Orientador: André Fattori / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T05:16:47Z (GMT). No. of bitstreams: 1 Silva_AnaPauladoAmaralCarvalhoe_M.pdf: 1884954 bytes, checksum: 6363b0a9250071fa079367c17b59869e (MD5) Previous issue date: 2012 / Resumo: O conhecimento sobre a fragilidade do idoso é relativamente recente. Poucos estudos procuraram relacionar hábitos de vida associados à anormalidades cardiocirculatórias e a fragilidade. Esta análise permite uma melhor definição sobre a participação dos aspectos multidimensionais versus biológico da síndrome e colabora na identificação de hábitos nocivos na proposta de abordagem terapêutica da fragilidade. Objetivo: Avaliar a associação entre os hábitos de vida (tabagismo, consumo nocivo de álcool e sedentarismo), permeados pela hipertensão arterial e a síndrome da fragilidade na amostra populacional de idosos do Projeto FIBRA - polo Unicamp. Material e Método: Trata-se de um estudo transversal onde foram entrevistados 3.478 idosos de ambos os sexos com idade igual ou superior a 65 anos residentes em seis municípios brasileiros. Os idosos foram recrutados em seus domicílios em setores censitários urbanos sorteados ao acaso. Para inclusão, os idosos deveriam ter idade igual ou superior a 65 anos, compreender as instruções, concordar em participar e ser residente permanente no domicilio e no setor censitário. Foram excluídos: a) os idosos com déficit cognitivo grave sugestivo de demência, evidenciado por problemas de memória, atenção, orientação espacial e temporal, e comunicação; b) os que estivessem usando cadeira de rodas ou que se encontrassem provisória ou definitivamente acamados; c) os portadores de sequelas graves de Acidente Vascular Encefálico, com perda localizada de força e/ou afasia; d) os portadores de Doença de Parkinson em estágio grave ou instável, com comprometimento grave da motricidade, da fala ou da afetividade; e) os portadores de graves déficits de audição ou de visão, que dificultassem consideravelmente a comunicação; e f) os que estivessem em estágio terminal. Os idosos participaram de uma sessão de coleta de dados e após assinarem o Termo de Consentimento Livre e Esclarecido, foram submetidos a um teste de rastreio mediante a aplicação do Mini Exame do Estado Mental (MEEM) e realizaram medidas de identificação sociodemográficas, antropométricas, de pressão arterial, de saúde bucal e de fragilidade. Os que pontuaram abaixo da nota de corte no MEEM foram dispensados e os que pontuaram acima foram encaminhados para a segunda parte do protocolo. Os 2.318 idosos passaram para segunda parte do protocolo onde participaram de outras avaliações: hábito tabágico, consumo de álcool, prática de atividade física e auto relato de Hipertensão arterial sistêmica presente no item para doenças cardiovasculares, os quais foram objeto de análise do presente estudo. Foram considerados frágeis aqueles que apresentaram três ou mais dos seguintes critérios: perda de peso não intencional, fadiga, lentidão da marcha, baixo nível de atividade física e baixa força de preensão manual. Os achados relativos ao hábito tabágico, consumo nocivo de álcool, prática de atividade física e hipertensão arterial sistêmica foram correlacionados com a fragilidade. Conclusão: Dos hábitos de vida avaliados nesta amostra, apenas o sedentarismo apresentou relação significativa com a fragilidade. A inatividade física é um dos mais fortes preditores de incapacidade física em idosos, conferindo aumento do risco de doença, institucionalização e morte; condições estas que definem a fragilidade no idoso / Abstract: Knowledge about frailty of the elderly is relatively recent. Few studies have attempted to investigate lifestyle and cardiovascular abnormalities in the frailty phenotype. This analysis allows a better comprehension of the biological versus multi-dimensional aspects of the syndrome, and it permits the identification of potentially adverse life behaviors to propose a therapeutic approach to frailty. Objective: To evaluate the association between behaviors related to cardiovascular risk (smoking, immoderate alcohol consumption and low physical training) and the transition to Frailty, as well to investigate the role of systemic arterial hypertension as a mediator of this transition in the elderly population of FIBRA Project - polo UNICAMP, Campinas, Brazil. Material and Methods: This is a cross-sectional study where were interviewed 3478 community-dwelling people of both sexes aged over 65 living in six Brazilian cities. The elderly were randomly recruited according to urban census areas. For inclusion, the elderly should be aged 65 years or older, to understand the instructions, agree to participate and belong to a previously defined census area. Exclusion criteria were: a) elderly people with severe cognitive impairment suggestive of dementia, as evidenced by problems with memory, attention, local and temporal orientation b) those who were using wheelchairs or who find themselves temporarily or permanently bedridden c) patients with serious stroke sequelae with localized loss of strength and/or aphasia d) patients with severe or unstable Parkinson's disease stage, with severe motor skills, speech or affection impairment e) patients with severe deficits in hearing or vision, which considerably hindered communication and f) those who were in terminal stage of life. Older people, who firstly attended a session of data collection and signed an informed consent, underwent to a screening test applying the Mini-Mental State Examination (MMSE). After all, evaluation of sociodemographic characteristics, and measures of anthropometric, blood pressure, oral health and frailty parameters were proceeded. Those who scored below the cutoff on the MMSE were dismissed, and those who scored above were referred to the second part of the protocol. 2318 seniors were selected to participate of the second part of the protocol, by which they were investigated about smoking, alcohol consumption, physical activity and self-reported hypertension. Those who were considered frail had three or more of the following criteria: unintentional weight loss, fatigue, slow gait, low physical activity and low handgrip strength. Findings related to smoking, immoderate alcohol consumption, low physical training and hypertension were correlated with the fragility. Conclusion: Of life behaviors assessed in this sample, only the sedentary lifestyle was related to frailty. Low physical training is one of the strongest predictors of disability in the elderly, conferring increased risk of disease, institutionalization and death, conditions which define frailty in the elderly / Mestrado / Gerontologia / Mestre em Gerontologia

Orientador: Arlete Maria Valente Coimbra / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T14:30:23Z (GMT). No. of bitstreams: 1 Santos_ManuelaNassimJorge_M.pdf: 1081090 bytes, checksum: d6279da8c10f7dff3b8a9cc272922fdf (MD5) Previous issue date: 2012 / Resumo: Objetivo: Este estudo tem como objetivo avaliar a relação entre composição corporal, mais especificamente a massa muscular apendicular e massa gorda total, segundo medidas de funcionalidade em idosas não institucionalizadas. Método: Trata-se de um estudo transversal analítico em uma amostra de 99 idosas acima de 60 anos que foram submetidas ao exame de Densitometria de Corpo Total com Dupla Emissão de Raio- X para avaliação da composição corporal e aplicados testes para medir a funcionalidade como teste TUG, força de preensão, velocidade de marcha foram considerados ainda a e perda de peso não intencional autorrelato de fadiga Resultados: A amostra deste estudo apresentou média da massa muscular apendicular de 16,91kg (± 3,28), média encontrada para massa gorda total de 25,47Kg (± 11,03); observou-se alteração estatisticamente significativa na composição dos tecidos corporais entre as faixas etária, sendo que foi encontrada uma menor massa muscular apendicular na faixa etária acima de 80 anos e menor massa gorda total também nesta faixa de idade. A medida de funcionalidade força de preensão está relacionada com massa muscular apendicular, sendo que, as idosas com menor FPM têm maior risco de menor massa muscular (OR 0,829; 95% - 0,732- 0,939; p< 0,003). O teste TUG apresentou associação estatísticamente significativa com massa gorda total, as idosas que realizaram o teste no intervalo entre 10 e 19 segundos têm 19.4 vezes mais chances de serem obesas, quando comparadas àquelas que realizaram o teste em menos de 10 segundos; as idosas que fizeram em tempo maior ou igual a 20 tiveram chance 23.3 vezes maior de serem obesas . Quando dividas em sub grupos, o sub grupo B, caracterizado por massa gorda total alta e massa magra baixa, apresentou maior comprometimento no teste TUG do que grupo A, massa magra e massa gorda diminuída com média do grupo A de 13.1 (±6.64) e a do grupo B de 16.60 (± 4.54) com p = 0.008..Conclusões: Os achados deste estudo mostraram que existe associação entre o aumento de massa gorda total e piora no desempenho no teste TUG; e menor massa muscular apendicular e menor força de preensão palmar. Mesmo quando divididos em sub grupos a massa gorda deve ser considerada como componente de risco para limitação funcional. Deste modo a avaliação da composição corporal se faz necessária para determinar os fatores associados ao declínio funcional e fragilidade / Abstract: Objective: This study aimed to evaluate the relationship between body composition, specifically appendicular muscle mass and total fat mass, according to measures of functionality in non-institutionalized elderly. Method: It is a crosssectional analytical sample of 99 elderly over age 60, who underwent examination Densitometry Total Body Dual X-Ray Emission for assessing body composition. In addition, tests were used to measure the functionality, like the TUG test, grip strength and gait speed. We considered also the unintentional weight loss of selfreport of fatigue. Results: The sample had a mean of appendicular muscle mass of 16.91 kg (± 3.28), mean found for total fat mass of 25.47 kg (± 11.03), we observed statistically significant differences in tissue composition body between the age groups, and found a lower appendicular muscle mass in subjects older than 80 years old and less total fat mass also in this age group. The extent of functionality in grip strength is related to muscle mass appendicular, and elderly women with less FPM have higher risk of lower muscle mass (OR 0.829, 95% - from 0.732 to 0.939, p <0.003). The TUG test were significantly associated with total fat mass; elderly women who underwent testing in the range between 10 and 19 seconds are 19.4 times more likely to be obese, compared to those who took the test in less than 10 seconds; elderly women made in time greater than or equal to 20 were 3.23 times greater chance of being obese. When divided into subgroups, the subgroup B, characterized by high total fat mass and lean mass low, showed more commitment in TUG test than group A; lean mass and fat mass decreased in group A with an average of 13.1 (± 6.64) and the group B of 16.60 (± 4.54) with p = 0.008. Conclusions: The findings of this study showed that there is an association between increased total fat mass and deterioration in TUG test performance, and lower appendicular muscle mass and lower grip strength. Even when divided into subgroups, fat mass should be considered as a component of risk for functional limitation. Thus the assessment of body composition is needed to determine the factors associated with functional decline and frailty / Mestrado / Gerontologia / Mestra em Gerontologia

Orientadores: Maria Elena Guariento, André Fattori / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T14:26:02Z (GMT). No. of bitstreams: 1 Stein_CristianeSerafim_M.pdf: 1514299 bytes, checksum: 40ece1177d3d24a813ac5689ba52c549 (MD5) Previous issue date: 2012 / Resumo: Introdução: Cresce no Brasil e no mundo a prevalência e o impacto das doenças crônicas não transmissíveis. O rápido envelhecimento da população brasileira está associado a esse crescimento e dificulta a efetiva prevenção e tratamento destas doenças e de suas complicações, levando, consequentemente, à perda de autonomia e de qualidade de vida. Entre essas doenças estão as doenças pulmonares crônicas. Numa projeção para as próximas décadas as doenças pulmonares crônicas estarão entre as cinco principais causas de anos de vida perdidos por morte precoce e por incapacidade. O tabagismo aumenta o risco das doenças pulmonares crônicas no adulto e, sobretudo no idoso agrava as alterações fisiológicas próprias do envelhecimento. Uma vez que a doença pulmonar crônica e o tabagismo participam significativamente de um quadro clínico pior, é interessante estudar sua relação com a síndrome da fragilidade, um evento biológico associado à maior vulnerabilidade de agentes estressores e comprometimento da homeostase, principalmente em faixas etárias mais avançadas. Objetivo: Este estudo objetivou investigar a prevalência de doença pulmonar crônica referida em amostra de idosos comunitários e sua relação com tabagismo, índice de massa corporal, sintomas depressivos e fragilidade e seus indicadores. Métodos: Trata-se de um estudo observacional e transversal, de base populacional, do qual participaram 2.315 idosos, com 65 anos e mais. Os dados foram obtidos em seis cidades brasileiras, localizadas nas regiões Norte, Nordeste, Sudeste e Sul, mediante recrutamento feito em domicílios localizados em setores censitários sorteados ao acaso, conforme plano amostral definido previamente, no período de 2.008 e 2.009. Avaliou-se doença pulmonar crônica referida, tabagismo atual e pregresso, bem como o fenótipo de fragilidade, segundo Fried et al, 2.001, em ambos os grupos (com e sem auto relato de doença pulmonar crônica. Constituíram-se quatro grupos para comparação: com autorrelato de doença pulmonar, com e sem tabagismo, separadamente; e outros dois sem o autorrelato de doença pulmonar, também com a presença ou não de tabagismo. As variáveis categóricas foram submetidas à análise de frequência absoluta e percentual. Para comparação das principais variáveis categóricas foram utilizados os testes de qui-quadrado ou exato de Fisher para valores esperados menores que cinco e o teste de Mann-Whitney para comparação de variáveis numéricas entre dois grupos. Para estudar os fatores associados com a presença de doença pulmonar crônica referida foi utilizada a análise de regressão logística univariada e multivariada, com critério stepwise de seleção das variáveis. Para verificar a associação entre doença pulmonar crônica referida e fragilidade, a variável "doença pulmonar crônica" foi selecionada como variável independente. O nível de significância adotado foi de 5% (p<0,05). Resultados: Dos entrevistados 10,8% referiram doença pulmonar crônica e 43% eram fumantes ou ex-fumantes. Verificou-se associação significativa em relação à doença pulmonar crônica referida e índice de massa corporal (com a condição de baixo peso, p<0,001) e com tabagismo (com os ex-fumantes, p<0,001). A análise de regressão logística para fragilidade mostrou associação com doença pulmonar crônica (p<0,001) e a fragilidade em fadiga também se associou com esta enfermidade (p=0,003). Após análise comparativa entre fragilidade (geral e indicadores) entre os quatro grupos formados da combinação entre doença pulmonar crônica referida e tabagismo, verificou-se maior frequência de fragilidade naqueles com doença pulmonar (com ou sem tabagismo), p= 0,013; maior frequência de fragilidade em fadiga nos com doença pulmonar (com ou sem tabagismo), p=0,006; maior frequência de fragilidade em perda de peso nos tabagistas (com ou sem doença pulmonar crônica); e maior frequência de lentidão na marcha nos com doença pulmonar crônica, não tabagistas, p= 0,013. Conclusão: Nesta amostra de população idosa brasileira com doença pulmonar crônica referida evidenciou-se associação desta com a fragilidade, baixo índice de massa corporal e ao ex-tabagismo. Este achado destaca a relevância de se desenvolverem estudos que permitam esclarecer melhor esta associação, bem como desenvolver estratégias que previnam uma piora do quadro e uma evolução para uma condição de fragilidade e seus conhecidos desfechos / Abstract: Introduction: It grows in Brazil and worldwide prevalence and impact of chronic diseases. The rapid aging of the population is associated with this growth and hinders effective prevention and treatment of these diseases and their complications, leading consequently to loss of independence and quality of life. Among these diseases are chronic pulmonary diseases. In a projection for the next decades the chronic pulmonary diseases will be among the top five causes of years of life lost due to premature death and disability. Cigarette smoking increases the risk of chronic pulmonary diseases in adults and especially in the elderly aggravates the physiological changes of aging. Once the chronic pulmonary diseases and smoking significantly participate in a clinical worst, it is interesting to study its relationship with the syndrome of frailty, a biological event associated with greater vulnerability to stressors and impaired homeostasis particularly in older age groups. Objective: This study aimed to investigate the prevalence of chronic pulmonary disease that in a sample of elderly community and its relation to smoking, body mass index, depressive symptoms and frailty and these indicators. Methods: This is an observational, cross-sectional population-based, which involved 2.315 elderly aged 65 years and older. Data were obtained in six Brazilian cities, located in the North, Northeast, Southeast and South, through recruitment done in households located in census tracts drawn randomly sampling plan as defined previously, between 2.008 and 2.009. It was evaluated that chronic pulmonary disease, former and current smoking, as well as the phenotype of frailty, Fried et al., 2.001, in both groups (with and without self-report chronic pulmonary disease. Four groups were formed for comparison: with self-reported pulmonary disease, with and without smoking, separately, and two others without self-reported lung disease, also with the presence or absence of smoking. Categorical variables were analyzed for absolute frequency and percentage. To comparison of the major categorical variables were used chi-square or Fisher exact test for expected values less than five and the Mann-Whitney test for comparison of numerical variables between two groups. To study the factors associated with the presence of chronic pulmonary disease such analysis was used for univariate and multivariate logistic regression with stepwise selection criterion variables. To investigate the association between chronic pulmonary disease and frailty the variable "chronic pulmonary disease" was selected as the independent variable. The significance was 5% (p <0.05). Results: 10.8% reported chronic pulmonary disease and 43% were smokers or former smokers. There was a significant association in relation to chronic pulmonary disease self-reported and the condition of pre-frailty and frailty (58.4% and 9.2% respectively, p = 0.003) and weakness in fatigue (27.8%, p = 0.002). After comparative analysis of frailty (general and indicators) among the four groups formed from the combination of smoking and chronic pulmonary disease self-reported, there was a higher frequency of frailty in those with chronic pulmonary disease (with or without smoking), p = 0.013; higher frequency of frailty in fatigue in those with chronic pulmonary disease (with or without smoking), p = 0.006; higher frequency of frailty in weight loss in smokers (with or without chronic pulmonary disease) and higher frequency of slow march with the chronic pulmonary disease, nonsmokers, p = 0.013. Conclusion: In this sample of Brazilian elderly population with chronic pulmonary disease that showed up this association was with the frailty, low body mass index, former smoking. This finding highlights the importance of developing studies to clarify this association, as well as develop strategies to prevent a worsening of symptoms and a trend for a condition known frailty and its outcomes / Mestrado / Gerontologia / Mestra em Gerontologia

Bakgrund: Välfärdstekniska hjälpmedel kan möjliggöra sköra äldre personers kvarboende i den egna bostaden och är därför viktiga att utveckla. Applikationer (appar) för mobilt trygghetslarm är ett exempel, för att skapa trygghet i aktiviteter i och framförallt utanför den egna bostaden, vilket bidrar med delaktighet i samhället för användaren. Det är dock oklart hur äldre personer ser på dessa hjälpmedel. Syfte: Syftet med studien var att beskriva sköra äldre personers aktiviteter utanför den egna bostaden samt deras attityder relaterat till framtida användning av mobilt trygghetslarm vid dessa aktiviteter. Metod: En enkätundersökning genomfördes på en geriatrisk slutenvårdsavdelning (n=47). Analyser, bland annat gruppjämförelser genomfördes via Chi2-test (χ2) och Mann Whitney U-test. Resultat: Antalet aktiviteter utanför bostaden en vanlig vecka ­var lågt (                         =3) och respondenterna avstod dessa aktiviteter då de ofta var otrygga (n=21), ensamma då de gick ut (n=30) eller kände oro (n=27). Ensamboende och kvinnor avstod i högre utsträckning aktiviteter utanför bostaden jämfört med sammanboende och män. Slutsats: Flera deltagare ansåg att appen skulle öka deras aktiviteter utanför den egna bostaden och respondenterna hade generellt en positiv attityd relaterat till framtida användning av app för mobilt trygghetslarm. / Background: Welfare technology aids can enable frail elderly people to age in place and are therefore important to develop. Applications for mobile security alarms are an example to create security in activities, especially outside the home, which contributes to engagement in the society. However, it is unclear how frail elderly people look at these aids. Objective: The purpose of the study was to describe activities of frail elderly people outside their own homes and their attitudes related to the potential future use of mobile security alarms in these activities. Method: A survey was conducted in a geriatric department (n=47). Analyses, including group comparisons, were conducted by Chi-Test (χ2) and Mann Whitney U-Test. Result: The number of activities outside the home a regular week was low (                          = 3) and the participants abstained from these activities because they were insecure (n=21), alone when they went out (n=30) or felt unease (n=27). Lonely living and women engaged significant lower in activities outside their home compared with cohabitants’ and men. Conclusion: Several participants considered that the application would increase their activities outside their own home and the participants generally had a positive attitude related to the future use of mobile security alarm applications.

Background Palliative care services have widened beyond cancer in recent years, yet frail older adults rarely receive such services. There is a need to understand the dynamic multidimensional end-of-life experiences of this group in order to assess how or if a palliative approach could be beneficial. Physical end-of-life trajectories for frail older people have been described but there remains little person centred research that describes changing experiences across physical, social, psychological and existential dimensions. Aims and objectives To explore the changing multidimensional experiences of frail older people towards the end of life and to reflect on the utility of a qualitative longitudinal multi-perspective design for this population. Methods Thirteen cognitively intact, community dwelling older adults considered to be moderately or severely frail, using a clinical frailty scale, and thirteen nominated informal carers participated in up to three narrative interviews over eighteen months. Eight nominated professionals were also interviewed. The interviews were participant led, audio-recorded and fully transcribed. The ‘voice centred relational’ narrative method, incorporating analyses of multidimensional experience, was used to analyse the data. The data were then analysed longitudinally to compile case studies for each older person. Findings The narratives of these frail older people approaching the end of life illustrate patterns of multidimensional experience that differ from the end-of-life trajectories of other groups. All participants experienced physical decline however three possible patterns of psychological, social and existential experience emerged. These were stable, regressive and tragic according to the capacity to hold on to core values, and maintain a sense of self and of belonging in the world and are illustrated using visual trajectories. When the sense of self was threatened these frail older people lacked valued alternative identities and struggled with the absence of clear causative factors to explain their circumstances. The participants frequently described fears of burdening others, of moving to a nursing home or of developing dementia more than fears of dying. Losses and sustaining factors are described for physical, social, psychological and existential dimensions revealing the importance of social and community networks for supporting frail older people. There were constraints and benefits to using a qualitative longitudinal multi-perspective method, however the method enabled a deep, contextualised and rich understanding of the dynamic experiences of frail older people. Conclusion Frail older people may be supported towards the end of life by considering ways to promote the integration of the self. This may involve promoting valued alternative identities, protecting personhood through social and health care practices and by investigating ways to alleviate or make tolerable greatest fears. Community health and social care structures and social and community networks appear essential for addressing the end-of-life needs of frail older people. A qualitative, longitudinal, multi-perspective design was beneficial for investigating the experiences of frail older people.

Magister Curationis - MCur / The international concern about human rights, gender equality, domestic violence and the increase in the aging populations has brought elder abuse into the public focus. Elder abuse is a complex, multi-faceted health, social, criminal justice, international public health and human rights issue. The widely divergent and varying definitions is a controversial problem to understanding elder abuse. The elderly have been excluded from national gender-based programs on domestic violence and the abuse of women and children. In South Africa victims of elder abuse are often physically and or cognitively unable to speak for themselves which necessitates that the public be empowered and trained to become advocates for the aged. Lachs & Pillemer ( 2004 : 1265 ) states that "the physical and psychological impairement of elder persons could be predisposing factors for elder abuse ". Statistical evidence on the incidence and prevalence rates of elder abuse is lacking as elderly persons are reluctant to identify care givers for fear of abandonment, retaliation and being left destitute ( Lachs & Pillemer, 2004 : 1265 ). Despite the Bill of Rights as set out in the South African Constitution and the Older Persons Act, No. 13 of 2006 which was developed to deal with the empowerment and protection of elder persons and promote and maintain their status, rights, safety, security and well being the abuse of elder person continues to occur ( Older Persons Act, No. 13 of 2006 ). This qualitative research study is allied with the phenomenological approach in an attempt to understand elder person&rsquo;s perception, viewpoints and perspectives from their lived experiences and personal lives. Three (3) focus group discussions and eighteen (18) one-on-one interviews were conducted with elder persons living in the suburbs of Cape Town. Data from participants were audio-taped, transcribed verbatim before an inductive analysis lead to the emergence of broad themes and patterns. The main findings of the research study concluded that elderly persons were informed but not empowered about financial, emotional and verbal abuse. The abuse of the elder person in old age homes also featured prominently. The findings of the research study can be used to provide education and empower elder persons and the general public on specific aspects related to elder abuse which are : Financial, Emotional, Verbal and the abuse by staff at old age homes. These findings could be utilized by health and social welfare advocates and organisations who offer community educational and development programs to advocate against elder abuse. / South Africa

Orientadores: Maria Elena Guariento, André Fattori / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T03:14:25Z (GMT). No. of bitstreams: 1 Gubel_VanessaMariaCamargoAndradeRibeiro_M.pdf: 969445 bytes, checksum: 371eedd775785b6aea4193dba817ccfb (MD5) Previous issue date: 2013 / Resumo: Objetivos: Descrever a ocorrência de quedas em uma amostra de idosos do município de Campinas (SP); investigar as relações entre quedas e fragilidade. Métodos: Participantes: Amostra probabilística de 689 idosos sem déficit cognitivo sugestivo de demência recrutados em domicílio no contexto do estudo multicêntrico e multidisciplinar "Perfil de Fragilidade de Idosos Brasileiros" (Rede FIBRA). Procedimentos: Primeira parte: Aplicou se um questionário com levantamento de dados sociodemográficos; doenças crônicas e / ou sintomas auto-referidos; uso regular de medicamentos auto-referido; medidas do fenótipo de fragilidade (segundo Fried et al., 2001); antecedentes de quedas. Resultados: A média de idade foi 72,27 anos; 68,37% eram mulheres; 69,10% relataram quedas; 50,87% eram pré-frágeis e 4,81% foram classificados como frágeis. Houve associação significativa entre ocorrência de quedas e as variáveis: idade ? 80 anos (p=0,004), sexo feminino (p<0,001), déficit visual (p=0,002), artrite referida (p=0,002) e sintomas depressivos (p=0,005). A análise de regressão logística multivariada evidenciou que sexo feminino, déficit visual e presença de critérios de fragilidade foram os fatores que apresentaram maior associação com quedas. Conclusões: Faz-se necessário identificar os fatores associados ao maior risco de quedas para que se obtenha um efetivo controle das mesmas. Entre esses, há que se destacar a presença de um ou mais dos critérios que compõem o fenótipo de fragilidade / Abstract: Objectives: to describe the occurrence of falls in community-dwelling elders from Campinas (SP); to investigate the relationship between falls and fragility. Methods: Participants: 689 community-dwelling elderly recruited during the multicenter and multidisciplinary project "Estudo do Perfil de Fragilidade de Idosos Brasileiros-FIBRA.UNICAMP", that means Frailty Profile of the Brazilian Elderly. Procedures: Fist part: It was applied a questionnaire which collected socio-demographic data; daily life activities; presence of depressive symptoms; cognitive evaluation; self-referred diseases and / or symptoms; self-referred medicines; body mass index; measures of the frailty's phenotype (according Fried et al., 2001); previous falls. Results: Mean age was 72.27 years, 68.37% were women. 69.10% of the elderly reported falls, and 55.68% presented at least one frailty criteria. There was significant association between falls and the variables: age ? 80 years (p = 0.004), female gender (p <0.001), visual impairment (p = 0.002), reported arthritis (p = 0.002), and depressive symptoms (p = 0.005). Multivariate analysis showed that female gender; visual impairment and frailty criteria had a greater association with falls. Conclusions: It's necessary to identify the events which are associated to the biggest risk of falls to obtain an effective control of them. Therefore, as it was demonstrated in this study it's important to recognize the presence of the criteria of frailty (Fried et al., 2001) / Mestrado / Gerontologia / Mestra em Gerontologia

Orientador: Paulo José Fortes Villas Boas / Resumo: Introdução: A Síndrome da Fragilidade (SF) descreve o estado clínico no qual o idoso apresenta diminuição das reservas fisiológicas e da função de diversos sistemas e órgãos, de tal modo que a capacidade para lidar com fatores estressores do dia a dia fica comprometida, resultando em vulnerabilidade clínica. A hospitalização é considerada um evento que traz consequências importantes para a funcionalidade do idoso e se tratando de idosos frágeis essa consequência pode ser ainda mais grave. Objetivo: Avaliar a prevalência da Síndrome da Fragilidade em idosos internados através de dois instrumentos: Critérios do Cardiovascular Health Study (CHS) e Índice do Study of Osteoporotic Fractures (SOF) e associar a SF com desfechos da internação. Métodos: Estudo observacional analítico e prospectivo. Foram avaliados 98 pacientes internados e identificados através da análise de prontuário os dados sociodemográficos e clínicos e aplicados, no início da internação, os instrumentos CHS e SOF, que classificaram os pacientes como frágeis, pré frágeis ou saudáveis. Após a saída do paciente, através de análise de prontuário, foi observado o desfecho da internação (tempo de internação, complicações na internação, reinternação e óbito na internação/reinternação). Foram feitas associações das variáveis clínicas e desfechos com a SF e análise de concordância entre os instrumentos. Resultados: A amostra foi composta por 98 pacientes com média de idade de 75,30±9,40 anos, sendo 50% do sexo feminino. ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The Frailty Syndrome (FS) describes the clinical stage in which the elderly people present a reduction of the physiological reserves as well as of the functions of diverse systems and body organs, in a way that the ability to deal with daily stress factors is compromised, resulting in a clinical vulnerability. Hospitalization is considered an event that brings important consequences to the elderly functionality and when dealing with frail elderly people this consequence can be even more serious. Objective: To evaluate the prevalence of the Frailty Syndrome in hospitalized elderly people through two criteria: Cardiovascular Health Study index (CHS) and the Study of Osteoporotic Fractures index (SOF) and to relate the FS with the hospitalization outcome. Methods: Analytical and prospective observational study. Ninety-eight hospitalized patients were evaluated, and based on the medical records, the sociodemographic and clinical data were identified and applied in the beginning of the hospitalization, the CHS and SOF indexes that classified the patients as frail, pre-frail, or healthy. After the patient was discharged from the hospital, the outcome of the hospitalization was observed based on the medical records analysis (hospitalization period, complications and death during the hospitalization and rehospitalization). Clinical variables associations were carried out with the FS and between indexes. Results: The sample was composed by 98 patients, with an average ag... (Complete abstract click electronic access below) / Mestre

No description available.

Two groups of urban residents present ongoing problems, the frail elderly and disadvantaged youth who are approaching transition from school to the work force. Many of the disadvantaged youth are at risk because of family background, inadequate education, and lack of work experience. Many of the frail elderly are unable to care for themselves because of debility, chronic illness, or functional impairments (Eustis, 1974). The United States is experiencing an unprecedented increase in the numbers of persons over 65 years of age and it is expected that between 1980 and 2000 there will be a 67 percent increase in persons 80 and over. These demographic changes are significant especially for long-term care policy for the elderly. There is an urgent need to provide the kind of care that permits them to continue to live in their own homes. The frail elderly perceive their need for a dependable source of food as a primary requirement. If this is not met, institutional care becomes the only possible option. Urban youth face an increasing pressure to take a job in order to earn money, often at the expense of further education. Part-time work and school can be managed, and with planning, the classroom curriculum can be blended with the job. Intergenerational programs present a possible solution to some of the problems of the frail elderly and youth. They can be brought together through one of these programs for their mutual benefit. Intergenerational programming is the process of planned and purposeful interaction between generations. The programs encompass a range of ideas as they are guided by the needs of the community and its resources to meet these needs (Newman, 1983). Project MAIN was one of these projects. In 1983 under the auspices of Portland Youth Advocates, Project MAIN was created to meet the needs of the frail elderly and youth in an urban area. Many of the frail elderly were confined to their homes, unable to do ordinary tasks such as grocery shopping. Low-income teenagers needed access to an income-generating jobs program that would permit them to remain in school. Project MAIN was planned to help disadvantaged youth and simultaneously enrich the lives of the elderly (Ventura-Merkel, 1988). Project MAIN was conceived as a dynamic entity that could not be seen directly, but perceived as a process that had qualitative effects on those with whom it came in contact. It was planned as an active participatory learning experience for youth. Relevant classroom curricula blended with part-time jobs. The focus was on full participation by the youth in the process of providing a shopping service for the homebound elderly. Two important elements of the project were active youth participation and project-oriented learning. The youth planned and operated a shopping service for the frail elderly clients. The youth continued with their education and worked part-time. They began with minimum wage and increases came regularly, following satisfactory evaluation by peers and staff. As they became more competent, they assisted the staff with supervision and instruction. A case study explored the outcomes of Project MAIN. A weakness in the data from guided interviews of the clients resulted from memory loss and confusion encountered in a few of the elderly. A strength was the flexible interviews which gave the elderly time to explore new ideas as they emerged. The outcomes of Project MAIN were measured by the level of satisfaction for both the elderly clients and the participating youth. The levels of satisfaction were high in the pilot project, with its four weeks of intensive training and careful supervision. Adequate funding from private organizations made this possible. In the demonstration phase, funding became an acute problem. Training and supervision of the youthful shoppers was curtailed. Although the clients found the service better than they had before Project MAIN, complaints of broken appointments and declining dependability began to be heard. It became evident that the youth were in need of better preparation and more intensive supervision. Because of lack of funds, it was not possible to supply staff for these tasks. From the outcomes of the pilot project, it is evident that the concept of Project MAIN is a viable one for meeting the needs of the frail elderly and youth. However, from the demonstration phase, it was seen that without adequate funding, the quality of the shopping service declined. Decisions need to be made in the early planning of a program like Project MAIN. Elimination of staff needed for training and supervision in favor if increasing the number of youthful shoppers can threaten the viability of the program.