Orientador: André Fattori / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T03:54:34Z (GMT). No. of bitstreams: 1 Santimaria_MarianaReis_M.pdf: 28450698 bytes, checksum: 2e1055cfe2400d22b7a31841a19cfc4b (MD5) Previous issue date: 2013 / Resumo: O resumo poderá ser visualizado no texto completo da tese digital / Abstract: The abstract is available with the full electronic document / Mestrado / Gerontologia / Mestra em Gerontologia

Orientador: Maria José D'Elboux / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-27T08:50:00Z (GMT). No. of bitstreams: 1 Silva_VanessaAbreuda_D.pdf: 2181192 bytes, checksum: f2b09456b1f7e48f3b035d252adb01da (MD5) Previous issue date: 2014 / Resumo: Este estudo teve como objetivo analisar os desfechos e fatores associados à síndrome da fragilidade de idosos atendidos em serviço de geriatria de um hospital escola. Trata-se de um estudo quantitativo, comparativo e com delineamento longitudinal, integrante da pesquisa maior intitulada "Qualidade de vida em idosos: indicadores de fragilidade e de bem-estar subjetivo", que compreende duas fases. Na Fase 1 (2005-2007), foram avaliados 150 idosos em acompanhamento no ambulatório de geriatria. Na Fase 2 (2013), os idosos foram novamente contatados, por telefone ou visita domiciliar, e submetidos, após o consentimento, a uma entrevista para a coleta de dados sociodemográficos, de saúde e funcionalidade. Foi adotado o fenótipo de fragilidade de Fried et al., 2001. Os desfechos estudados foram: queda, hospitalização, comorbidade e óbito. Na fase 2, dos 150 idosos participantes da primeira fase, 71 evoluíram a óbito e 25 foram excluídos. Assim, a amostra contou com 54 idosos respondentes, com predomínio do sexo feminino e idade igual ou superior a 80 anos. No que diz respeito à saúde e à funcionalidade, houve diferença estatisticamente significante entre todas as variáveis estudadas, com exceção do número de hospitalizações e do número de quedas. É notável o declínio da funcionalidade desses idosos, avaliada por meio dos instrumentos: SPPB, MIF e AIVD, cujas médias dos seus escores reduziram significativamente. O estado cognitivo também apresentou diferença estatística com redução da média do escore do MEEM na fase 2 (p<0,001). Quanto à fragilidade, houve aumento na média do número de critérios (3,83) quando comparados à fase 1 (2,43), e a maioria dos idosos pontuou para todos os critérios de fragilidade, com exceção para o critério "perda de peso não intencional". Houve aumento na proporção de idosos classificados como frágeis (50,0% fase 1 e 88,9% fase 2) e nenhum idoso foi considerado não frágil. O desfecho queda (fase 2) associou-se a hospitalização e com os critérios de fragilidade exaustão e perda de peso não-intencional na fase 1. O idoso que relatou hospitalização na fase 1 teve maior risco de hospitalização na fase 2. Do mesmo modo o desfecho comorbidade (Índice de Comorbidade de Charlson) foi associado a própria comorbidade na fase 1. Sobre o desfecho óbito verificou-se diferença significativa para a variável idade, níveis de fragilidade, comorbidade e o critério de fragilidade baixo nível de atividade física. Este estudo longitudinal proporcionou maior conhecimento sobre os eventos adversos da síndrome da fragilidade em idosos em acompanhamento ambulatorial / Abstract: This study aimed to analyze the outcomes and factors related to the frailty syndrome in a population of elderly patients treated in the outpatient geriatric service of a teaching hospital. This quantitative, comparative and longitudinal study is part of the larger research project "Quality of life in the elderly: frailty and subjective welfare indicators", conducted at the Geriatric Clinic of the Hospital of the State University of Campinas. This study used a convenience sample and had two phases (Phase 1 and 2). In Phase 1 (2005-2007),150 elderly patients followed up at the geriatric clinic were assessed. In Phase 2 (2013), the elderly were contacted again by phone or home visit and, after their consent, they were interviewed to collect sociodemographic and health data. Moreover, frailty was assessed according to the frailty criteria defined by Fried et al. (2001). The following events were considered as outcomes: fall, hospitalization, comorbidity and death. In Phase 2, of the 150 participants in Phase1, 71 died and 25 were excluded. Thus, Phase 2 sample had 54 respondents, predominantly women, and the rate of 80-year-old or older patients almost doubled (34% in Phase 1 and 64.4% in Phase 2). Concerning health and functionality, there was a statistically significant difference between all variables under study, except for number of hospitalizations and number of falls. The decline of functionalityis marked among these elderly and it was assessed using the tools SPPB, FIM and IADL, whose average scores decreased considerably. The cognitive state also showed a statistical difference, with a decrease in the average MMSE score in Phase 2 (p<0.001). As to frailty, the average number of criteria increased in Phase 2 (3.83) when compared to Phase 1 (2.43), and most of the elderly scored on all frailty criteria, except for "unintentional weight loss". The rate of the elderly classified as frail increased (50% in Phase1 and 88.9% in Phase 2) and none of the elderly was considered as non-frail. The outcome fall (Phase 2) was related to hospitalization and to the frailty criteria "exhaustion" and "unintentional weight loss" in Phase 1. Also was observed that the elderly who were hospitalized in Phase 1 were at a higher risk of hospitalization in Phase 2. As regards the outcome comorbidity (Charlson Comorbidity Index), the variable associated was comorbidity itself. Concerning the outcome death, we observed a significant difference in age, levels of frailty, comorbidity, and in the frailty criterion "low level of physical activity". This longitudinal study provided a more comprehensive knowledge of the adverse events of the frailty syndrome in the elderly followed up at an outpatient geriatric clinic. Therefore, we expect to contribute to more efficient public policies for the elderly population, considering the phenomenon of population aging and the magnitude of the frailty syndrome / Doutorado / Enfermagem e Trabalho / Doutora em Ciências da Saúde

Background: In older adults, respiratory function may be seriously compromised when a marked decrease of respiratory muscle (RM) strength coexists with comorbidity and activity limitation. Respiratory muscle training has been widely studied and recommended as a treatment option for people who are unable to participate in whole-body exercise training (WBET); however, the effects of inspiratory muscle training and yoga breathing exercises on RM function remain unknown, specifi cally in impaired older adults. Purpose: To evaluate the effects of inspiratory threshold training (ITT) and yoga respiratory training (YRT) on RM function in institutionalized frail older adults. Methods: Eighty-one residents (90% women; mean age, 85 years), who were unable to perform WBET (inability to independently walk more than 10 m), were randomly assigned to a control group or one of the 2 experimental groups (ITT or YRT). Experimental groups performed a supervised intervalbased training protocol, either through threshold inspiratory muscle training device or yoga breathing exercises, which lasted 6 weeks (5 days per week). Outcome measures were collected at 4 time points (pretraining, intermediate, posttraining, and follow-up) and included the maximum respiratory pressures (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) and the maximum voluntary ventilation (MVV). Results: Seventy-one residents completed the study: control (n = 24); ITT (n = 23); YRT (n = 24). The treatment on had a signifi cant effect on MIP YRT (F 6,204 = 6.755, P <.001, η 2 = 0.166), MEP (F 6,204 = 4.257, P <.001, η 2 = 0.111), and MVV (F 6,204 = 5.322, P <.001, η 2 = 0.135). Analyses showed that the YRT group had a greater increase of RM strength (MIP and MEP) and endurance (MVV) than control and/or ITT groups. Conclusion: Yoga respiratory training appears to be an effective and well-tolerated exercise regimen in frail older adults and may therefore be a useful alternative to ITT or no training, to improve RM function in older population, when WBET is not possible.

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Background and Purpose: Evidence now links poor oral hygiene to systemic and infectious diseases such as pneumonia. Hospitalized patients, who now retain their teeth into older adulthood, often rely on nurses to provide oral hygiene care. Nurses have the potential to impact oral health outcomes and quality of life by controlling plaque. However, oral hygiene care practices of nurses in post-acute hospital settings are relatively unknown. The purpose of this study was to explore how nurses provide bedtime oral hygiene care, how they decide on interventions provided, and how certain factors influence their ability to provide oral care. Methods: A qualitative, exploratory multiple-case study was conducted with 25 nurses working on five inpatient units at different hospitals. Nurses were accompanied on their evening rounds to observe oral care practices, the physical environment, and workflow. Thematic analysis was used to analyse the case study data base including transcripts of guided conversations, field notes, and documents. Within-case analysis was followed by cross-case analysis. Findings: Findings indicate that: (a) nurses often convey oral hygiene care to their patients as being optional; (b) nurses are inclined to preserve patient autonomy in oral hygiene care; (c) oral hygiene care is often spontaneous and variable, and may not be informed by evidence; and (d) oral hygiene care is not embedded into bedtime care routines. Implications: Oral health history and assessment data are essential to the creation of individualized, feasible oral hygiene care plans that consider patient dignity. Knowledge of the health benefits of oral care, and skills related to assessment and approaches to oral care are required by nurses. Availability of effective products and supplies facilitates provision of oral care. The evidence for oral hygiene care practices, outcomes of nurse-administered oral care, and the role of nurses in influencing the oral health literacy of patients requires further study. / Dissertation / Doctor of Philosophy (PhD) / When in hospital, older people often rely on nurses for help with oral care. Little is known about how nurses provide this type of care, but poor oral care can lead to pneumonia, gum disease, and other diseases of the body. In this study, nurses were accompanied as they provided bedtime oral care to patients. Findings showed that: (a) nurses let patients decide about doing oral care and do not encourage it, (b) nurses let patients do oral care themselves, even if they cannot do a good job, (c) the oral care given depends on the nurse, and (d) bedtime oral care, the most important time of day, is not part of the bedtime routine. Nurses should (a) ask patients about their oral health and inspect their mouths, (b) have the right supplies available so they can more easily provide effective oral care, and (c) teach their patients about the importance of oral hygiene.

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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23753号 / 医博第4799号 / 新制||医||1055(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中本 裕士, 教授 松田 秀一, 教授 山本 洋介 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Frailty is defined as a biological syndrome marked by reduced physiological reserve and heightened vulnerability to stressors, leading to adverse health outcomes like dependency, functional impairment, cognitive decline, and mortality. While various conditions have been associated with frailty, oral health is one of them. However, the precise relationship and the underlying pathways through which oral health conditions may be associated with frailty remain unclear. Limitations such as small sample sizes, inadequate control for confounders, inconsistent results across studies, and variations in frailty assessment methods have contributed to the inconclusiveness of this relationship. Considering these limitations, this dissertation intends to address them by using a rigorous cohort with a robust design, which will allow for a larger sample size, appropriate confounder assessment, and the opportunity to create a practical frailty index (FI) using data from this cohort. This approach enables a comprehensive investigation of the association between clinical, functional, and microbiological oral health and frailty, both cross-sectionally and longitudinally (12 years of follow-up). Furthermore, this study aims to conduct an initial exploration of the mediating effects of inflammatory biomarkers in this relationship.Three specific aims were pursued to achieve this goal. Firstly, a systematic review was conducted to critically summarize the existing evidence on the association between poor oral health and frailty, assessed through any frailty index instrument. Subsequently, two analytical aims were undertaken to delve into the association between oral health and frailty. The initial analytical aim comprised two parts. The first part focused on creating and validating a population frailty index score using data from the Oral Infections and Vascular Disease Epidemiology Study (INVEST). The second part aimed to investigate, cross-sectionally, whether poor oral health independent of factors such as sex, age, occupation, educational level, marital status, and smoking is positively associated with frailty. Additionally, the study aimed to test the robustness and replicability of both the FI and the cross-sectional relationship, utilizing a smaller set of oral data from the Chilean National Health Survey conducted in 2016-2017. The second analytical aim was to explore the prospective association between oral health – assessed clinically, functionally, and microbiologically- and frailty, using the INVEST cohort with its 12 years of follow-up and repeated measures for the exposure, confounders and outcome. As a secondary aim, we explored the mediating effects of select inflammatory biomarkers in this relationship. The systematic review identified 11 studies that investigated the relationship between oral health and frailty, utilizing the FI as an instrument for assessing frailty. All these studies were cross-sectional, and the FI employed in them encompassed a range of deficits, varying from 32 to 76 items. The most frequently incorporated constructs in the frailty index were comorbidities, cognitive impairment, activities of daily living (ADL and/or IADL), functional limitations or abilities, anthropometry, depressive symptoms, and self-reported health status. In terms of the association between oral health and frailty, the review showed that a lower number of teeth, poor self-reported oral health, and experiencing chewing or oral cavity pain were associated with an increased likelihood of frailty, as indicated by any FI. Notably, no studies reported an association between periodontal disease, cavities, use of dental prostheses, and frailty. The second aim showed that within the U.S. population, functional oral health (assessed as the number of teeth and higher number of occlusive tooth pairs) was associated with frailty. Similarly, among the Chilean population aged 55 years and older, frailty was also associated with functional oral health (lower number of additional teeth, wearing dental prostheses, and not having a functional dentition). This study also showed that the inclusion of periodontal microbiota in the regression models improved the model’s fit, suggesting that this microbiota may play a role in the association between oral health and frailty. Finally, the third aim showed that after 12 years of follow-up, a higher incidence of frailty was associated with functional and clinical oral health. In fact, people who exhibited a lower number of additional teeth, had less than 21 teeth, wearing complete dental prostheses, and had periodontal disease had a higher incidence of frailty. Moreover, CRP, IL-6, and TNF- exhibited small, but not statistically significant, effects as potential mediators between oral health and frailty. These findings suggest the potential for further research to explore the action of other inflammatory biomarkers and pathways through which oral health may be associated with frailty.