The main aim of this study is to explore the effects of risk factors contributing to death in the elderly American population. To achieve this purpose, we constructed Cox proportional hazard regression models and logistic regression models with the complex survey dataset from the national Second Longitudinal Study of Aging (LSOA II) to calculate the hazard ratios (HR)/odds ratios (OR) and confidence interval (CI) of risk factors. Our results show that in addition to chronic disease conditions, many risk factors, such as demographic factors (gender and age), social factors (interaction with friends or relatives), personal health behaviors (smoking and exercise), and biomedical factors (Body mass index and emotional factors) have significant effects on death in the elderly American population. This will provide important information for elderly people to prolong lifespan regardless of whether they have chronic disease/diseases or not.

Orientador: Maria de Lourdes Ribeiro de Souza da Cunha / Resumo: A epidemiologia das infecções estafilocócicas tem sofrido importante modificação nas últimas décadas. A emergência de linhagens de Staphylococcus aureus resistentes à meticilina associados à comunidade (CA-MRSA) representa risco especial para populações reconhecidamente vulneráveis como os idosos. Neste âmbito, duas situações distintas são de especial interesse: os indivíduos institucionalizados, vivendo em casas de repouso, que representam um espaço intermediário entre a comunidade e o hospital; e os dependentes (acamados) cuidados em domicílio, expostos de forma intermitente aos serviços de saúde. Nosso objetivo foi identificar a prevalência e fatores associados ao carreamento nasal, oral e retal de S. aureus e MRSA em indivíduos acamados ou residindo em instituições de longa permanência para idosos (ILPIs) no município de Botucatu, SP, bem como a identificação de clones importantes de S. aureus e MRSA nessa população. Estudo com delineamento transversal, em que swabs da nasofaringe, orofaringe e reto de 226 indivíduos (150 residentes em nove ILPIs e 76 acamados em domicílio) foram coletados juntamente com um questionário que, através de entrevista com o próprio indivíduo ou responsável legal, levantou informações como dados demográficos (gênero e idade), tempo de institucionalização ou restrição ao leito, dados clínicos (comorbidades), dispositivos invasivos, internações recentes, doenças infeccionas e uso de antimicrobianos, para identificação dos fatores de risco. O isol... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The epidemiology of staphylococcal infections has undergone important changes in recent decades. The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains represents a special risk to populations recognized as vulnerable, such as the elderly. Within this context, two different situations are of special interest: institutionalized individuals living in nursing homes, which represent an intermediary space between the community and the hospital, and dependent (bedridden) patients cared for at home, who are intermittently exposed to health services. Our objective was to determine the prevalence and factors associated with nasal, oral and rectal carriage of S. aureus and MRSA in bedridden patients and residents of long-term care facilities (LTCF) for the elderly in the city of Botucatu, SP, and to identify important S. aureus and MRSA clones in this population. In a cross-sectional study, nasopharyngeal, oropharyngeal and rectal swab samples were collected from 226 individuals (150 individuals from nine LTCF and 76 bedridden patients living at home). In addition, a questionnaire was applied by interview with the subject himself or the legal representative for the collection of demographic data (gender and age), length of institutionalization or bedridden period, clinical data (comorbidities), invasive devices, recent hospitalizations, infectious diseases, and antimicrobial use in order to identify risk factors. Staphylococcus aureus was is... (Complete abstract click electronic access below) / Mestre

Malgré la fréquence d’utilisation des psychotropes chez les personnes plus âgées et leur propension aux événements indésirables liés aux médicaments, peu d’études se sont intéressées au respect des règles de bon usage des psychotropes dans cette population. L’objectif de ce travail était d’évaluer les modalités d’utilisation des psychotropes et le respect des recommandations de bon usage publiées en France. Deux types de population ont été inclus : un échantillon clinique constitué de patients âgés d’au moins 65 ans hospitalisés dans deux Pôles de psychiatrie à Bordeaux, et un échantillon de la population générale âgée d’au moins 65 ans, à partir d’une base de données de l’assurance maladie française. En population clinique, les règles de bon usage étaient plutôt bien respectées, avec, pour les benzodiazépines, la prescription d’une produit à demi-vie courte dans près de trois quarts des prescriptions et une posologie adéquate dans près de deux tiers des cas. Toutefois, un arrêt de traitement n’était jamais prévu dès l’initiation du traitement et le rythme de prescription était discontinu dans seulement un tiers des cas. Dans la population générale âgée, la durée et la surveillance biologique des traitements antidépresseurs étaient conformes chez moins de 20% des sujets, alors que près des trois quarts des sujets initiant un traitement par benzodiazépine recevaient une durée adéquate. En revanche moins de la moitié des délivrances concernaient une benzodiazépine anxiolytique à demi-vie courte. L’étude de l’impact de la publication des recommandations n’a pas montré qu’elle permettait une amélioration de l’utilisation des psychotropes. Il est nécessaire d’accompagner la publication des recommandations d’autres mesures, afin d’insister sur le bon usage des psychotropes, notamment la durée nécessaire de traitement antidépresseur et le choix d’un anxiolytique à demi-vie courte. / Despite a high frequency of use and a tendency to present with adverse events of drugs, few studies assessed compliance with guidelines related to proper use of psychotropic drugs in the older population. The aim was to assess the patterns of psychotropic drugs use in this population, as well as the compliance with French guidelines. Two population samples were included, a clinical sample of older psychiatric inpatients and a sample of the older general population using claims database of the national health insurance. In clinical population, compliance with guidelines was rather good, with prescription of a short half-life benzodiazepine in nearly three quarters of prescriptions and adequate dosage in nearly two third of cases. However, treatment discontinuation was never specified at the time of treatment initiation and rhythm of prescription was discontinuous in only one third of cases. In the older general population, duration of antidepressant treatment and biological monitoring was appropriate in only 20 % of patients, whereas nearly three quarters of subjects initiating a benzodiazepine treatment were treated over an appropriate duration. However, less than half of them had received a benzodiazepine anxiolytic of short half-life. The assessment of the impact of practice guidelines publication found no improvement of psychotropic drugs use. Other interventions should accompany guidelines publication in order to underline the importance of proper use of drugs, particularly antidepressant treatment duration and use of short half-life benzodiazepine drugs.

Le vieillissement de la population nécessite une politique de prévention des chutes efficace chez les personnes âgées. Les chutes ont des conséquences importantes aussi bien en termes de baisse de qualité de vie et de perte d’autonomie, que financiers, occasionnés par leurs soins et leur prise en charge. Cependant, la complexité du mécanisme de la chute et son caractère multifactoriel, rendent le diagnostic et l’évaluation du risque de chute encore difficile, notamment parmi la population des personnes dites « en bonne santé ». Conjointement, bien que les programmes multi-interventionnels commencent à montrer leur efficacité, ces derniers restent peu, sinon mal, évalués. Par ailleurs, la mise en place d’une politique de prévention adaptée et efficace, doit être centrée sur la qualité du soin et la satisfaction du patient. Celles-ci nécessitent le passage vers un mode d’organisation du travail coopératif, en réseau. Toutefois, ce changement conduit à des modifications dans les pratiques et identités professionnelles. Cette thèse a pour objectif d’étudier les conditions de réussite d’une action de prévention, structurée et coordonnée, en santé publique. Nous présentons et proposons tout d’abord les conditions et outils permettant une homogénéisation et une standardisation des pratiques incontournables pour la mutualisation des efforts individuels et permettre ainsi une plus grande efficacité. Nous étudions également les impacts d’une telle intervention, en termes financiers et de risque de chute. Nous analysons ensuite comment conduire le changement pour permettre une évolution et une adaptation des mentalités mais aussi des modes d’organisation de l’activité. / The prevention of falls amongst the elderly population is a major public health concern. Since the elderly live longer and longer, it is crucial to think of efficient measures in order to prevent such falls. Falls amongst the elderly can have dramatic consequences such as a decrease in quality of life, a loss of autonomy as will cause financial difficulty due to high cost of rehabilitation. However, depending upon the complexity of the fall and its multiple determinants, diagnosing and evaluating the risk of a fall remains complicated, particularly amongst those in "good health". While multi interventional programs may exist such as equilibrium coordination and muscular reinforcement, these programs are rarely proved to be efficient in fall prevention. An adapted and efficient method of prevention must be centered on quality and satisfaction of the patient in the offered care. Such method would imply replacement of an older organization with a system defined in a network activity. However, this method would go hand in hand with the modifications in professional practices and identities. In this thesis I will examine the success rate to implement a structured method of health care prevention against falls. To achieve this prevention, we must first present the necessary conditions and tools which will homogenize and standardize these success rates. Next, I will analyze the characteristics of current methods to prevent falls in order to modernize and rationalize the process. In order to be successful, this process needs to be targeted towards a network strategy.

Introdução - O envelhecimento da população tem implicações significativas para a organização da atenção odontológica. Objetivo - Este estudo teve por objetivo avaliar as condições de saúde bucal de idosos moradores na área urbana do município de São Paulo em 2006. Método - O Estudo SABE (Saúde Bem Estar e Envelhecimento) é um estudo multicêntrico envolvendo sete países da América Latina e Caribe cuja primeira fase teve início em 2000 e em 2006 transformou-se em um estudo longitudinal. Em 2006, foram examinadas 1.212 pessoas de 65 anos de idade e mais que representaram 515.040 idosos residentes na área urbana do município de São Paulo. Os exames foram realizados por 15 cirurgiões-dentistas calibrados segundo os critérios metodológicos recomendados pela Organização Mundial da Saúde. Resultados - A média do Índice CPOD (número de dentes cariados, perdidos e restaurados) nas mulheres foi de 29,87 e entre os homens de 27,42. A freqüência do CPOD variou de 7 a 32 nas mulheres e de 8 a 32 nos homens. Não houve idosos com todos os dentes presentes. A necessidade de tratamento mais prevalente foi de exodontia. Em relação à condição periodontal, nas mulheres, 90,84% dos sextantes superiores e 84,56% dos sextantes inferiores eram edêntulos e, nos homens, 82,11% e 74,96, respectivamente. Perda de inserção periodontal de 0 a 3 mm foi a alteração periodontal mais freqüente em ambos os sexos. A prevalência do edentulismo total foi de 69,40% nas mulheres e 30,60% nos homens; 74,48% das mulheres e 53,43% dos homens faziam uso de prótese total superior e 45,51% das mulheres e 33,77% dos homens faziam uso de prótese total inferior. Uso de prótese total superior e inferior teve prevalência de 44,40% em mulheres e 32,90% em homens. O uso de prótese parcial removível foi mais comum no arco dentário inferior em mulheres (16,38%). Necessitavam de prótese total, mas não a usavam 5,70% da população, sendo que a porcentagem foi maior na população masculina (14,78%). A necessidade de prótese total teve maior prevalência seguida da necessidade de prótese parcial removível. Dentre os idosos que usam outros tipos de prótese a média de dentes presentes foi de 11,62 nas mulheres e 13,84 nos homens. No que diz respeito a presença de lesão em tecidos moles da cavidade bucal, 18,93% da mulheres e 15,95% dos homens, apresentaram algum tipo de lesão. Conclusão - As mulheres apresentaram índice CPOD maior que os homens. Com exceção do número de dentes cariados que foi maior entre a população masculina, os demais componentes tiveram maior prevalência entre a população feminina. Quanto à condição periodontal, a maior prevalência de sextantes nulos ocorreu entre as mulheres. Também o número de mulheres edêntulas foi maior que o número de homens nessa condição, assim como o uso de próteses foi mais prevalente entre elas. A presença de lesões nos tecidos moles da boca foi mais prevalente na população feminina. Pode-se concluir que as mulheres tiveram mais acesso aos serviços odontológicos e que os homens apresentaram grandes necessidades de tratamento acumuladas. Pela medida de mutilação apresentada pelas mulheres e pelas grandes necessidades acumuladas entre os homens, pode-se concluir que se deve buscar uma nova abordagem no cuidado em saúde bucal para o idoso. / Introduction - The aging of the population has material effects on the dental assistance organization. Purpose - The purpose of this study was to evaluate the clinical conditions of dental health among the elderly population living in the city of São Paulo in 2006. Methodology - The SABE Study - Health, Welfare and Aging is a multicenter study made in seven countries of Latin America and Caribbean region. The first phase of this study began in 2000, having become a longitudinal study in 2006, year at which 1,212 people of 65 years old or more were examined, representing 515.040 elderly resident in the metropolitan area of São Paulo. 15 dental surgeons conducted the exams according to the methodological criteria established by the Wealth World Organization. Results - DMFT (number of lost or restored teeth or teeth with caries) rate average was 29.87 in the female population and 27.42 in the male population. The DMFT frequency had a variation from 7 to 32 in the female population and 8 to 32 in the male population. There were no elderly elements with all their permanent teeth. The more prevailing treatment was extraction. Among the female population 90.84% have no upper high sextant and 84.56% have no anterior sextant. Among the male population 82.11% and 74.96%, respectively, have no sextants. Attachment losses from 0 to 3 mm were more frequent in both male and female population. The prevalence of total edentulism was 69.40% in the female population and 30.60% in the male population; 74.48% of women and 53.43% of men have total superior prostheses implanted and 45.51% of women and 33.77% of men have total inferior prostheses implanted. The use of total superior and inferior prosthesis prevailed among 44.40% in the female population and 32.90% in the male population; on the other hand, the removable partial prosthesis was more common in the inferior arcade of the female population (16.38%). The average of population in the need but without a total prosthesis was 5.70%, and the largest percentage was found among the male population (14.78%). The necessity of total prosthesis was more prevailing, followed by removable partial prosthesis. Among the elderly population that has other prosthesis types implanted, the average of present teeth was 11.62 in the female population and 13.84 in the male population. As to the presence of injury in soft tissues in the oral cavity, 18.93% in the female population and 15.95% in the male population have any kind of injury. Conclusion - The female population had a higher DMFT ratio than the male population. Except the number of teeth with caries, which was higher among the male population, the other elements showed a higher prevalence among the female population. As to the periodontal condition, the higher prevalence of sextants inexistency was found, as well as the edentulous women, and the use o prosthesis. The presence of injury in the oral soft tissues was more prevailing among the female population. It is possible to conclude that the female population had more access to dental services and the male population has more accrued necessities. By the scope of the mutilation showed by women and accrued necessities found among the male population it is possible to conclude that a new approach should be use to address dental treatment in the elderly population.

Introdução - O envelhecimento da população tem implicações significativas para a organização da atenção odontológica. Objetivo - Este estudo teve por objetivo avaliar as condições de saúde bucal de idosos moradores na área urbana do município de São Paulo em 2006. Método - O Estudo SABE (Saúde Bem Estar e Envelhecimento) é um estudo multicêntrico envolvendo sete países da América Latina e Caribe cuja primeira fase teve início em 2000 e em 2006 transformou-se em um estudo longitudinal. Em 2006, foram examinadas 1.212 pessoas de 65 anos de idade e mais que representaram 515.040 idosos residentes na área urbana do município de São Paulo. Os exames foram realizados por 15 cirurgiões-dentistas calibrados segundo os critérios metodológicos recomendados pela Organização Mundial da Saúde. Resultados - A média do Índice CPOD (número de dentes cariados, perdidos e restaurados) nas mulheres foi de 29,87 e entre os homens de 27,42. A freqüência do CPOD variou de 7 a 32 nas mulheres e de 8 a 32 nos homens. Não houve idosos com todos os dentes presentes. A necessidade de tratamento mais prevalente foi de exodontia. Em relação à condição periodontal, nas mulheres, 90,84% dos sextantes superiores e 84,56% dos sextantes inferiores eram edêntulos e, nos homens, 82,11% e 74,96, respectivamente. Perda de inserção periodontal de 0 a 3 mm foi a alteração periodontal mais freqüente em ambos os sexos. A prevalência do edentulismo total foi de 69,40% nas mulheres e 30,60% nos homens; 74,48% das mulheres e 53,43% dos homens faziam uso de prótese total superior e 45,51% das mulheres e 33,77% dos homens faziam uso de prótese total inferior. Uso de prótese total superior e inferior teve prevalência de 44,40% em mulheres e 32,90% em homens. O uso de prótese parcial removível foi mais comum no arco dentário inferior em mulheres (16,38%). Necessitavam de prótese total, mas não a usavam 5,70% da população, sendo que a porcentagem foi maior na população masculina (14,78%). A necessidade de prótese total teve maior prevalência seguida da necessidade de prótese parcial removível. Dentre os idosos que usam outros tipos de prótese a média de dentes presentes foi de 11,62 nas mulheres e 13,84 nos homens. No que diz respeito a presença de lesão em tecidos moles da cavidade bucal, 18,93% da mulheres e 15,95% dos homens, apresentaram algum tipo de lesão. Conclusão - As mulheres apresentaram índice CPOD maior que os homens. Com exceção do número de dentes cariados que foi maior entre a população masculina, os demais componentes tiveram maior prevalência entre a população feminina. Quanto à condição periodontal, a maior prevalência de sextantes nulos ocorreu entre as mulheres. Também o número de mulheres edêntulas foi maior que o número de homens nessa condição, assim como o uso de próteses foi mais prevalente entre elas. A presença de lesões nos tecidos moles da boca foi mais prevalente na população feminina. Pode-se concluir que as mulheres tiveram mais acesso aos serviços odontológicos e que os homens apresentaram grandes necessidades de tratamento acumuladas. Pela medida de mutilação apresentada pelas mulheres e pelas grandes necessidades acumuladas entre os homens, pode-se concluir que se deve buscar uma nova abordagem no cuidado em saúde bucal para o idoso. / Introduction - The aging of the population has material effects on the dental assistance organization. Purpose - The purpose of this study was to evaluate the clinical conditions of dental health among the elderly population living in the city of São Paulo in 2006. Methodology - The SABE Study - Health, Welfare and Aging is a multicenter study made in seven countries of Latin America and Caribbean region. The first phase of this study began in 2000, having become a longitudinal study in 2006, year at which 1,212 people of 65 years old or more were examined, representing 515.040 elderly resident in the metropolitan area of São Paulo. 15 dental surgeons conducted the exams according to the methodological criteria established by the Wealth World Organization. Results - DMFT (number of lost or restored teeth or teeth with caries) rate average was 29.87 in the female population and 27.42 in the male population. The DMFT frequency had a variation from 7 to 32 in the female population and 8 to 32 in the male population. There were no elderly elements with all their permanent teeth. The more prevailing treatment was extraction. Among the female population 90.84% have no upper high sextant and 84.56% have no anterior sextant. Among the male population 82.11% and 74.96%, respectively, have no sextants. Attachment losses from 0 to 3 mm were more frequent in both male and female population. The prevalence of total edentulism was 69.40% in the female population and 30.60% in the male population; 74.48% of women and 53.43% of men have total superior prostheses implanted and 45.51% of women and 33.77% of men have total inferior prostheses implanted. The use of total superior and inferior prosthesis prevailed among 44.40% in the female population and 32.90% in the male population; on the other hand, the removable partial prosthesis was more common in the inferior arcade of the female population (16.38%). The average of population in the need but without a total prosthesis was 5.70%, and the largest percentage was found among the male population (14.78%). The necessity of total prosthesis was more prevailing, followed by removable partial prosthesis. Among the elderly population that has other prosthesis types implanted, the average of present teeth was 11.62 in the female population and 13.84 in the male population. As to the presence of injury in soft tissues in the oral cavity, 18.93% in the female population and 15.95% in the male population have any kind of injury. Conclusion - The female population had a higher DMFT ratio than the male population. Except the number of teeth with caries, which was higher among the male population, the other elements showed a higher prevalence among the female population. As to the periodontal condition, the higher prevalence of sextants inexistency was found, as well as the edentulous women, and the use o prosthesis. The presence of injury in the oral soft tissues was more prevailing among the female population. It is possible to conclude that the female population had more access to dental services and the male population has more accrued necessities. By the scope of the mutilation showed by women and accrued necessities found among the male population it is possible to conclude that a new approach should be use to address dental treatment in the elderly population.

<p>The population of Sweden is ageing as in almost every European country. Improved medical progresses and treatment options lead to a decreasing mortality at older ages, increasing life expectance and an advanced health of the elderly. Due to these improvements and the so called ‘baby- boomers’, a great number of persons born in the 1940s that will reach retirement age the coming years, their total number will increase strongly in the near future all over Sweden. To enable these elderly to live a normal, active and independent life as long as possible activities, services and special housing with improved accessibility and meeting places for elderly has to be provided. Thus, for local authorities it is essential to know the actual and favoured living conditions as well as environments of elderly. This study aims therefore to investigate the characteristic of preferred residential neighbourhoods of the elderly in the city of Norrköping. The demographic, social and crime situation was examined for the districts of the city using several methods from both Statistics and GIS. Statistical methods included classifications, indexes or indicators and bivariate correlations. A model was developed to combine demographic and social data to characterise districts. GIS was to a major extent used as a visualisation tool. Choropleth mapping and Kernel density estimations were used to illustrate distribution of elderly and crime. Preliminary global statistical tests were used to verify clustering in the crime data set. An accessibility analysis was conducted with the help of the network analyst tool. Results indicate that districts experiencing the highest total numbers and proportion of elderly are very distributed throughout the city of Norrköping. They are, with some exceptions, characterised by lower social status. Four districts of the city show considerable evidences of demographic ageing, experiencing a population pyramid formed like an urn. Beside districts where elderly constitute a bigger proportion of the population, they tend to live in districts characterised by a relatively high proportion of young adults aged between 20 and 29. Crime analyses have shown crime clusters in different parts of the city. A high proportion of elderly faces a high crime level in the districts Gamla staden, Nordantill and Hageby. However, it has been proved that only some hot spots of crime within these areas contribute to the high crime level. Districts such as Skarphagen, Såpkullen, Smedby and Linö, all (except Såpkullen) situated on the outskirts of the city, hold high or middle elderly and a low crime level. Accessibility analyses have shown that elderly aged over 80 do not live significant closer to health centres and the public transport stops compared to the age groups 20 – 65 and inhabitants aged between 65 and 79.</p>

The population of Sweden is ageing as in almost every European country. Improved medical progresses and treatment options lead to a decreasing mortality at older ages, increasing life expectance and an advanced health of the elderly. Due to these improvements and the so called ‘baby- boomers’, a great number of persons born in the 1940s that will reach retirement age the coming years, their total number will increase strongly in the near future all over Sweden. To enable these elderly to live a normal, active and independent life as long as possible activities, services and special housing with improved accessibility and meeting places for elderly has to be provided. Thus, for local authorities it is essential to know the actual and favoured living conditions as well as environments of elderly. This study aims therefore to investigate the characteristic of preferred residential neighbourhoods of the elderly in the city of Norrköping. The demographic, social and crime situation was examined for the districts of the city using several methods from both Statistics and GIS. Statistical methods included classifications, indexes or indicators and bivariate correlations. A model was developed to combine demographic and social data to characterise districts. GIS was to a major extent used as a visualisation tool. Choropleth mapping and Kernel density estimations were used to illustrate distribution of elderly and crime. Preliminary global statistical tests were used to verify clustering in the crime data set. An accessibility analysis was conducted with the help of the network analyst tool. Results indicate that districts experiencing the highest total numbers and proportion of elderly are very distributed throughout the city of Norrköping. They are, with some exceptions, characterised by lower social status. Four districts of the city show considerable evidences of demographic ageing, experiencing a population pyramid formed like an urn. Beside districts where elderly constitute a bigger proportion of the population, they tend to live in districts characterised by a relatively high proportion of young adults aged between 20 and 29. Crime analyses have shown crime clusters in different parts of the city. A high proportion of elderly faces a high crime level in the districts Gamla staden, Nordantill and Hageby. However, it has been proved that only some hot spots of crime within these areas contribute to the high crime level. Districts such as Skarphagen, Såpkullen, Smedby and Linö, all (except Såpkullen) situated on the outskirts of the city, hold high or middle elderly and a low crime level. Accessibility analyses have shown that elderly aged over 80 do not live significant closer to health centres and the public transport stops compared to the age groups 20 – 65 and inhabitants aged between 65 and 79.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-04-13T18:00:01Z No. of bitstreams: 1 David Costa Monteiro.pdf: 2947151 bytes, checksum: 2fa8ac9f19e8e0fa52699b42e5e4ca34 (MD5) / Made available in DSpace on 2018-04-13T18:00:01Z (GMT). No. of bitstreams: 1 David Costa Monteiro.pdf: 2947151 bytes, checksum: 2fa8ac9f19e8e0fa52699b42e5e4ca34 (MD5) Previous issue date: 2018-02-28 / The sustainability of cities depends on the logistics aspect related to the transportation of people residing in peripheral regions of large municipalities and who need attention regarding access to goods and services, whether public or private. In the particular case of the elderly residents far from the center of the city of São Paulo they go through the difficulty of aging itself, the question of recklessness in the face of low security in the most central area of the city, lack of public transportation options, distances extended by human growth and inaccessibility to public and private services. We investigated the issue of the elderly with hearing problems who need care to acquire hearing aids and the maintenance of such equipment. The general objective is to present the elements, based on the three pillars of sustainability (Triple Bottom Line), which can contribute to the improvement of the provision of goods and services to elderly people who use hearing aids and live in peripheral regions of the city of São Paulo. Methodologically, the research was based on a mixed approach: qualitative and quantitative, and also based on bibliographic review, documentary analysis and statistical analysis from a field survey and structured questionnaire application. From the economic point of view, the company under study provided new possibilities and new real gains with the new sales strategy adopted, which is consistent with door to door sales and through agreements with commercial partners located in the neighborhoods where their clientele reside. Socially, there was a great deficit of urban rigging and public investments in the direction of adequately adapting to the local needs of the population: the access to health to be improved, ergonomically lacking works, optimization of the elements essential to urban mobility (in face of the neighborhoods of Capão Redondo and Grajaú) such as public transport and others. From the environmental point of view, the company under study innovated by being able to reduce the amount of carbon dioxide initially promoted in its regionally directed sales. The contributions to the presented practice showed that new strategies of approaching the company with the clientele can supply the demand of a sustainable way for the lesser part of the city. As contributions to the theory the research was shown to be relevant when presenting that the tripod of sustainability can be applied by companies in diverse segments, as exposed, the branch of hearing aids in peripheral regions of the city of São Paulo. It is also concluded that if the entrepreneurs intelligently apply their resources, beneficially will influence the quality of life of their clientele, even more positively enhancing their business as a whole. / A sustentabilidade das cidades passa pelo aspecto da logística relativo ao transporte de pessoas residentes em regiões periféricas dos grandes municípios e que carecem de atenção quanto ao acesso aos bens e serviços, sejam estes de caráter público ou de caráter privado. No caso particular dos idosos residentes distante do centro da cidade de São Paulo, é possível observar que passam pela dificuldade oriunda do próprio envelhecimento, a questão da temeridade em face da baixa segurança na área mais central da cidade, falta de opções de transporte público, distâncias alongadas pelo crescimento humano e inacessibilidade a serviços públicos e privados. Investigou-se a questão do idoso portador de problemas auditivos que carece de atendimento para adquirir aparelhos auditivos e a manutenção desses equipamentos. Por objetivo geral têm-se apresentar os elementos com base nos três pilares da sustentabilidade (Triple Bottom Line), que podem contribuir na melhoria da prestação de bens e serviços a idosos que utilizam aparelhos auditivos e residem em regiões periféricas da cidade de São Paulo. Metodologicamente optou-se pela investigação de abordagem mista: qualitativa e quantitativa e, ainda, baseada nas técnicas de revisão bibliográfica, análise documental e análise estatística a partir de levantamento em campo e aplicação de questionário estruturado. Por resultados, pôde-se encontrar que, do ponto de vista econômico, a empresa sob estudo proporcionou novas possibilidades e novos ganhos reais com a nova estratégia de vendas adotadas, esta consistente nas vendas door to door e por intermédio de acordos com parceiros comerciais localizados nos distritos em que sua clientela reside. Socialmente, apurou-se grande déficit de aparelhamento urbano e investimentos públicos na direção de se bem adequar às necessidades populacionais locais: é o caso do acesso à saúde a ser melhorado, calçamento ergonomicamente carente de obras, otimização dos elementos essenciais à mobilidade urbana (em face dos bairros do Capão Redondo e Grajaú), como o transporte público e outros. Do ponto de vista ambiental, a empresa estudada inovou ao conseguir diminuir o montante de gás carbônico inicialmente promovido em suas vendas regionalmente direcionadas. As contribuições para a prática apresentadas mostraram que novas estratégias de aproximação da empresa com a clientela podem suprir a demanda de uma forma sustentável para a parte menos abastada da cidade. Como contribuições para a teoria a pesquisa se mostrou relevante ao apresentar que o tripé da sustentabilidade pode ser aplicado por empresas em seguimentos diversos, como exposto, o ramo de aparelhos auditivos em regiões periféricas da cidade de São Paulo. Conclui-se, igualmente, que se o empresariado aplicar de modo inteligente seus recursos, beneficamente influenciará na qualidade de vida de sua clientela, potencializando, inclusive, de modo mais positivo, seus negócios como um todo.

Aquesta tesi avalua l'existència de diferencies per gènere en la relació entre discapacitat i mortalitat, i aspectes metodològics en l'anàlisi de supervivènciad'estudis de gent gran. Es van utilitzar les dades provinents d'una cohort de 1.315 subjectes amb edats superiors o iguals a 65 anys que van ser seguits durant un periode de 8 anys. La discapacitat es va mesurar mitjançant la capacitat que declarava l'individu per dur a terme activitats de la vida diària bàsiques. La discapacitat va evolucionar al llarg del temps empitjorant amb l'edat, però una proporció no menyspreable va ser capaç de recuperar-se. Es van observar diferències per gènere en l'evolució de la discapacitat: les dones tenien més dificultats en recuperar la seva capacitat funcional un cop esdevenien discapacitades. La força de l'associació entre la discapacitat i la mortalitat disminuia a edats avançades. Es van trobar diferencies per sexe: les dones depenents mostraven un risc de morir més alt que el homes depenents. Polítiques de salut dirigides a dones discapacitades haurien de ser implementades degut a la proporció més elevada de dones discapacitades, la probabilitat menor que tenen de recuperar la capacitat funcional, i el risc de morir més elevat que presenten comparat amb homes dicapacitats. / This thesis evaluates the existence of gender differences in the relationship between disability and mortality, as well as methodological aspects of the survival analysis for elderly studies. Data from a cohort of 1,315 subjects aged 65 years and older followed-up 8 years was used. Disability was assessed by self-reported difficulty to perform basic activities of daily living. Disability evolved over time worsening with age, but a non-negligible proportion was able to recover. There were gender differences in the evolution of disability: women were less able to regain functional capacity once they become disabled. The strength of the association between disability and mortality decreased in the older ages. But differences by gender were found: dependent elderly women showed a higher risk of dying compared to dependent men. Health policies focusing on disabled women should be implemented, due to the higher proportion of disabled women, the lower probability of regaining functional capacity, and their higher risk of dying compared to disabled men.