No / This paper examines key challenges and strategies for including older people with dementia in an ethnographic study of quality of life in institutional care settings. The methods of interview and observation are described in relation to meeting four research challenges: verbal communication impairment, memory loss, decision-making capacity, and emotional disposition. A range of strategies for privileging the voice of the person with dementia is recommended which include: using different methods bespoke to each person with dementia; greater flexibility and time; preliminary meetings with the person with dementia; discussions with formal and informal carers; and research training. The researchers also conclude that the use of observation and interview are 'meaning-making occasions' which are qualitatively different but equally valuable for understanding quality of life in care settings.

No / Visual impairment is an important risk factor for falls, but relatively little is known about how it affects stair negotiation. The present study determined how medio-lateral (ML) dynamics of stepping and single limb support stability when stepping up or down to a new level were affected by blurring the vision of healthy elderly subjects. Twelve elderly subjects (72.3±4.2years) were analysed performing single steps up and single steps down to a new level (7.2, 14.4 and 21.6cm). Stepping dynamics were assessed by determining the ML ground reaction force (GRF) impulse, lateral position of the centre of mass (CM) relative to the supporting foot (average horizontal ML distance between CM and CP during single support) and movement time. Stability was determined as the rms fluctuation in ML position of the centre of pressure (CP) during single support. Differences between optimal and blurred visual conditions were analysed using a random effects model. Duration of double and single support, and the ML GRF impulse were significantly greater when vision was blurred, while the average CM¿CP ML distance and ML stability was reduced. ML stability decreased with increasing step height and was further decreased when stepping down than when stepping up. These findings indicate that ML balance during stepping up and down was significantly affected by blurring vision. In particular, single limb support stability was considerably reduced, especially so during stepping down. The findings highlight the importance of accurate visual feedback in the precise control of stepping dynamics when stepping up or down to a new level, and suggest that correcting common visual problems, such as uncorrected refractive errors and cataract may be an important intervention strategy in improving how the elderly negotiate stairs.

No / This study utilises a rarely examined biomechanical parameter – the free vertical moment to determine age-related differences in rotational kinetics of the body about the vertical-axis when stepping down from a stationary position. Ten older and 10 young adults completed step-downs from three heights. Free vertical moment impulse and peak during step-initiation double-support and the subsequent step-execution phase, and vertical-axis pelvis angular displacement and velocity at instant of landing were compared. The free vertical moment during double-support was directed away from the intended leadlimb side, producing a change in vertical-axis rotational momentum that moved the lead-limb in a forwards- medial direction about the stationary support/trailing limb during the subsequent step-execution phase. The free vertical moment during step-execution was directed towards the lead-limb side and acted to slow/halt the body’s vertical-axis rotation away from lead-limb side. Free vertical moment impulse and peak during double-support were similar between groups (P > 0.05), but during step-execution were significantly reduced in older adults (P = 0.002). As a result older adults had greater verticalaxis pelvis angular displacement and velocity at instant of landing (directed away from lead-limb side), with significant (P < 0.001) group-by-step height interactions indicating that differences between groups became more pronounced with increasing step-height. These findings highlight that older adults were unable to exert the same vertical-axis control during single-support as young subjects did. Findings also highlight that the analysis of free vertical moment data can be a useful biomechanical tool to highlight age-related differences in how steps/stairs are negotiated.

No / Falls in the elderly are a major cause of serious injury and mortality. Impaired and absent stereopsis may be a significant risk factor for falls or hip fracture, although data from epidemiological studies are not consistent. Previous laboratory based studies, however, do suggest that stereoacuity is an important factor in adaptive gait. The present study investigates how acute impairment of stereopsis, through monocular blur of differing levels, ranging from 0.50 diopter (D) to a monovision correction affected gait when negotiating a raised surface in elderly subjects. Eleven elderly subjects (73.3 3.6 years) walked up to and negotiated a raised surface under nine visual conditions, binocular vision, one eye occluded and 0.50 D, 1.00 D and monovision correction (mean 2.50 D 0.20 D) with blur and occlusion either over the dominant or non-dominant eye. Analysis focused on foot positioning and toe clearance parameters. There was no effect of ocular dominance on any parameters. Monocular blur impaired stereopsis (p 0.01), with more minor effects on high and low contrast acuity. Vertical and horizontal lead limb toe clearance both increased under all levels of monocular blur including the lowest level of 0.50 DBlur (p 0.03) and monovision correction led to toe clearance levels similar to that found with occlusion of one eye. Findings demonstrated that even small amounts of monocular blur can lead to a change in gait when negotiating a raised surface, suggesting acute monocular blur affected the ability to accurately judge the height of a step in the travel path. Further work is required to investigate if similar adaptations are used by patients with chronic monocular blur.

BACKGROUND: Hearing loss is the third most prevalent chronic condition faced by older adults and has been linked to difficulties in speech perception, activities of daily living, and social interaction. Recent studies have suggested a correlation between severity of hearing loss and an individual's cognitive function; however, a causative link has yet to be established. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation. We performed a review to determine the status of the literature on the potential influence of cochlear implantation on cognition in the older adult population. METHODS: Over 3800 articles related to cochlear implants, cognition, and older adults were reviewed. Inclusion criteria were as follows: (1) study population including adults > 65 years, (2) intervention with cochlear implantation, and (3) cognition as the primary outcome measure of implantation. RESULTS: Out of 3,886 studies selected, 3 met inclusion criteria for the review. CONCLUSIONS: While many publications have shown that cochlear implants improve speech perception, social functioning, and overall quality of life, we found no studies in the English literature that have prospectively evaluated changes in cognitive function after implantation with modern cochlear implants in older adults. The state of the current literature reveals a need for further clinical research on the impact of cochlear implantation on cognition in older adults.

<p> </p><p>We are aware of the fact that elderly people suffering from alcoholism doesn’t stop their be-haviour the day they turn 65. But when they do turn 65, they might become a case for social workers who only handle cases regarding people over 65, and we wanted to find out if they have any experience of working with elderly who have problems related to alcohol. We de-cided that a group interview, a focus group, would be the best method when our purpose was to try discovering their own experiences, so we interviewed seven social workers in the Stockholm area. The interview was based on four main questions: the social workers experi-ences, difficulties in the cases, how to handle the difficulties and how the social workers talk about these cases among themselves. These questions were analysed with the theory of social construction, Bourdieu´s theory of doxa and Goffman´s theory of stigma. The analyse showed that the social workers had experience but that they didn’t want more recourses, they wanted a cooperation with social workers who specializes on clients with alcohol related problems. They currently focus on the individual, not the alcohol issue which we believe might be a problem in the future.</p>

Much of the developed world is experiencing an aging population. This requires society to adapt to take care of a growing elderly population and improve their quality of life. Today, mobile systems are available that makes it possible to monitor and improve health (m-health). Even though these systems could be immensely helpful for the elderly population, this has not been the primary demographic for the current m-health systems. This case study aimed at examining how persuasive technology (technology for changing behavior and/or attitude) can be used to promote usage of m-health applications by the elderly. For this purpose, a theoretical framework for supporting m-health systems is proposed. This framework consist of persuasive technology (for motivation and support for fulfillment of human needs), knowledge of elderly issues in interacting with mobile interfaces, smartphone usability heuristics and the Plan-Do-Study-Act (PDSA) cycle (to support goalsetting and incremental progress). To determine how persuasive technology can be used to motivate elderly and find effective strategies for this purpose, the case study examined health behavior, motivations for healthy behavior, attitude to health, general goal setting behavior, needs, preferences, technological experience and self-efficacy, as well as usage of m-health systems using qualitative and participatory methods. Methods used included semi-structured interviews, future workshop, revolutionary rapid prototyping and usability evaluation. The findings of the interviews and the future workshop suggested the primary motivation for healthy behavior was derived from social aspects. Thus, the most effective persuasive strategies for the elderly likely target their need for social belonging and socialization. Based on the findings, an interactive prototype was developed. The prototype proposed an m-health application with self-monitoring that implemented an elderly community around healthy behavior, with opportunities to earn digital rewards and challenge other users to competition. The interactive prototype was then used in a usability evaluation to gauge its usability by the elderly and revised in higher fidelity according to their feedback.

A longevidade é um processo inevitável, irreversível e de extrema importância para a civilização. A população de idosos de 80 anos ou mais tem aumentado, demandando atenção e compromisso por parte dos profissionais de saúde. Conhecer o processo de envelhecimento envolve o estudo de vários fatores, dentre eles, o estilo de vida que pode estar relacionado a maior longevidade desses idosos muito velhos. Portanto, o objetivo geral deste estudo foi avaliar o estilo de vida e sua associação com a longevidade de idosos muito velhos do município de Aracaju-SE. Metodologia: estudo descritivo-exploratório, transversal, com abordagem quantitativa. O cenário de estudo foi o município de Aracaju, uma das capitais do nordeste que apresentou crescimento acelerado do número de idosos nos últimos 40 anos. Os critérios de inclusão para a população foram: idosos cadastrados nas Unidades de Saúde da Família, de ambos os sexos, com 80 anos ou mais, que deveriam atingir o mínimo de 19 pontos no Mini-Exame do Estado Mental (MEEM). Foram realizadas entrevistas estruturadas por meio de três formulários: um com dados do MEEM; outro com dados socioeconômico e demográfico, de saúde, de nutrição e de longevidade e o terceiro com dados do Perfil do Estilo de Vida Individual (PEVI)-Pentáculo do Bem-Estar. Para a análise dos dados, foi aplicada a estatística descritiva. Para a análise da associação entre PEVI e perfil socioeconômico e demográfico, de saúde, de nutrição e de longevidade, bem como para o conhecimento da consistência interna do formulário PEVI, foram utilizados testes estatísticos. Resultados: Foram entrevistados 524 idosos muito velhos, a faixa etária variou de 80 a 108 anos, com prevalência de idosos entre 80 a 85 anos, predominância do sexo feminino, baixa escolaridade, mais da metade eram viúvos, aposentados, católicos, residentes em casa própria. Com relação ao PEVI Pentáculo do Bem-estar - a maioria obteve referência para um bem-estar positivo para os determinantes nutrição, comportamento preventivo, relacionamento sociale controle do stress. Somente o determinante atividade física apresentou predominância de índice negativo para o bem-estar. Houve associação estatisticamente significativa com a longevidade para as variáveis: idade, escolaridade, consumo diário de verduras e legumes, de feijão, de hortaliças, ingestão de água, de leite integral ou semi-desnatado, de suco natural, chá e de café, a condição de saúde e ter plano de saúde. Quanto aos fatores de longevidade que tiveram associação significativa temos: avós/bisavós que viveram mais de 80 anos, contato pessoal familiar e atividade social. Os resultados do PEVI apresentaram adequada consistência interna, com medidas psicométricas confiáveis para avaliar o estilo de vida de idosos nesta faixa etária. Conclusões: A aplicação do instrumento PEVI em uma faixa etáriaaté então pouco explorada mostrou a possibilidade de identificar e diagnosticar o perfil do estilo de vida dos idosos muito velhos, permitindo estabelecer uma associação entre os componentes do pentáculo com a longevidade. Dessa forma, os resultados proporcionaram o perfil do estilo de vida desses idosos que podem constituir uma base de informações para que os profissionais de saúde realizem intervenções de saúde, seja no cuidado, orientação e planejamento, buscando proporcionar um envelhecimento saudável e de qualidade. / Longevity is an unavoidable process, irreversible and of extreme importance to civilization. The population of over-80 elderly has increased, demanding attention and commitment of health professionals. Learning about the aging process involves the study of several factors, among them, lifestyle which can be related to greater longevity of these very aged elderly. Therefore, the general objective of this study was to evaluate lifestyle and its association to longevity or very old elderly of Aracaju-SE (Brazil). Methodology: descriptive-exploratory study, cross-sectional, quantitative approach. Study setting was the City of Aracaju, one of the capitals of Brazilian Northeast which showed a rapid growth in the number of elderly in the last 40 years. Inclusion criteria to population were: elderly registered in Family Health Unities, from both sexes, over-80, 19 or more points in Mini-Mental State Examination (MMSE). Structured interviews were performed by means of three forms: one with MMSE data; another with socioeconomic, demographic, health, nutrition and longevity data and a third one with Individual Lifestyle Profile data, Welfare Pentacle (PEVI). To data analysis, descriptive statistics was applied. To analysis of association between PEVI and socioeconomic, demographic, nutrition and longevity profile, as well as knowledge about internal consistence of the PEVI form, statistical tests were used. Results: 524 very old elderly were interviewed, their age group between 80 and 108 years-old, with 80-85 elderly prevalence, female predominance, low schooling, most of them widowers, retired, catholic, living in own home. On what concerns PEVI Welfare Pentacle most of them obtained reference of a positive welfare for the determiners of nutrition, preventive behavior, social relationship and stress controlling. Only determiner physical activity presented predominance of negative index to welfare. There was statistically significant association to longevity to the variable: age, schooling, daily consumption of vegetables, beans and greenery, water, whole or semi-skimmed milk, natural juice, tea and coffee intake, the healthy condition and having health insurance. On what concerns longevity factors which had significant association, we have: great-grandparents and grandparents which lived 80 years or more, personal family contact and social activity. PEVI results showed appropriate internal consistency, with reliable psychometric measures to assess elderly lifestyle in this age group. Final thoughts: PEVI instrument application to an age group until then underexplored showed the possibility of identifying and diagnosing very old elderly lifestyle, allowing the establishment of an association between the pentacle components and longevity. This way, results provided the lifestyle profile of these elderly which can constitute a basis of information for health professionals to perform health interventions in care, orientation or planning, targeting to provide a healthy and quality aging.

O envelhecimento populacional é, hoje, fenômeno mundial consequente a um crescimento mais elevado da população idosa com relação aos demais grupos etários. O declínio da habilidade física e mental freqüentemente associado ao envelhecimento tem implicações sociais, econômicas e com a saúde pública. O presente estudo realizado com idosos residentes no município de Batatais-SP, objetivou estudar algumas características dos idosos, a prática de exercício físico e a cognição. Pesquisou-se 400 idosos de ambos os sexos, com idade igual ou superior a 60 anos, utilizando-se um questionário estruturado;o Questionário de Atividade Física Internacional (IPAQ)-versão curta e para a avaliação cognitiva o mini-exame do estado mental (MEEM). Os dados receberam tratamento estatístico para observações de associações de variáveis através de regressão logística utilizando o procedimento PROC SURVEYLOGISTIC do programa SAS versão 9. Os resultados mostraram que 161 (40,2%) eram do sexo masculino e 239 (59,8%) do feminino. A idade média encontrada foi de 72 anos (DP= 8,3). A maioria, 62,7% dos idosos possuía baixa escolaridade com até 4 anos de estudo. Dos idosos 224(56%) morava com companheiros, sendo maior este percentual entre os homens (72,7%). Entre os que moravam com parentes verificou-se uma associação com déficit cognitivo (OR = 2,13 [1,27; 3,58]). Eram sedentários 86,7% dos idosos, sendo que as mulheres (15,5%) praticavam mais exercícios do que os homens (9,9%).Apenas 4,7% dos idosos foram classificados como ativos e 8,5% como irregularmente ativos. O uso de medicamentos foi mais freqüente entre as mulheres (89,2%). Dos idosos 40,5% de ambos os sexos não faziam nenhuma atividade intelectual. As mulheres tiveram maior participação nas atividades em grupo (58,7%). Nas atividades individuais 86,7% dos idosos realizavam de 1 a 2 atividades. A maior freqüência de déficit cognitivo foi encontrada nas mulheres (45,6%) (OR = 1,64 [1,10; 2,45]) e nos idosos com idade de 80 anos e mais 61,9% (OR = 3,26 [1,92; 5,51]). Os resultados indicam a importância da adoção de um estilo de vida saudável, com prática de exercício físico e em outras atividades de integração, que podem melhorar a qualidade de vida promovendo a autonomia dos idosos para a realização das atividades do cotidiano. / The population aging is a present worldwide phenomenon, consequence of a higher growth on the old age population compared to the other age groups. The decrease of mental and physical ability usually linked to aging has social and economical implications and with public health. The current study made with the elderly who live in Batatais-São Paulo, aims at studying some characteristics of the elderly, the practice of physical exercise and cognition. A group of 400 elderly of both genders with the age of 60 or over was researched, by using a structured questionnaire; the international physical activity questionnaire (IPAQ) short version and for the cognitive evaluation the mini exam of the mental state (MEEM) was applied. The data were statistically analyzed for observations of associations of variables through logistic regression using the procedure PROC SURVEYLOGISTIC of the SAS program version 9. The results obtained showed that 161 (40,2 %) were male and 239 (59,8%) were female. The average age was 72 years old (DP= 8,3). Most of them, 62,7% of the elderly had low academic level up to 4 years of study. Most of the elderly lived with partners, 224 (56%), and the highest percentage was among men (72,7). Among the ones who lived with relatives, an association with cognition deficit was checked (OR= 2,13[ 1,27;3,58]). It was also observed that 86,7% of the elderly belong to the sedentary group and that the women (15,5%) practice more exercise than men (9,9%). Only 4,7% of the elderly were classified as active and 8,5% as irregularly active. The women are the ones who most use medicine (89,2%). From the elderly, 40,5% of male and female elderly dont have any kind of intellectual activity. The women have a greater participation in group activities (58,7%). Concerning to individual activities 86,7% of the elderly practice 1 or 2 activities. The most incidence of cognitive deficit is found among the women (45,6%) (OR= 1,64] 1,10;2,45]) and from the 80-year-old elderly on, 61,9%(OR=3,26]1,92;5,51]). The outcomes show that both the habit of a healthy way of living through the practice of physical exercises and in other group activities can enhance the life quality, this way promoting the old people more self confidence to the fulfillment of the everyday activities.

O estudo teve por objetivo avaliar a capacidade funcional de idosos de 60 a 74 anos, antes do trauma e após 6 meses da alta hospitalar. A pesquisa foi conduzida na linha quantitativa através de um estudo observacional, transversal, realizado de julho a dezembro de 2004. Participaram do estudo 121 idosos, residentes na cidade de Londrina, Pr e Região Metropolitana, que sofreram trauma e foram internados em três hospitais gerais, terciários de Londrina. Após aprovação do Comitê de Ética em Pesquisa, os dados foram coletados, no domicílio, por meio de entrevistas, previamente agendadas, com idosos e seus cuidadores, utilizando-se um instrumento de Avaliação do Perfil Social, Estilo de Vida e Problema de Saúde e a Medida de Independência Funcional (MIF) para avaliação da capacidade funcional, e a análise utilizada foi a estatística descritiva. Os resultados evidenciaram que 59,5% dos idosos eram do sexo masculino e 40,5%, do feminino, com uma média de idade de 67,7 anos, sendo 62,0% casados e 19,8% viúvos. Quanto à escolaridade, 49,6% dos idosos referiram ter o primário. A maioria (76,8%) deles tem renda proveniente de aposentadoria, pensão e/ou aluguel e 78,5% têm casa própria. Os traumas sofridos apresentaram a seguinte distribuição: 62,0% quedas, 25,6% acidentes de transporte e 3,3% agressões e violências. Como conseqüência ao trauma, tiveram uma a três lesões, sendo que a maioria dos homens apresentou traumatismos nos membros inferiores, seguidos por outros nos membros superiores; nas mulheres houve predominância de luxações, entorses e distensões. Após o trauma, 31,4% necessitaram de cuidadores, sendo a maioria mulher, filha do idoso, casada, com idade entre 61 a 70 anos, sem remuneração pelo trabalho, sem outra atividade e com moradia junto ao idoso. Dos 121, a maior parte (51,2%) referiu não ter comorbidade, porém houve a presença de 1, 2 ou 3 e as principais foram: doença do sistema nervoso, doenças osteomusculares e tecido conjuntivo e doenças do aparelho geniturinário. Quanto às questionadas, as principais foram: hipertensão arterial, problemas de visão, tontura, depressão, esquecimento, colesterol elevado, diabetes mellitus, osteoporose, problemas de audição, artrose, incontinência urinária, obesidade, doenças do coração, perda de peso, derrame e artrite. A maioria (82,6%) dos idosos referiu fazer uso de medicamentos de 1 até 9, sendo os tipos mais utilizados: anti-hipertensivos (incluindo os diuréticos), hipoglicemiantes, analgésicos e antiinflamatórios, cardioterápicos e anticonvulsivantes. O trauma foi fatal para 11 idosos (9,1%), os quais eram totalmente independentes antes do mesmo. Dos 110, que sobreviveram, a aplicação da MIF mostrou que o trauma causou maior impacto no domínio motor, com diminuição da capacidade funcional, principalmente nas atividades de autocuidado e locomoção. Quanto ao nível de dependência dos idosos, foi mais evidente na necessidade de até 25% de assistência (dependência mínima). No autocuidado, as atividades que passaram a ter maior dependência, após o trauma, foram no banho e na habilidade de vestir-se abaixo da cintura; na locomoção, o maior impacto foi sentido na marcha e na capacidade para subir e descer escadas. Esses dados mostram que os idosos mais jovens, quando sofrem um trauma, podem ter sua capacidade funcional comprometida, mesmo 6 meses após a ocorrência do evento. / The research aimed to evaluate the functional capacity of younger elderly (60 to 74 years old), before trauma and six months after hospital discharge. The research was conducted in a qualitative line through an observatory and cross-sectional study, realized during the period of June to December of 2004.121 elderlies participated on the study, all residents of the city of Londrina, Pr and the metropolitan area, who had suffered traumas and had been admitted in three general tertiary hospitals, in Londrina. After the approval of the Committee of Ethics in Research, the data was collected in domicile through interviews, previously booked, with elderlies and their caregivers, using an instrument of Valuation of the Social Profile, Life Stile and Health Problem and the Functional Independence Measure (FIM) to the functional capacity valuation, and the analysis used was the descriptive statistical. The results evinced that 59.5% of the elderlies were men and 40.5% were women, with an age average of 67.7 years old, with 62.0% being married and 19.8% widows. Relating to the scholar degree, 49.6% of the elderlies said they had finished the elementary school. Most of the elderlies (76.8%) have an income proceeding from retirement, pension and/or renting and 78.5% have their own house. The traumas suffered by the elderlies present the following distribution: 62.0% a fall, 25.6% transportation accidents, 3.3% aggressions and violence. As a consequence of the trauma, the elderlies had one to three lesions, most of the men had inferior members? injuries, followed by superior members? injuries, and the women had a prevalence of dislocations, sprains and distensions. After the trauma, 31.4% of the elderlies needed caregivers. Most of the caregivers were women, the elderly?s daughter, married, between 61 to 70 years old, did not receive for the work, did not have another activity and lived with the elderly. From the 121 elderlies, most of them (51.2%) reported that they did not have comorbidities, however, there were a presence of 1, 2 or 3 comorbidities reported and the main ones were: nervous system disease, musculoskeletal and connective tissue disease and genitourinary tract diseases. Related to the comorbidities questioned the main ones were: arterial hypertension, vision problems, dizziness, depression, forgetfulness, high cholesterol, diabetes mellitus, osteoporosis, hearing problems, arthrosis, urinary incontinence, obesity, heart diseases, lost of weight, stroke and arthritis. Most of the elderlies (82.6%) reported about using medicines and they consume from 1 to 9 medicines, and the most used ones: antihypertensives (including the diuretics), hypoglycemiants, analgesics and anti-inflammatory drugs, cardiac drugs and anticonvulsants. The trauma was fatal to 11 elderlies (9.1%) who were totally independent before the trauma. From the 110 elderlies who survived from the trauma, the application of the FIM showed that the trauma caused more impact on the motor domain, with a reduction of the functional capacity, mainly on the activities of self-care and locomotion. Related to the level of elderlies? dependence, it was more evinced on the necessity of till 25% of attendance (minimun dependence). On the self-care, the activities that the elderlies started to have more dependence, after the trauma, were the shower and the capacity of getting dressed beneath the waist; on the locomotion, the biggest impact sensed was the pace and the capacity of climb and step down the stairs. This data showed that when the younger elderlies suffer a trauma they may have their functional capacity compromised, even six months after the occurrence of the event.