Conselho Nacional de Desenvolvimento Científico e Tecnológico / Este estudo visa avaliar, através de uma revisão, as qualidades conceituais e psicométricas dos instrumentos de avaliação do estado funcional do paciente idoso, e de suas adaptações para o contexto do Brasil. A dissertação está estruturada em três partes. A primeira é constituída de cinco seções que introduzem os temas do envelhecimento da população mundial e de países emergentes como o Brasil como razões de base para um estudo do atendimento do paciente idoso. Descreve-se o que se entende por estado funcional do paciente idoso no contexto da avaliação geriátrica interdisciplinar. A parte 2 se constitui no artigo da dissertação. Na seção de material e métodos descreve-se detalhadamente a revisão realizada e os bancos de dados utilizados. Nas últimas duas seções do artigo apresentam-se os resultados e a discussão, em que se verificam, em primeiro lugar, um bom número de instrumentos com propriedades psicométricas adequadas que avaliam as subdimensões do estado funcional. Dos 30 instrumentos escolhidos utilizando critérios explicitados pelos autores, apenas dois, o Multiple Outcomes Study SF-36 e o Health Assessment Questionnaire, possuem adaptação para 0 português. Entretanto, alguns dos instrumentos revisados vêm sendo utilizados em nosso meio sem adaptação formal prévia. Vários destes instrumentos possuem bons históricos em sua língua original, porém este fato ainda não despertou a preocupação da comunidade brasileira para adaptações formais dos mesmos. Também se constatam a escassez de estudos de adaptação e concepção de instrumentos desta dimensão no contexto brasileiro. Alguns aspectos deste problema são discutidos, além de possíveis caminhos para corrigi-lo. Na parte final desta dissertação são sucintamente descritos os instrumentos de cada subdimensão de estado funcional escolhidos como mais interessantes na parte 2. Em seguida, são indicadas outras dimensões consideradas pertinentes para um escrutínio semelhante. A conclusão geral sugere uma melhor utilização de medidas de saúde estruturadas no contexto da avaliação geriátrica no Brasil. / This study aims to evaluate, through a review, conceptual and psychometric qualities of the instruments to assess the functional status of elderly patients, and their adaptation to the context of Brazil. The dissertation is structured in three parts. The first consists of five sections that introduce the themes of global aging and emerging countries like Brazil reasons as the basis for a study of the care of elderly patients. Described what is meant by functional status of elderly patients in the context of interdisciplinary geriatric assessment. Part 2 constitutes the article dissertation. In the section of materials and methods are described in detail the review performed and the databases used. In the last two sections of the article presents the results and discussion, in which there are, firstly, a number of instruments with adequate psychometric properties that assess the subdimensions of functional status. Of the 30 instruments selected using the criteria described by the authors, only two, the Multiple Outcomes Study SF-36 and the Health Assessment Questionnaire, have adapted to 0 Portuguese. However, some of the reviewed instruments have been used in our midst without prior formal adaptation. Several of these instruments have good historical in its original language, but this fact has not aroused the concern of the Brazilian community for formal adaptations thereof. Also note the lack of studies of adaptation and design of instruments of this size in the Brazilian context. Some aspects of this problem are discussed, and possible ways to fix it. In the final part of this dissertation are briefly described the instruments of each sub dimension of functional status chosen as most interesting in part 2. Then, are indicated other dimensions deemed relevant to similar scrutiny. The general conclusion suggests a better use of health measures in the context of structured geriatric assessment in Brazil.

The widespread use of antibiotics has led to dramatic increases in the incidence and severity of Clostridium difficile infection (CDI). No group of patients suffers more from CDI than the elderly. Nursing homes (NH) represent the perfect storm of a vulnerable group of frail elders living in confined communities. Nursing home residents suffer from increased morbidity and mortality from CDI and corresponding high rates of C. difficile colonization. Upwards of 40 to 50% of CDI current cases originate from NHs and the prevalence of colonization rates remain high within these facilities, with as many as half of the residents being colonized with C. difficile at any given time. One factor that has become of increasing interest and a target of preventive strategies is the human intestinal microbiome. A healthy, diverse microbiome interacts with the host immune system and contributes to pathogen resistance. In this investigation, we first examine elder specific variables to determine if the associated risks of CDI differ by home living environment (nursing home versus community-dwelling). We then go on explore the relationships of NH environment, frailty, nutritional status, and residents’ age with microbiome composition and potential metabolic function. Finally, we describe the C. difficile colonization patterns among elderly NH residents and the associated risk of colonization based on clinical variables and microbiome determinants. A better understanding of the microbiome’s contribution to C. difficile colonization will provide the basis for informing rational interventions and public health policies to better combat CDI in the nursing home.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Este estudo visa avaliar, através de uma revisão, as qualidades conceituais e psicométricas dos instrumentos de avaliação do estado funcional do paciente idoso, e de suas adaptações para o contexto do Brasil. A dissertação está estruturada em três partes. A primeira é constituída de cinco seções que introduzem os temas do envelhecimento da população mundial e de países emergentes como o Brasil como razões de base para um estudo do atendimento do paciente idoso. Descreve-se o que se entende por estado funcional do paciente idoso no contexto da avaliação geriátrica interdisciplinar. A parte 2 se constitui no artigo da dissertação. Na seção de material e métodos descreve-se detalhadamente a revisão realizada e os bancos de dados utilizados. Nas últimas duas seções do artigo apresentam-se os resultados e a discussão, em que se verificam, em primeiro lugar, um bom número de instrumentos com propriedades psicométricas adequadas que avaliam as subdimensões do estado funcional. Dos 30 instrumentos escolhidos utilizando critérios explicitados pelos autores, apenas dois, o Multiple Outcomes Study SF-36 e o Health Assessment Questionnaire, possuem adaptação para 0 português. Entretanto, alguns dos instrumentos revisados vêm sendo utilizados em nosso meio sem adaptação formal prévia. Vários destes instrumentos possuem bons históricos em sua língua original, porém este fato ainda não despertou a preocupação da comunidade brasileira para adaptações formais dos mesmos. Também se constatam a escassez de estudos de adaptação e concepção de instrumentos desta dimensão no contexto brasileiro. Alguns aspectos deste problema são discutidos, além de possíveis caminhos para corrigi-lo. Na parte final desta dissertação são sucintamente descritos os instrumentos de cada subdimensão de estado funcional escolhidos como mais interessantes na parte 2. Em seguida, são indicadas outras dimensões consideradas pertinentes para um escrutínio semelhante. A conclusão geral sugere uma melhor utilização de medidas de saúde estruturadas no contexto da avaliação geriátrica no Brasil. / This study aims to evaluate, through a review, conceptual and psychometric qualities of the instruments to assess the functional status of elderly patients, and their adaptation to the context of Brazil. The dissertation is structured in three parts. The first consists of five sections that introduce the themes of global aging and emerging countries like Brazil reasons as the basis for a study of the care of elderly patients. Described what is meant by functional status of elderly patients in the context of interdisciplinary geriatric assessment. Part 2 constitutes the article dissertation. In the section of materials and methods are described in detail the review performed and the databases used. In the last two sections of the article presents the results and discussion, in which there are, firstly, a number of instruments with adequate psychometric properties that assess the subdimensions of functional status. Of the 30 instruments selected using the criteria described by the authors, only two, the Multiple Outcomes Study SF-36 and the Health Assessment Questionnaire, have adapted to 0 Portuguese. However, some of the reviewed instruments have been used in our midst without prior formal adaptation. Several of these instruments have good historical in its original language, but this fact has not aroused the concern of the Brazilian community for formal adaptations thereof. Also note the lack of studies of adaptation and design of instruments of this size in the Brazilian context. Some aspects of this problem are discussed, and possible ways to fix it. In the final part of this dissertation are briefly described the instruments of each sub dimension of functional status chosen as most interesting in part 2. Then, are indicated other dimensions deemed relevant to similar scrutiny. The general conclusion suggests a better use of health measures in the context of structured geriatric assessment in Brazil.

O contexto do envelhecimento dos idosos mais velhos necessita ser considerado em decorrência dos fatores socioeconômicos, políticos e demográficos do país, além do processo de redefinição da família como instituição social. Dessa forma, a pesquisa relacionada aos arranjos domiciliares e a rede de suporte social, vem de encontro com as questões relacionadas ao cuidado do idoso no domicilio, principalmente dos idosos mais velhos. Tratase de um estudo epidemiológico, transversal, que teve por objetivo caracterizar o arranjo domiciliar e a rede de suporte social dos idosos mais velhos residentes na comunidade de Ribeirão Preto, SP, além da sua funcionalidade. A amostra constituiu-se de 147 idosos. Os dados foram coletados em entrevistas domiciliares, utilizando-se identificação e perfil social, o Mapa Mínimo de Relações do Idoso (MMRI) para investigar a rede de suporte, a Medida de Independência Funcional (MIF) e questões sobre os arranjos domiciliares. A idade média das idosas foi de 84,4 anos e dos idosos de 84,1 anos, sendo 63,3% na faixa etária de 80-84 anos, 27,2% na de 85-89 anos e 9,5% na de 90 anos ou mais. Há maior número de idosas viúvas, 91,3% e analfabetas, 83,3%. Do total dos idosos, 41,5% recebem aposentadoria, possuem de um a três salários mínimos (72,1%) e moram em casa própria quitada (74,1%). Os idosos possuem em média 4,08 filhos e residem com 2,8 pessoas. Quanto à funcionalidade, a variação dos escores observados foi igual à variação possível da MIF motora, cognitiva social e total, assim como em seus domínios, com a média das pontuações próxima aos valores máximos possíveis. A maioria dos idosos classificou-se na categoria independência completa/modificada, 81,6% e 15% na dependência mínima. À medida que os idosos se tornam mais velhos se tornam mais dependentes (p < 0, 001). Não foi encontrada significância estatística entre a MIF total e arranjo domiciliar, apesar da tendência de morar sozinho aumentar conforme aumenta a pontuação na MIF. A relação com o suporte social também não foi significativa. Grande parte dos idosos vive com o cônjuge, 26,5% e 14,3% vivem sozinhos. Mais da metade dos domicílios são chefiados pelo próprio idoso, 57,1%. Conforme aumenta a faixa etária diminui o número de idosos que vivem com o cônjuge e aumenta os que vivem com os filhos. Quanto à configuração da rede de suporte social dos idosos, houve predomínio de pessoas no primeiro círculo, isto é, freqüentemente, com ênfase para os filhos e familiares, para todas as funções analisadas. A média do número de amigos e pessoas da comunidade para todos os tipos de apoio foi menor que um, o que reforça a família como protetora e cuidadora dos idosos. / The context of aging of the elder elderly needs to be considered due to the countrys socioeconomic, political and demographic factors, besides the process of redefining family as a social institution. In this way, research regarding the domestic organization and the social support network, meets the questions related to elderly care at home, especially the elder elderly. It is an epidemiologic cross-sectional study, which aimed to characterize the domestic organization and the social support network of the elder elderly living in Ribeirão Preto, SP, as well as its functionality. The sample was made of 147 elderly. Data were collected in interviews at home, using the social identification and profile, the Minimum Map of Elderly Relations (MMRI) to investigate the support network, the Functional Independence Measure (MIF) and questions about the domestic organizations. The average age of female elderly was 84,4 years, and male 84,1 years, 63,3% were in the age group 80-84 years, 27,2% between 85- 89 years and 9,5% were 90 years or more. There is a larger number of old widows (91,3%) and illiterates (83,3%). From the total of the elderly, 41,5% receive pension, earn from one to three minimum wages (72,1%) and live in their own house (74,1%). The elderly have 4,08 children and live with 2,8 people. Regarding functionality, the variation of the observed score was equal the possible variation of motor, social cognitive and total MIF, as well as its domains, with average scoring close to full score. Most elderly people (81,6%) was classified under the complete/modified independence category, and 15% as minimum dependence, as the elderly get older they become more dependent (p < 0, 001). There was no statistic significance between total MIF and domestic organization, despite the increasing tendency to live alone as MIF scoring raises. The relation to social support was not significant either. Great part (26,5%) of the elderly lives with the spouse, and 14,3% live alone. More them half of the domiciles (57,1%) are lead by the elderly itself. As the age group increases the number of elderly living with the spouse decreases, and increases the ones living with sons/daughters. Regarding the elderly social support network configuration, there was prevalence of people in the first circle, that is, frequently with emphasis for children and family, for all off the analyzed functions. The average of the number of friends and people from the community for all kinds of support was lower than one, what reinforces family as protector and caregiver of the elderly.

Background: Frequent ED users are generally over the age of 65 years, Medicare beneficiaries, sicker and have more health issues than non-frequent users. Elderly patients suffer a 20% mortality rate upon admission and a 30% decrease in activities of daily living (ADL) after discharge. Transitional care programs (TCP) decrease ED visits and readmission rates, improves ADLs, and increases event-free survival. Purpose: To evaluate the need of an ED TCP in the ED. Aims are to assess ED providers’, nurses’ and managers’ perceptions of elderly frequent ED users’ discharge needs, resources, and potential role of a TCP. Methods: Conducted within one community based ED in Tucson, Arizona. Survey content determined by a review of the literature focused upon elderly transitional care. Recruitment of nurses, providers, and managers following verbal consent. Inclusion criteria: willingness to participate in a 10-minute survey and work two shifts a month minimum within the ED. The survey is comprised of 19 questions focused on patient needs, current resources and the role of a TCP. Surveys were followed by a 5-minute post-survey session to review questions regarding content. Questions structured using a Likert scale format and categorical answers. Data analyzed using descriptive statistics. A needs assessment (NA) executive summary was presented to the ED staff and management. Results: One hundred providers, nurses, and managers completed the survey of which 79% were female, 73% registered nurses, 14% physicians, and 10% advanced practice providers. The majority of respondents believed elderly patients are discharged unsafely, additional resources were needed, more time was spend caring for elderly patients, and TCPs were a viable supportive option. “What is a transitional care team (TCT)?” was the most asked question during question and answer session. Implications: This NA revealed providers’, nurses’, and managers’ perceptions of elderly frequent ED user needs and the role of a TCP. Concerns identified are consistent with the literature. This NA provided information about ED staff perceptions of elderly frequent users and addressed transitional care while laying the groundwork for the potential future implementation of a TCP initiated in the ED.

Improved life expectancy is a triumph of modern medicine. However, today’s senior citizens are predicted to soon consume 75% of the available health-care resources. Identifying new strategies to promote a healthy ageing process has thus become a priority. In contribution to the research field of healthy ageing this thesis is focused on the health and gut function of older adults. Paper I explored ‘optimal functionality’; a new approach to put the older adult’s own perspectives on health in focus. According to the results a plethora of factors related to the body, the self and the external environment needs to be considered in order to create a comprehensive understanding of the health experience in old age. Paper II characterised senior orienteering athletes as a new model of healthy ageing, due to their significantly better percived health as compared to other free-living older adults; in particular they report better gut health. As the gut is important to health maintenance and immune function paper III explored inflammation and oxidative stress in senior orienteering athletes, and older adults with gut problems, generally finding low levels in both groups. Subsequently, Paper IV investigated the health status of free-living older adults in Örebro County and also reports the results from a randomised controlled trial evaluating the effect of a probiotic supplement on self-reported health and gut symptoms. Two-thirds of the included older adults reported gut problems, however, the probiotic intervention failed to show any effects. This thesis provides additional perspectives on older adults health and gut function, by concluding that 1) optimal functionality may be a useful concept to map areas of importance to the older adult’s health experience, 2) senior orienteers may be regarded as a suitable model to study healthy ageing, 3) the prevalence of gut problems among the general population of Swedish older adults is high, but was not improved by probiotic supplementation with Lactobacillus reuteri.

Diabetes prevalence is increasing in our ageing and increasingly obese society. Diabetes is a heterogeneous condition, and challenges remain in all aspects of its management - from diagnosis through to optimising treatment, to managing complications. Increasing age brings altered physiological responses to disease, treatments and complications - and there may be more wide-ranging considerations such as dietary, mobility, dependency or cognition, to name just a few. Hypoglycaemia is one of the most important potential side-effects of insulin-therapy, and elderly adults are at particular risk from its consequences. Insulin-treated patients may have long-standing Type 1 diabetes, or have Type 2 diabetes which has progressed to requiring insulin treatment, due to progressive beta cell deficiency. Even within this group of patients, there is heterogeneity, and assessment of risks can be challenging. Endogenous insulin levels can be assessed by measuring C-peptide. Recent advances in this has meant this is much more practical, enabling assessment of endogenous levels in large numbers of patients more feasible, and hence allowing important questions to be addressed. In the context of older patients, particularly interesting questions are whether patients with long-standing Type 2 diabetes can develop severe insulin deficiency, and whether absolute/severe endogenous insulin levels have an impact on treatment or complications of diabetes within insulin-treated cohorts – such as hypoglycaemia. This may thence raise the question of whether C-peptide measurement could potentially be used as an extra clinical tool for risk assessment in a patient population which can be tricky to manage at times. The aim of this thesis is thus to explore some of the issues around management of diabetes in the elderly: in particular hypoglycaemia, and use of C-peptide to more fully assess patients and consider a possible role for it in routine clinical care of some patients. Chapter 1 puts the thesis in context, firstly reviewing hypoglycaemia in the elderly in general, and then considering aspects of endogenous insulin levels and C-peptide measurement. Chapter 2 addresses the problem of recognition of hypoglycaemia in an elderly population, using primary care records and documented symptoms at consultations. Are we missing hypoglycaemia in this population? Accurate diagnosis of diabetes is crucial for getting people on the right treatment guidelines, and can be challenging. Chapter 3 uses a spot urine measure of C-peptide to test for the first time the accuracy of the UK Practical Classification Guidelines (published by the Royal College of General Practitioners and NHS Diabetes). Progressive insulin deficiency in Type 2 diabetes is the main reason people with long-standing Type 2 diabetes may eventually require insulin treatment. Chapter 4 uses the spot urine measure of C-peptide as a screening tool to assess if insulin-treated people with a clinical diagnosis of Type 2 diabetes may develop absolute insulin deficiency. Even more practical than a spot urine test to measure C-peptide, could be a random non-fasting blood measure of C-peptide, which could thus be measured when patients have their routine blood tests done in the community or outpatient appointments. Chapter 5 looks at how such a measure correlates with the gold-standard mixed meal tolerance test C-peptide measure. Severe insulin deficiency in Type 1 diabetes has been correlated with increased complications including hypoglycaemia, but the impact of endogenous insulin levels has not been assessed greatly in Type 2 diabetes. Chapter 6 reports a study looking into this possible relationship, using hypoglycaemia questionnaire responses from a large number of community-dwelling insulin-treated adults (of both diagnoses), in the context of their clinical diabetes diagnosis and their random non-fasted blood C-peptide levels. Chapter 7 assesses in more detail the rates of hypoglycaemia in a small group of insulin-treated patients with a clinical diagnosis of Type 2 diabetes, selected on the basis of their endogenous C-peptide levels. As well as subjective assessment of their hypoglycaemia experience using questionnaires, continuous glucose monitoring was used to objectively assess their rates of hypoglycaemia and glucose variability. Chapter 8 pulls all the above chapters together, summarising them in the context of other research, discussing their limitations and possible areas for future research, and their implications for now for clinical practice.

: INTRODUCTION : Osteoarthritis (OA) is a degenerative disease that predominantly affects geriatric population. However, geriatric patients are not often treated according to specific geriatric recommendations. OA also belongs to highly prevalent disorders managed mostly by symptomatic, analgetic drug treatment. The aim of this diploma thesis was to evaluate to which extend are clinical guidelines for management of OA focused (generallly and in areas of individual pharmacotherapeutic strategies) on specific aspects of rational geriatric pharmacotherapy. Diploma thesis was completed as a recherche thesis (part I.) for follow-up studies dealing with rationality of analgetic drug treatment in older patients (rigorous thesis of M. Miklasová MS, Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, 2016). METHOD : 4 national and 3 international clinical guidelines for management of osteoarthritis in accessible languages, published between 2005 and 2014 years, were identified by literature search conducted between 9/2015- 3/2017. Following guidelines were included : czech (2012), german (2009), australian (2009), american (2012) and recommendations of international societies OARSI (2008-2010), EULAR (2005, 2007) and NICE (2014).This diploma...

Jakobsbergsgeriatriken och Stockholms Läns Sjukvårdsområde betonar vikten av värdeskapande insatser och arbetssätt. Med patientperspektiv skapas resultat av betydelse för patienten. Delaktighet anges som en viktig del. Återkommande patientenkäter  visar att det finns ett gap mellan målbild och arbetssätt på kliniken. Syftet med förbättringsarbetet var att öka patienternas delaktighet under hela vårdtillfället. Syftet med studien var att identifiera vilka erfarenheter som kunde knytas till förändrade arbetssätt. Med kvalitativ metod genom interaktiv forskningsansats för förbättringsarbetet arbetade medarbetarna fram förslag på arbetssätt och metoder som bättre kunde gynna patientdelaktighet, vilka testades genom upprepade PDSA-hjul. För att besvara frågeställningarna till studien av förbättringsarbetet användes mixed method. Semistrukturerad fokusgruppsintervju, enskilda djupintervjuer, två patientenkäter låg till grund för utvärdering av upplevelser av de förändrade arbetssätten.   Förbättringsarbetet resulterade i ett flertal förändrade arbetssätt från inskrivning till utskrivning, där patientens egna förväntningar, önskemål och behov blivit tydligare.  Exempel på förändringar;  Fokus på delaktighet från inskrivningssamtalet, avstämning halvvägs in i vårdtillfället för att fånga nya frågor och ytterligare identifierande behov/ förväntningar. Studiens resultat påvisar vikten av tydlig kommunikation/information inom teamet och med patienten som partner i beslutsfattande. Insikter om teamprocesser och aktiviteter som behöver anpassas ytterligare under vårdprocessen för att skapa bättre förutsättningar för ökad patientdelaktighet. / Jakobsberg Geriatric Clinic emphasizes the importance of value creation and working methods from a patient perspective that gives results of relevance to the patient, where participation is given as an essential part. Patient surveys have shown that there is a gap between the target and working processes, which does not promote participation sufficiently.   The purpose of the improvement work was to increase patient participation throughout the hospital stay. The purpose of the study was to identify experiences that could be linked to the changing working methods, through a patient’s as well as an employee’s perspective.  The Improvement work was performed with a quality design and an interactive research approach where care-staff drafted proposals on useful methods that would better favor patient participation. These methods were then tested by repeated PDSA-wheels.  To answer the questions to the study, mixed method was used. Semi-structured focused group interviews were conducted and participation observations occurred. Individual interviews were held and patient’s surveys were filled out to evaluate the experience of the changing working method.  The improvement work resulted in a number of changes, from admission to discharge, where the patient’s own expectations, wishes and needs, became more central. Examples of changes; an increased focus on patient participation, from the enrollment, as well a reconciliation offered midway through the care episode with the purpose to catch arising issues and to identify additional needs.  The findings in the study demonstrate the importance of clear communication / information within the team and with the patient as a partner in decision-making. Insights on team processes and activities that need to be further adapted during the care process to create better conditions for increased.

Orientador: Djalma de Carvalho Moreira Filho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T11:38:57Z (GMT). No. of bitstreams: 1 Vidal_EdisonIglesiasdeOliveira_M.pdf: 1778837 bytes, checksum: d1969cdf36d980491cc004d14fb05459 (MD5) Previous issue date: 2006 / Resumo: Dentre as fraturas associadas à osteoporose, as Fraturas de Quadril (FQ) são consideradas como as mais graves e com maior impacto em termos de morbi-mortalidade para a população idosa e para os sistemas de saúde. Um dos fatores de risco para a mortalidade de idosos pós-FQ mais debatidos na literatura médica corresponde ao tempo decorrido entre a FQ e a cirurgia reparadora. Uma limitação importante de muitos dos estudos que avaliaram esta temática previamente reside na aferição apenas do intervalo de tempo entre a internação hospitalar e a cirurgia, ao invés do intervalo entre o momento da fratura propriamente dita e o procedimento cirúrgico. Outro ponto de debate interessante dentro da temática dos idosos com FQ reside na diferença de mortalidade entre os sexos, sendo poucas as investigações sobre as causas óbito em relação a esta variável. Deste modo, com o objetivo de avaliar a relação entre a mortalidade intra-hospitalar de idosos que sofreram FQ osteoporótica e o intervalo de tempo da FQ à cirurgia e explorar as diferenças de mortalidade entre os sexos, propõe-se um estudo observacional tipo coorte retrospectivo, baseado na análise de banco de dados de internação hospitalar relativo ao período de 1° de abril de 2003 a 31 de março de 2004 na província do Québec no Canadá. Os dados foram estudados por meio de análises univariadas e por regressão logística múltipla, tendo como variável resposta a presença de óbito intra-hospitalar. Foram incluídas no modelo da regressão logística múltipla para controle de confundimento sobre o efeito do intervalo da fratura à cirurgia na mortalidade intra-hospitalar as variáveis que haviam demonstrado significância nas análises de regressão logística univariada. Resultados: o intervalo de tempo da fratura à cirurgia alcançou significância estatística como preditor do óbito intra-hospitalar apenas na análise univariada (p < 0,001, OR = 1,08, IC95% 1,03-1,12). Após o controle para confundimento pelas demais variáveis no modelo de regressão múltipla, o período de tempo da fratura à cirurgia deixou de apresentar qualquer capacidade preditora sobre a mortalidade intra-hospitalar (p = 0,36, OR = 1,02, IC95% 0,97-1,07). O sexo masculino mostrou-se associado significativamente ao óbito hospitalar (p < 0,001, OR = 1,9, IC95% 1,45 ¿ 2,5) e, no que concerne às três principais causas de óbito, houve maior freqüência de mortes entre homens para as causas infecciosas e respiratórias, representando razões de chance de 2,92 (p < 0,001, IC95% 1,93 ¿ 4,42) e 2,23 (p = 0,002, IC95% 1,35 ¿ 3,69), respectivamente. Conclusão: Após controle para sexo, idade, número de diagnósticos secundários, comorbidades, tipo de fratura, modalidade cirúrgica e anestésica, não foi observada correlação entre o intervalo de tempo do momento da FQ à cirurgia e a mortalidade hospitalar de pacientes idosos submetidos a cirurgia reparadora de FQ no Québec entre 1° de abril de 2003 e 31 de março de 2004 com base na análise de dados administrativos. Neste mesmo grupo de pacientes, os homens apresentaram maior chance de morte intra-hospitalar que as mulheres. No que diz respeito às três principais causas de óbito, os homens morreram mais que as mulheres por causas infecciosas e respiratórias, não havendo diferença detectável neste estudo quanto à mortalidade cardiovascular entre os sexos / Abstract: Hip fractures (HF) are considered the most severe of the osteoporótica fractures as well as the ones with greater impact in morbidity and mortality for the elderly population and health care systems. The role of the delay between the HF and its operative treatment on the post-HF mortality of elderly patients is certainly one of the most controversial issues on HF epidemiology in the medical literature. One striking limitation of most previous studies on this theme abides in records regarding only the time between hospital admission and the surgical procedure, instead of the time between the fracture itself and the operative treatment. Another interesting point of debate in the subject of elderly with HF encompasses the differences in mortality between men and women, with few investigations on the causes of death according to gender. Therefore, targeting to evaluate the relationship between the inhospital mortality of elderly with osteoporotic HF and the span of time from fracture to surgery as well as to explore the differences in mortality amid sexes, it was designed an observational retrospective cohort study based on database analysis of hospital admissions relative to the period from April 1st 2003 to March 31st 2004 in the province of Québec, Canada. The data were studied through univariate analysis and multiple logistic regression modeling, assigning as response variable the presence of inhospital death. The variables which attained significance in the univariate analysis were included in the logistic regression model to control for confounding in the relationship between the time from fracture to surgery and the inhospital mortality. Results: The time between HF and surgery reached statistical significance as a predictor of inhospital mortality only in the univariate analysis (p < 0.001, OR = 1.08, IC95% 1.03-1.12). After controlling for confounding in the multiple logistic regression model, the delay from HF to operative repair no longer displayed any predictive ability over inhospital mortality (p = 0.36, OR = 1.02, IC95% 0.97-1.07). Male sex was significantly associated to inhospital death (p < 0.001, OR = 1.9, IC95% 1.45 ¿ 2,5). In regard to the three principal causes of death, there was a higher frequency of death for men among infectious and respiratory causes, accounting for odds ratios of 2.92 (p < 0.001, IC95% 1.93 ¿ 4.42) and 2.23 (p = 0.002, IC95% 1.35 ¿ 3.69), respectively. Conclusion: Based on administrative data, after controlling for sex, age, number of secondary diagnosis, comorbidities, type of fracture, surgical and anesthesiologic procedures, it was not observed any relationship between the time gap from HF to surgery and inhospital mortality of elderly patients submitted to HF surgical repair in Québec from April 12003 to March 312004. In this cohort of patients men displayed higher inhospital mortality odds than women. With regard to the three main causes of death, men died more often than women from infectious and respiratory causes and there was no detectable difference between genders concerning cardiovascular mortality / Mestrado / Epidemiologia / Mestre em Saude Coletiva