O Ministério da Saúde define os idosos como \"pessoas com idade igual ou superior a 60 (sessenta) anos\". A população brasileira ganhou 4,8 milhões de idosos de 2012 a 2017, superando a marca dos 30,2 milhões. Em estudos 6,9% dos idosos foram identificados como frágeis e 47% apresentaram fragilidade intermediária. As divisões de Nutrição e Metabolismo do departamento de Ciências da Saúde e de Geriatria do departamento de Clínica Médica do Hospital das Clínicas de Ribeirão Preto, investiram na identificação de idosos frágeis na comunidade, uma adaptação do projeto francês Gerontopole de Toulouse. No entanto o protocolo inicial foi feito em fichas de papel, a informação em papel está disponível somente a um profissional ao mesmo tempo, possui baixa mobilidade e está sujeito a ilegibilidade, ambiguidade, perda de dados, dificuldade de pesquisa coletiva, falta de padronização, dificuldade de acesso, e requer amplos espaços para arquivamento. Neste trabalho foi desenvolvida uma plataforma web / mobile para avaliação e diagnóstico de fragilidade em idosos. Foi utilizada a arquitetura de projetos MVC, e as linguagens PHP, JavaScript, CSS3 e HTML5. O sistema possui as funcionalidades de cadastro, edição e deleção para todas as escalas, pacientes e usuários, também é possível gerar relatórios das escalas. Os usuários avaliaram o sistema no teste de usabilidade WAMMI resultando na pontuação 75 de 100. A maior parte das recomendações de usabilidade e segurança da Sociedade Brasileira de Informática em Saúde foram atendidas pelo software desenvolvido / The Ministry of Health defines the elderly as \"persons aged 60 or over (60)\". The Brazilian population gained 4.8 million elderly people from 2012 to 2017, surpassing the mark of 30.2 million. In studies 6.9% of the elderly were identified as fragile and 47% presented intermediate frailty. The Nutrition and Metabolism and Geriatrics divisions of the Clinical Medicine Department of the Hospital das Clínicas of Ribeirão Preto invested in the identification of fragile elderly in the community, an adaptation of the French Gerontopole project in Toulouse. However the initial protocol was made in paper chips, paper information is available only to a professional at the same time, has low mobility and is subject to illegibility, ambiguity, loss of data, difficulty in collective research, lack of standardization, difficult to access, and requires ample space for archiving. In this project a web / mobile platform was developed to evaluate and diagnose frailty in the elderly. The MVC project architecture was used, along with the languages PHP, JavaScript, CSS3 and HTML5. The system has the registration, editing and deletion features for all scales, patients and users, it is also possible to generate reports of scales. The users evaluated the system in the WAMMI usability test resulting in a score of 75 out of 100. Most of the usability and security recommendations of the Brazilian Society of Health Informatics were met by the software developed

Alzheimer’s disease (AD) is the commonest form of dementia and is characterised with neuropathological hallmarks such as aggregated amyloid plaques and hyper-phosphorylated tau protein. One type of AD is autosomal dominant AD (ADAD) which is caused by highly penetrant variants in one of three genes (APP, PSEN1 and PSEN2), other cases of AD are described as sporadic and can have a late onset of disease symptoms (> 65 years of age) or early onset (≤ 65 years or age). Late-onset Alzheimer’s disease (LOAD) is estimated to be 70% heritable and is common. Conversely sporadic early-onset Alzheimer’s disease (sEOAD) is estimated to 90% heritable but is relatively rare. The difference in prevalence between the two types of AD has resulted in genome wide association studies focusing on LOAD with sEOAD receiving little attention. Here we use an Illumina human exome genotyping chip customised with neurodegenerative markers (NeuroX) to genotype the coding region of sEOAD samples in a hope to elucidate the genetic aetiology of sEOAD. Sanger sequencing exons 16 and 17 of APP was conducted in a sEOAD cohort (n=451) to screen for variants known to cause ADAD; 9% (n=4) of the cohort were heterozygous for known causative variants and where subsequently removed from the sEOAD NeuroX genotyping data before analyses. Screening also highlighted an intronic 6bp deletion downstream of exon 17 in APP with a non-significant increased minor allele frequency (MAF) in sEOAD, however it did not appear to influence splicing of exon 17. Screening the sEOAD cohort for other variants known to cause neurodegenerative disease was conducted using the NeuroX genotyping data (n=408) which identified two samples with variants in PARK2, these variants are thought to contribute susceptibility to Parkinson’s disease (PD) suggesting these variants might elicit risk for multiple diseases. A further study with increased power would ascertain if the 6bp deletion and PARK2 variants are associated with sEOAD. Statistical analyses of the sEOAD NeuroX genotypes highlighted many variants, genes and pathways that could be contributing to susceptibility to disease; however no tests reached significance after adjusting for multiple testing. The genes most associated (PDZK1, DCLK3, SLC33A1 and BLOC1S2) appear to be biologically relevant and would be ideal candidates for further study. Additionally, just under half of the variants that are significant associated with LOAD were genotyped on the NeuroX and two of these were significantly associated with sEOAD after correcting for multiple testing (rs3851179 and rs3764650). The genotypes of all the variants highlighted would need to be verified before their functionalities were investigated further.

Background: Fear of falling is now recognized as an independent fall risk factor due to its prevalence in older adults. Objectives: The purpose of this study was to gain a better understanding of fear of falling levels in community-dwelling older adults before and after attending a fall prevention clinic. Methods: An explanatory sequential mixed methods design was used. The Falls Efficacy Scale-International (FES-I) tool assessed fear of falling levels before and after attending a fall prevention clinic (n=32). Semi-structured interviews were then conducted in a sample of these participants (n=12). Results: There was no statistically significant difference in the before (M=30.44, SD=9.8) and after (M=31.72, SD=8.3) FES-I scores. Three themes emerged from the qualitative analysis: 1. Concerns about falling, 2. Decreased concerns about falling and 3. An increased self-awareness of fall risks. Conclusion: Further use of cognitive-behavioural therapy should be considered in falls risk reduction interventions for community-dwelling older adults with fear of falling.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-05T16:48:46Z No. of bitstreams: 1 BrunaFornazari_dissert.pdf: 798218 bytes, checksum: d8fe2e664ab7726078dadd6bfb7bcc94 (MD5) / Made available in DSpace on 2018-11-05T16:48:46Z (GMT). No. of bitstreams: 1 BrunaFornazari_dissert.pdf: 798218 bytes, checksum: d8fe2e664ab7726078dadd6bfb7bcc94 (MD5) Previous issue date: 2018-03-09 / The increases due to population aging, the prevalence of chronic-degenerative diseases increases significantly and, among these, dementia stands out as a risk factor for disability and functional loss, which implies constant care that reverts in compromising quality of life and burnout to informal caregivers. Objectives: To characterize the profile of the informal caregivers of the elderly attend geriatrics and psycho-geriatrics outpatient clinics and to evaluate the quality of life related to health and burnout. Methods: This is a descriptive / cross-sectional study. Participants included 60 informal caregivers of elderly men and women, aged between 25 and 84 years who care for the elderly between 60 and 85 years, with chronic diseases and accompanied them in the outpatient care of Geriatrics and Psycho-geriatrics. The following materials were used to collect: Socio-Demographic Questionnaire; Quality of Life Questionnaire SF36 and Zarit Burden Interview Scale. Participants were invited to participate in the study after confirming that they were informal caregivers of the elderly, that is, they perform non-professional care. Results: Of the total number of participants, the predominance of women (80%), with a mean age of 54.93 years, was ± 14.6, married (66.7%), active at work (38.3%), mainly family members, daughters (43.3%), or wives (20%), who live with the elderly (65%), and who attended incomplete primary education (40%). The majority (51.7%) dedicate more than 10 hours a day to care, take care of their family members between 01 to 05 years, do not carpeted with other family members and 86.6% cannot pay someone to help with the care of the elderly. Regarding the overload of care in the present study, 45% and 25% of the caregivers presented moderate and moderate to severe overload, respectively, with a variation from 8 to 74 (mean of 33.06 and dp = 15.86), it was verified in the different analyzed dimensions of SF-36, with the lowest results being general health status and social aspects. Conclusion: The results reinforce the existence of a relationship between caregiver burnout and quality of life impairment, therefore, it is necessary to invest in public health policies that act directly to minimize the effects of burnout and quality of life of this population, optimization of care network and health services. / Devido ao envelhecimento populacional, a prevalência de doenças crônicodegenerativas tem crescido significativamente e, entre essas, a demência se destaca como um fator de risco para a incapacidade e a perda funcional, que implica em cuidados constantes que se revertem em comprometimento da qualidade de vida e sobrecarga de trabalho dos cuidadores informais. Objetivos: Caracterizar o perfil dos cuidadores informais de idosos atendidos no ambulatório de geriatria e neurogeriatria e avaliar a sobrecarga e a qualidade de vida relacionada a saúde. Método: Trata-se de um estudo do tipo descritivo / transversal. Participaram 60 cuidadores informais de idosos, de ambos os sexos, com idade entre 25 e 84 anos que cuidam de idosos com idade entre 60 e 85 anos, com doenças crônicas e os acompanharam no atendimento ambulatorial de Geriatria e Neurogeriatria. Para a coleta de dados foram utilizados um Questionário sócio demográfico; Questionário de Qualidade de Vida SF36 e a Escala Zarit Burden Interview. Os participantes foram convidados a participar do estudo após confirmarem que eram cuidadores informais do idoso, ou seja, que desempenham cuidado não profissional. Resultados: Do total de participantes, observou-se entre os cuidadores, predominância do sexo feminino (80%), com média de idade de 54,93 anos, ± 14,6, casados (66,7%), ativos no trabalho (38,3%), sobretudo membros da família, filhas (43,3%), ou esposas (20%), que residem com o idoso (65%), e que frequentaram o ensino fundamental incompleto (40%). A maioria (51,7%), dedica mais de 10 horas por dia ao cuidado, cuidam entre 01 a 05 anos de seu familiar, não realizavam rodízio com outros membros da família e 86,6% não tem condições de pagar alguém para ajudar nos cuidados do idoso. Com relação a sobrecarga de cuidado, 45% e 25% dos cuidadores apresentaram sobrecarga moderada e moderada à severa, respectivamente, com variação de 8 a 74 (M = 33,06 e DP = 15,86), comprometimento nas diferentes dimensões analisadas do SF-36, sendo que os menores resultados foram estado geral de saúde e aspectos sociais. Conclusão: Os resultados reforçam a existência de relação entre sobrecarga do cuidador e agravo da qualidade de vida. Portanto, é necessário investimento em políticas públicas de saúde que atuem diretamente na minimização de efeitos da sobrecarga e qualidade de vida dessa população, otimização da rede de cuidados e serviços de saúde.

O traçado eletrocardiográfico, observado durante a anestesia geral, pode diferir morfologicamente do traçado pré-anestésico. O que não se conhece é o grau de influência que os fármacos anestésicos exercem sobre o registro eletrocardiográfico de um cão geriátrico submetido à anestesia geral e a que ponto estas alterações eletrocardiográficas interferem em sua hemodinâmica. Avaliou-se oitenta e dois cães geriátricos (categoria de risco I ou II) foram distribuídos em três grupos: grupo I, cães de pequeno porte (até 10 kg, n=36); grupo II, cães de médio porte (11 a 25 kg, n=27), e grupo III, cães de grande porte (26 a 45 kg, n=19). Além da avaliação eletrocardiográfica, os exames pré-anestésicos constaram de hemograma completo, mensuração sérica de uréia, creatinina, proteína total e albumina; foram feitas mensurações séricas de potássio, cálcio, sódio e magnésio. A medicação pré-anestésica constou de acepromazina associada à morfina ou a meperidina ou somente morfina. A indução foi feita com propofol ou propofol associado ao midazolam, e a manutenção da anestesia realizada com isofluorano em oxigênio a 100%. Durante a anestesia, os cães foram monitorados continuamente com auxílio de um eletrocardiógrafo computadorizado que avaliou o ritmo cardíaco, a freqüência cardíaca, o intervalo PR, a largura e a morfologia do complexo QRS, o segmento ST, a morfologia, a amplitude e a polaridade da onda T. Avaliou-se também a pressão arterial sistólica, média e diastólica; a freqüência respiratória; a ventilação avaliada através da observação da concentração de dióxido de carbono expirado e dos valores de pressão parcial de dióxido de carbono no sangue arterial; a oxigenação, avaliada através da oximetria de pulso, da pressão parcial de oxigênio no sangue arterial e da saturação da oxi-hemoglobina arterial. Os animais foram submetidos à ventilação assistida ou à controlada quando observou-se hipoventilação e hipercapnia. Nos três grupos, o ritmo cardíaco mais freqüente foi o sinusal normal (88%). Observou-se taquicardia sinusal em alguns momentos do trans-operatório em 9% dos animais. Pouco freqüente, mas com importância hemodinâmica, observou-se bradicardia sinusal (3%) associada à hipotensão. Assim, neste estudo o isofluorano não proporcionou o aparecimento de arritmias e promoveu estabilização hemodinâmica dos animais. Observou-se aumento não significante do intervalo PR que do ponto de vista biológico deve ser considerado importante, visto que aproximadamente 11% dos animais que apresentavam intervalo PR normal com ritmo sinusal , evoluíram para bloqueio atrioventricular de primeiro grau. Observou-se bloqueio atrioventricular de primeiro grau em 2% dos animais no eletrocardiograma pré-anestésico, e 1% evoluiu com bloqueio atrioventricular de 2o grau Mobitz tipo I. As alterações no segmento ST e onda T durante o período trans-anestésico, foram muito freqüentes e relacionadas principalmente a hipoventilação. / The electrocardiogram observed during the general anesthesia, can differ from the morfology of the preanesthetic record. It is unknown the influence of the anesthetic drugs in the electrocardiographic record of a elderly dog during general anesthesia, and if electrocardiographic disturbances interfere in their hemodynamic. Eighty two geriatrics dogs (risk category I or II) were evaluated and distributed in three groups: group I, small-size breeds (less than 10 kg, n=36); group II, medium-size breeds (11 to 25 kg, n=27), and group III, large-size breeds (26 to 45 kg, n=19). Beyond electrocardiographic evaluation, the preanesthetic profile consisted in packed cell volume, seric measurement of urea, creatinine, total protein and albumin; the eletrolytes (potassium, calcium, sodium and magnesium). The preanesthetic medication consisted in acepromazine with morphine or meperidine or only morphine. Anesthesia was induced with propofol or propofol with midazolam and maintained with isoflurane in 100% oxygen. During the anesthesia, the animals were monitoried with a continued computadorized electrocardiogram, recording rhythm, heart rate, P-R interval, QRS complex, ST segment and T wave. The systemic blood pressure (systolic, mean and dyastolic), the respiratory rate, the end-tidal carbon dioxide, partial pressure of arterial CO2, the arterial oxygen saturation, the partial pressure of arterial oxygen and oxygen saturation of hemoglobin were evaluated continuously. The animals were submitted to assisted or controled ventilation when hypoventilation and hypercapnia were observed. In the three groups, the normal sinus rhythm was more common (88%). Sinus tachycardia was observed in 9% of the animals. Sinus bradycardia and a decrease in the systemic blood pressure was observed in 3% of the animals. In view of the results obtained it is possible to conclude that, the isoflurane didn\'t provide the observation of arrhythmias and it gave hemodynamic stability. The prolonged P-R interval was observed although of no statistical significance. However it is important, because 11% of the animals that have prolonged P-R interval, developed first degree atrioventricularricular block. First degree AV block was observed in 2% of the animals in the preanesthetic electocardiogram, and 1% developed second degree AV block Mobitz I during the anesthesia. The changes of ST segment and T wave during the anesthetic proceeding was too common and it was related to hipoventilation.

No description available.

Given the increasingly growing elderly population, and the large number of young Speech-Language Pathologists (SLPs), cultural competence regarding intergenerational ageism is a necessity. The current study aimed to discover whether SLP students are influenced by age-related stereotypes or judge communication objectively when assessing the language of older adults. First-year and second-year SLP graduate students evaluated narratives paired with images of older and younger adults on rating scales of language and communication. The results show that, although students primarily judge narratives based on quality, their language judgments are influenced by gender- and age-related stereotypes. Students judged males and females differently based on their age, with younger males rated worse overall. Students also appeared to lower their expectations when judging the language of older adults, suggesting that they expected poorer language skills to be more typical of older adults. The extent to which such biases may influence the students' communication with older adults is still unknown.

Dementia, a clinical condition that affects the psychological ability of patients, is distinguished by a significant overall decline in cognitive function that results in distorted perception. Guiding nursing practice in the long-term care (LTC) setting to decrease the unnecessary use of psychotropics is critical because doing so relates to the patients' quality of life and safety. In the LTC facility that served as the practicum site for this study, there was an observed overuse of psychotropic medications in the care of patients with dementia. The practice-focused question guiding this project asked whether a nursing staff development program would decrease the use of psychotropics in dementia patients. The purpose of the project was to inform nursing staff through an educational program on alternative methods to use when dementia patients exhibit increased disturbing behaviors. The conceptual framework for the project was the knowledge-to-action model. The nursing staff development program had a positive effect on the nursing staff as evidenced by a statistically significant improvement in knowledge and attitudes about the use of psychotropics in caring for dementia patients. The use of psychotropic in the dementia patient decreased from 22.32% to 15.77%, the lowest score achieved by the organization in 5 years. The dementia patients benefited from this project and its positive social change implications for nursing practice by decreasing dementia patients use of psychotropics, minimizing their side effects to the patients and providing an overall feeling of well-being.

Alzheimer's disease and other forms of dementia cause cognitive disabilities in the afflicted person. As a result, the person with dementia often requires assistance from a primary caregiver. However, while the caregiver is away from the home they are unaware of the person's status and may not be able to find out without returning to the home due to dementia's effects on cognition. In this thesis work, a system of embedded devices is presented which tracks a solitary dementia patient in the home in real-time. The system is composed of three main hardware components. Multiple passive and active sensors are strategically placed to monitor the patient. A number of custom battery-powered embedded systems read the sensors and wirelessly transmit the sensor's values. A central computational node collects the wireless transmissions and analyzes the data. Two algorithms were developed that detect the patient's eating activities and location throughout the home from the sensor data. A web-based user interface was designed that allows a primary caregiver to remotely view the patient's status while away from the home. Numerous trials are performed which test the system's ability to monitor the patient's eating activities and location. The positive results of the trials show that the proposed system is able to detect eating patterns as defined by rules and localize in real-time the patient in the home, accurate to a single quadrant of a room. The proposed embedded system is highly affordable and has two novel features, namely eating detection and patient localization accurate to a single quadrant of any room in the home. Both features use sensors installed in the home and do not require the patient to wear any sensors on their person. The state-of-the-art products currently available are able to localize only to a single room without the patient wearing sensors.

<p>Att drabbas av demens är idag den vanligaste sjukdomen bland äldre och innebär en fortskridande och permanent nedbrytning av hjärnans funktioner. Demens är en sjukdom som innefattar många kognitiva brister där minnesnedsättning är den allra vanligaste. En konsekvens av demens är även att det påverkar personens förmåga till kommunikation vilket gör det extra viktigt att som sjuksköterska anpassa sig till individens nivå. Syftet med denna litteraturstudie var att belysa kommunikationsmöjligheter vid omvårdnaden av personer med demens. I studien ingick tolv artiklar och den metod som användes var systematisk litteraturstudie. Resultatet presenterades utifrån två huvudkategorier; stöd och samspel samt fyra underkategorier; stimulering genom terapi, sjuksköterskans stöd, att finna balans och mötas på lika villkor. I studien låg fokus på att hitta strategier för att skapa en bra kommunikation. Flera olika strategier för kommunikation togs upp och resultatet visar på många bra lösningar samt en vilja att utvecklas hos vårdpersonalen.</p>