantly more frequently in the moderate-functionality group and was significantly correlated with an increased frequency of falls. CONCLUSIONS: These findings suggest that the POMA Ia assessment can identify individuals with an increased risk of falling, and the treatment of risk factors such as depression or a psychiatric record, and muscle weakness could help prevent the occurrence of falls in elders with moderate functionality as determined by the POMA Ia assessment.OBJETIVO: Traçar o perfil sócio-funcional e clínico de idosos com risco moderado de quedas e compará-lo com idosos de baixo risco, identificando os fatores avaliados que correlacionassem com o risco e o relato de queda. MÉTODOS: O estudo avaliou 49 idosos (com média de idade de 71,24 anos, DP 5,47) que procuraram atendimento num ambulatório de triagem geriátrica de um hospital de nível terciário. Foram avaliados: equilíbrio, marcha (avaliados pelo teste POMA Ia), força muscular (30's chair stand), velocidade da marcha (timed up and go), incidência de quedas e outros riscos clínicos. RESULTADOS: O grupo de risco moderado relatou mais quedas (14 idosos) do que o baixo risco (3), atingindo a significância estatística (chi2 = 0,0052). Dentre os fatores de risco avaliados a presença de depressão ou antecedentes psiquiátricos foi mais freqüente no risco moderado (chi2 = 0,0016), porém, não apresentou diferença quando a variável era o relato prévio de quedas. A presença de fraqueza muscular apresentou associação estatística tanto em relação ao risco (chiÇ2 =0,0284) quanto à queda (chi2 =0,0013). CONCLUSÃO: Estes dados sugerem que o POMA Ia é um instrumento para a identificação de pacientes com risco de quedas e que fatores como depressão ou antecedentes e fraqueza muscular estão associados a ocorrência de quedas em idosos de risco moderado

Tongue forces and handgrip strength in normal individuals: association with swallowing

OBJECTIVES: To describe and correlate tongue force and grip strength measures and to verify the association of these measures with water swallowing in different age groups. METHOD: Tongue force was evaluated using the Iowa Oral Performance Instrument and grip strength using the Hand Grip in 90 normal individuals, who were divided into three groups: young (18-39 years old), adult (40-59 years old) and elderly (above 60 years old) individuals. The time and number of swallows required for the continuous ingestion of 200 ml of water were also measured. RESULTS: A reduction in tongue force and grip strength, as well as an increase in the time required to drink 200 ml of water, were observed with increasing participant age. There was no difference in the number of swallows among the three groups. A correlation was observed between reductions in tongue force and grip strength in the groups of young and elderly individuals. CONCLUSION: There were differences in the measures of tongue force in young, adult and elderly individuals. Greater variations within these differences were observed when repeated movements were performed; in addition, a decrease in strength was associated with an increase in age. The decrease in tongue force among the elderly was offset by the increase in time needed to swallow the liquid. There was an association between the measures of tongue force and grip strength in the different age groups. The results of this study can be applied clinically and may act as a basis for guidelines in healthy or vulnerable elderly populations

Iron deficiency in the elderly

Anemia é comum em idosos e é associada a significante morbidade e mortalidade. Mais de 10% dos indivíduos acima de 65 anos tem anemia. Com uma proporção crescente da população mundial atingindo idade igual ou superior a 65 anos, a prevalência de anemia certamente aumentará no futuro. O diagnóstico precoce é importante para prevenir piora do quadro, diminuir progressão da doença e melhorar a evolução dos pacientes. Os critérios mais utilizados em estudos epidemiológicos para definir anemia em idosos são os da OMS (hemoglobina<12 g/dL para mulheres e hemoglobina <13 g/dL para homens). Aproximadamente um terço dos idosos com anemia tem deficiência de ferro, folato e/ou vitamina B12, um terço tem insuficiência renal e/ou inflamação crônica e o terço remanescente tem anemia inexplicada. A anemia ferropênica é microcítica e hipocrômica e caracteriza-se por baixos níveis de ferritina sérica, capacidade total de ligação de ferro do plasma aumentada, saturação da transferrina diminuída, concentração do receptor solúvel da transferrina elevada e ausência de ferro na medula óssea. É causada geralmente por perda de sangue pelo trato gastrointestinal devido a gastrite, úlceras, câncer de colo ou angiodisplasia. Anormalidades do trato gastrointestinal podem ser identificadas na maioria dos pacientes. Em alguns casos, ingestão ou absorção inadequada de ferro pode contribuir para a anemia. Entretanto, em todos os casos deveria ser exaustivamente investigada e excluída perda de sangue antes de assumir que a deficiência de ferro é devida a outras causas. O tratamento inclui parar o sangramento e repor o ferro.Anemia is a common problem in the elderly and is associated with significant morbidity and mortality. More than 10% of all individuals above the age of 65 have anemia. Because an increasing proportion of the world's population is aged 65 and older, it is inevitable that the prevalence of anemia will increase in the future. Thus, early diagnosis of anemia is important to prevent the condition from worsening, to slow disease progression, and improve outcomes in patients. The WHO definition of anemia (hemoglobin concentration <12 g/dL, in women and <13 g/dL, in men) is most often used in epidemiologic studies of older adults. Among older adults with anemia approximately one-third have evidence of iron, folate, and/or vitamin B12 deficiency, another third have renal insufficiency and/or chronic inflammation, and the remaining third have anemia that is unexplained. Anemia due to iron deficiency (IDA) is microcytic and hypochromic. Low serum ferritin levels, high total iron-binding capacity, low transferrin saturation, high concentrations of soluble transferrin receptor, and absent bone marrow iron stores accompany IDA. Iron deficiency in the elderly usually occurs as a result of chronic gastrointestinal blood loss caused by gastritis, ulcers, colon cancer, or angiodysplasia. Gastrointestinal tract abnormalities can be identified in the majority of patients with IDA. In some cases, inadequate intake or inadequate absorption of iron may contribute to the anemia. However, in all cases blood loss should be investigated and excluded before assuming that iron deficiency is due to other causes. Treatment includes stopping blood loss and replacing iron

Prognostic Factors for Mortality Among Patients Above the 6th Decade Undergoing Non-Cardiac Surgery: (Cares – Clinical Assessment and Research in Elderly Surgical Patients)

PURPOSE: To ascertain perioperative morbimortality and identify prognostic factors for mortality among patients >55 years who undergo non-cardiac surgery. METHODS: A retrospective cohort of 403 patients relating to perioperative morbidity-mortality. Data were collected from a standardized protocol on gender, age, comorbidities, medications used, smoking, alcohol abuse, chronic use of benzodiazepine, nutritional status, presence of anemia, activities of daily living, American Society of Anesthesiology classification, Detsky's modified cardiac risk index - American College of Physicians, renal function evaluation, pulmonary risk according to the Torrington scale, risk of thromboembolic events, presence of malignant disease and complementary examinations. RESULTS: The mean age of the subjects was 70.8 &plusmn; 8.1 years. The "very old" (>80 years) represented 14%. The mortality rate was 8.2%, and the complication rate was 15.8%. Multiple logistic regression showed that a history of coronary heart disease (OR: 3.75; p=0.02) and/or valvular heart disease (OR: 31.79; p=0.006) were predictors of mortality. The American Society of Anesthesiology classification was shown to be the best scale to mark risk (OR: 3.01; p=0.016). Nutritional status was a protective factor, in which serum albumin increases of 1 mg/dl decreased risk by 63%. DISCUSSION: The results indicate that serum albumin, coronary heart disease, valvular heart disease and the American Society of Anesthesiology classification could be prognostic predictors for aged patients in a perioperative setting. In this sample, provided that pulmonary, cardiac and thromboembolic risks were properly controlled, they did not constitute risk factors for mortality. Furthermore, continuous effort to learn more about the preoperative assessment of elderly patients could yield intervention possibilities and minimize morbimortality

Body composition alterarions, energy expenditure and fat oxidation in elderly males suffering from prostate cancer, pre and post orchiectomy

INTRODUCTION: Testosterone is needed for normal male development, muscle strength, bone mineralization, hematopoietic function, and sexual and reproductive functions. The main purpose of androgen deprivation therapy in prostate cancer is to reduce tumor progression, but therapy is often accompanied by significant adverse effects. OBJECTIVE: This study aimed to determine the effects of androgen deprivation therapy on body composition and resting metabolic rate in patients with prostate cancer. PATIENTS AND METHODS: A prospective study was performed to evaluate the body composition of 16 elderly males (aged 63-96; median age 71) with prostate cancer scheduled for orchiectomy, one year before and after surgery. Body composition was measured by DEXA, and energy expenditure, fat and carbohydrate oxidation were measured by indirect calorimetry. RESULTS: Body weight (p=0.01), lean mass (p=0.004), and lipid oxidation (p=0.001) decreased significantly. Carbohydrate oxidation (p=0.02), FSH (p=0.0001) and LH (p=0.0001) levels increased significantly. Changes in fat mass (p=0.06) and bone mineral density (p=0.48) were not significant. CONCLUSIONS: After 12 months of androgen deprivation therapy, elderly men with metastatic prostate cancer exhibit a decline in lean body mass and lipid oxidation, together with increased carbohydrate oxidation

Body Composition Alterations, Energy Expenditure and Fat Oxidation in Elderly Males Suffering from Prostate Cancer, Pre and Post Orchiectomy

INTRODUCTION: Testosterone is needed for normal male development, muscle strength, bone mineralization, hematopoietic function, and sexual and reproductive functions. The main purpose of androgen deprivation therapy in prostate cancer is to reduce tumor progression, but therapy is often accompanied by significant adverse effects. OBJECTIVE: This study aimed to determine the effects of androgen deprivation therapy on body composition and resting metabolic rate in patients with prostate cancer. PATIENTS AND METHODS: A prospective study was performed to evaluate the body composition of 16 elderly males (aged 63-96; median age 71) with prostate cancer scheduled for orchiectomy, one year before and after surgery. Body composition was measured by DEXA, and energy expenditure, fat and carbohydrate oxidation were measured by indirect calorimetry. RESULTS: Body weight (p=0.01), lean mass (p=0.004), and lipid oxidation (p=0.001) decreased significantly. Carbohydrate oxidation (p=0.02), FSH (p=0.0001) and LH (p=0.0001) levels increased significantly. Changes in fat mass (p=0.06) and bone mineral density (p=0.48) were not significant. CONCLUSIONS: After 12 months of androgen deprivation therapy, elderly men with metastatic prostate cancer exhibit a decline in lean body mass and lipid oxidation, together with increased carbohydrate oxidation