Medication regimen complexity in institutionalized elderly people in an aging society

Background Complex medication regimens may adversely affect compliance and treatment outcomes. Complexity can be assessed with the medication regimen complexity index (MRCI), which has proved to be a valid, reliable tool, with potential uses in both practice and research. Objective To use the MRCI to assess medication regimen complexity in institutionalized elderly people. Setting Five nursing homes in mainland Portugal. Methods A descriptive, cross-sectional study of institutionalized elderly people (n = 415) was performed from March to June 2009, including all inpatients aged 65 and over taking at least one medication per day. Main outcome measure Medication regimen complexity index. Results The mean age of the sample was 83.9 years (±6.6 years), and 60.2 % were women. The elderly patients were taking a large number of drugs, with 76.6 % taking more than five medications per day. The average medication regimen complexity was 18.2 (±SD = 9.6), and was higher in the females (p < 0.001). The most decisive factors contributing to the complexity were the number of drugs and dosage frequency. In regimens with the same number of medications, schedule was the most relevant factor in the final score (r = 0.922), followed by pharmaceutical forms (r = 0.768) and additional instructions (r = 0.742). Conclusion Medication regimen complexity proved to be high. There is certainly potential for the pharmacist’s intervention to reduce it as part as the medication review routine in all the patients.

Health Problems of Institutionalized Elderly

Introduction: human aging is marked by a decrease in the performance of some daily tasks, some even considered banal and imperceptibly when this limitation is followed by chronic diseases, the elderly becomes a source of concern for the family. Objective: identifying the health problems of the elderly living in long-stay institutions from self-reported diseases. This is a descriptive and quantitative study, conducted in northeastern Brazil capital, involving 138 elderly. For data collection we used a questionnaire containing demographic variables, institutional and related to self-reported health problems. Data were evaluated using bivariate analysis and association chi-square. Results: predominance of women was found (61.6%), aged 60-69 years old (39.1%), coming from the state capital (51.4%), and institutional permanence time between 1-5 years (77.5%). The most frequent diseases were related to the cardiovascular system (15.9%) and endocrine, nutritional and metabolic diseases (9.4%). It showed a significant association between self-reported diseases and the age of the elderly (p=0.047). Conclusion: it is expected to raise awareness among health professionals to provide a better assistance to the institutionalized elderly focusing on the real needs of these persons.

Increased physical activity and fitness above the 50th percentile prevents the institutionalization of elderly people: a cross-sectional pilot study.

Introduction Institutionalization in a nursing home restricts autonomy, most notably free will, free choice, and free action. Decreased physical activity and fitness are predictive of disability and dependence (Rikli & Jones, 2013; Tak, Kuiper, Chorus, & Hopman-Rock, 2014); however little is known about the impact of these factors on institutionalization. Thus, this study aimed to analyze the impact of physical activity and fitness and on the risk of elderly people without cognitive impairment become institutionalized. Methods This cross-sectional study involved 195 non-institutionalized (80.14.4yrs) and 186 institutionalized (83.85.2yrs) participants. Cognitive impairment was assessed using Mini-Mental State Examination, physical activity was assessed using the International Physical Activity Questionnaire, and measures of physical fitness were determined by the Senior Fitness Test. Results: Multivariate binary logistic analysis selected 4 main predictors of institutionalization in both genders. The likelihood of becoming institutionalized increased by +18.6% for each additional year of age, while it decreased by -24.8% by each fewer kg/m2 in BMI, by -0.9% for each additional meter performed in the aerobic endurance test and by -2.0% for each additional 100MET-min/wk of physical activity expenditure (p<0.05). Values ≤50th percentile (age ≥81yrs, BMI≥26.7kg/m2, aerobic endurance ≤367.6m, and physical activity ≤693MET-min/wk) were computed using Receiver Operating Characteristics analysis as cut-offs discriminating institutionalized from non-institutionalized elderly people. Conclusion The performance of physical activity, allied to an improvement in physical fitness (mainly BMI and aerobic endurance) may prevent the institutionalization of elderly people without cognitive impairment only if they are above the 50th percentile; the following is highly recommend: expending ≥693MET-min/wk on physical activity, being ≤26.7kg/m2 on BMI, and being able to walk ≥367.6m in the aerobic endurance test, especially above the age of 80 years. The discovery of this trigger justifies the development of physical activity programs targeting the pointed cut-offs in old, and very old people. References Rikli, R., & Jones, C. (2013). Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist, 53, 255-267. Tak, E., Kuiper, R., Chorus, A., & Hopman-Rock, M. (2014). Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing Res Rev, 12, 329-338.

Influência do nível de actividade física e da institucionalização na qualidade de vida dos idosos do concelho de Évora

Objectivo: Caracterizar a qualidade de vida dos idosos do concelho de Évora, avaliando a influência da institucionalização e do nível de actividade física na mesma. Métodos: Foram analisados 196 idosos institucionalizados em lar da rede pública e 189 idosos não institucionalizados pertencentes a associações de reformados do concelho. A recolha dos dados foi efectuada utilizando o questionário de qualidade de vida da OMS- WHOQOL-BREF e o questionário de avaliação do nível de actividade física-IPAQ. Resultados: Os idosos do concelho de Évora têm uma avaliação positiva da qualidade de vida, apresentando os idosos não institucionalizados melhores resultados no domínio físico, psicológico e do ambiente. Verificou-se ainda que os idosos mais activos apresentam melhores resultados no domínio físico e psicológico da qualidade de vida, assim como uma melhor percepção da qualidade de vida global. Conclusão: A principal conclusão deste estudo revela que, embora a institucionalização contribua negativamente para a qualidade de vida dos idosos, esta poderia ser compensada pela prática regular de actividade física e pela implementação de actividades organizadas que promovam a actividade física dos idosos institucionalizados. ABSTRATC; Objective: Characterize the quality of life of elderly in the district of Évora, by assessing the influence of institutionalization and the level of physical activity in it. Methods: We analyzed 196 elderly institutionalized in a public home, and 189 non-institutionalized elderly that belong to associations of pensioners of the county. The collection of data was conducted using the questionnaire of quality of life of the WHO-WHOQOL-BREF, and the questionnaire for assessing the level of physical activity-IPAQ. Results: The elderly in the district of Évora have a positive assessment of the quality of life where the non-institutionalized elderly people have better results in physical, psychological and environmental domains. Additionally it was assessed that the elderly with more assets have better physical and psychological quality of life and a better perception of quality of life in overall. Conclusion: The main conclusion of this study shows that although the institutionalization contributes negatively on the quality of life of older people, these could be offset by regular practice of physical activity and implementation of activities that promote physical activity in institutionalized elderly.

Efeito de dois programas de reabilitação psicomotora (atividade contínua versus atividade intervalada) na capacidade neuromotora de idosos institucionalizados

Objetivo: Investigar o efeito de dois programas de reabilitação psicomotora (atividade contínua versus atividade intervalada) na capacidade neuromotora de idosos institucionalizados. Metodologia: A amostra integrou 17 participantes (85,81±6,26 anos) que, numa fase inicial, mantiveram as atividades durante 6 semanas (período de controlo) e, posteriormente, 9 integraram um programa com intervenção intervalada (GI) e 8 um programa com intervenção contínua (GC). Ambos os programas tiveram a duração de 12 semanas, com uma periodicidade de 2 sessões por semana e duração de 60 minutos. Foram avaliadas as variáveis atenção (Trail Making Test), capacidade de planeamento (Torre de Londres), o desempenho em situação de dupla tarefa (Timed Up and Go modificado) e equilíbrio (Timed Up and Go e Índice de Tinetti). Resultados: O GI evidenciou melhorias significativas nas variáveis da atenção, da capacidade de planeamento, dupla tarefa e equilíbrio (p<0,05), enquanto que o GC apenas o evidenciou na variável capacidade de planeamento (p<0,05). Conclusão: Os resultados sugerem que o programa de reabilitação psicomotora com atividade intervalada será mais benéfico para os idosos institucionalizados que programa com atividade contínua, particularmente na atenção, no desempenho em situação de dupla tarefa e no equilíbrio; ABSTRACT: Objective: To research the effect of two psychomotor rehabilitation programs (continuous activity against intervealed activity) in the neuromotor ability of institutionalized elderly people. Metodology: The sample had 17 participants (85.81 ± 6.26 years), that in an initial phase retained activity for 6 weeks (control period) and then, 9 integrated a program with intervealed intervention (GI) and 8 a program with continuous intervention (GC). ). Both of the programs had 12 weeks, 2 sessions per week and 60 minutes per session. Was evaluated the variables attention (Trail Making Test); planning capacity (London Tower); dual task capacity (modified Timed Up and Go) and balance (Timed Up and Go and Tinetti Index). Results: The GI showed significant improvements in the variables attention, performance in dual task ability and balance (p<0,05), while GC revealed significant improvements in planning capacity (p<0,05). Conclusion: The results suggest that the psychomotor rehabilitation program with intervealed activity will be more beneficial for the institutionalized elderly than the program with continuous activity, particularly in the attention, planning capacity, performance in dual task ability and balance.

Does an In-Season Detraining Period Affect the Shoulder Rotator Cuff Strength and Balance of Young Swimmers?

Aims: To compare the physical activity, sedentary activity and health-related quality of life (HRQoL) in institutionalized vs. non-institutionalized elderly, and to establish a pattern of relationship and prediction of physical and sedentary activity with physical and mental components of HRQoL. Methods: The sample consisted of 383 elderly with ≥ 75 years old (n=187 institutionalized and n=196 non-institutionalized). Were administered the International Physical Activity Questionnaire (IPAQ) and Short Form 36 Health Survey (SF-36) for evaluated the physical and sedentary activity and HRQoL. Also was used the Mini Mental State Examination (MMSE) as exclusion criteria for cognitive problems in the elderly. Results: Differences between institutionalized and non-institutionalized elderly were found in moderate-intensity activities and walking, a favour of non-institutionalized. The institutionalized elderly remain more minutes in sedentary activity. Also, were observed differences between both groups in physical component of HRQoL, a favour of non-institutionalized elderly. The mental component remained unchanged. The multivariate regression analyses showed that physical activity predicted the physical (8 to 12%) and mental (5 to 8%) components of HRQoL for institutionalized and non-institutionalized elderly. Conclusions: Non-institutionalized elderly were more physically active, spent less time in sedentary activity and showed better perception physical component of HRQoL that institutionalized elderly. An important and encouraging result of this study was that physical activity is a predictor of improved physical and mental component of HRQoL for institutionalized and non-institutionalized elderly.

Efeitos de um programa de exercício multimodal em pessoas idosas institucionalizadas

Objetivo: Investigar os efeitos de um programa de exercício multimodal sobre o funcionamento cognitivo e aptidão física funcional em pessoas idosas institucionalizadas. Método: Os participantes foram selecionados por conveniência entre os utentes de duas instituições de apoio a pessoas idosas. O grupo inicial foi constituído por um total de 21 pessoas de ambos os sexos (77-92 anos). Inicialmente, foi garantido um “período de controlo” de 4 semanas, em que os participantes mantiveram as suas atividades de vida quotidianas normais. Posteriormente, todos os idosos integraram um programa de exercício multimodal durante 8 semanas. Para estudar os efeitos da intervenção foram recolhidos dados em 3 momentos distintos: previamente ao período de controlo, após o período de controlo e no final do programa de intervenção. Foram efetuados testes físicos/motores, cognitivos e de dupla-tarefa (motor-cognitivo). Durante as sessões de exercício, alternaram-se períodos constituídos por tarefas motoras com períodos em que as tarefas motoras implicavam uma mobilização simultânea de recursos cognitivos. Resultados: A análise estatística dos dados recolhidos nos três momentos de avaliação, revelou efeitos positivos da intervenção ao nível da atenção, tempo de reação, força muscular, agilidade e capacidade cardiorrespiratória. Nos testes realizados em dupla-tarefa, foram encontradas melhorias no teste timed up and go, mas não se verificaram melhorias no teste de tempo de reação. A análise estatística dos dados recolhidos nos três momentos de avaliação, revelou efeitos positivos (p<0.05). da intervenção ao nível da atenção, tempo de reação, força muscular, agilidade e capacidade cardiorrespiratória. Nos testes realizados em dupla-tarefa, foram encontradas melhorias no teste timed up and go (p<0.05), mas não se verificaram melhorias no teste de tempo de reação. Conclusões: Um programa de exercícios multimodal induz melhorias no funcionamento cognitivo e motor de pessoas idosas institucionalizadas. É aconselhada a divulgação deste tipo de intervenção para pessoas idosas institucionalizadas; Effects of a Multimodal Exercise Program for Elderly Institutionalized Abstract: Objective: To investigate wthe effects of a multimodal exercise program on cognitive functioning and physical fitness of institutionalized elderly. Method: Participants were selected by convenience among two nursing home residents. Twenty-one people (77-92 years old) of both genders participated. During the first 4 weeks (control period), participants were not engaged in the exercise program and continue with their normal daily life activities. After the control period, the group was engaged in a multimodal exercise program for 8 weeks (2 times per week). To study the effects of a multimodal exercise program, data were collected at three different times: prior to the control period, after the control period, and at the end of the intervention. Several motor tests (physical fitness), cognitive tests and dual-tasks (motor-cognitive) were performed. The exercise sessions alternated between periods of motor taks and periods with motor plus cognitive tasks performed simultaneously. Results: The analysis of the data collected in the three moments of evaluation, show positive effects of the exercise program in cognitive dimensions (information processing speed and attention) and functional physical fitness components (muscle resistance, cardiorespiratory fitness and dynamic balance). In tests carried out in dual-task conditions, the exercise program promoted improvements in the timed up and go test (with mental calculations). Statistical analysis of the data collected at the three evaluation moments revealed positive effects (p <0.05). Of attention intervention, reaction time, muscle strength, agility and cardiorespiratory capacity. In the double-task tests, improvements were found in the timed up and go test (p <0.05), but there were no improvements in the reaction time test. Conclusions: The results of this study indicate that a multimodal exercise program can improve cognitive functioning and physical fitness in institutionalized older people. Thus, this type of intervention should be promoted among nursing home residents.

Qualidade de vida e aptidão física funcional dos idosos do concelho de Évora

Já na antiguidade o Homem se debruçava sobre a temática do envelhecimento, todavia os anos passaram e este fenómeno constitui-se como um dos assuntos da ordem do dia que nos abrange a todos, porque todos queremos vivenciar o prazer de envelhecer, à semelhança dos nossos antepassados. Porém estes procuravam o elixir de uma vida eterna e nós ambicionamos o elixir de uma longa vida com qualidade. Objectivo: Avaliar a qualidade de vida e aptidão física funcional dos idosos residentes do Concelho de Évora em instituições da rede solidária e nos seus domicílios com idade igual ou superior a 75 anos. Métodos: Após a selecção aleatória e tendo por base os critérios de exclusão (sem défice cognitivo avaliado pelo MMS e sem problemas físicos que impedissem de realizar os testes funcionais) aceitaram participar no estudo 396 idosos do Concelho de Évora dos quais 196 se encontram institucionalizados nos lares da rede solidária e 200 residem nos seus domicílios. Os instrumentos de avaliação utilizados foram o EASYcare e a bateria de testes Rikly Jones- Senior Fitness Test. Conclusões: Os idosos não institucionalizados apresentam melhor qualidade de vida e aptidão física funcional face aos idosos institucionalizados. Os níveis de incapacidade do grupo de idosos são baixos, o que revela que estamos perante um grupo maioritariamente independente. Por sua vez os homens apresentam melhor auto­ percepção da sua qualidade de vida e melhor desempenho nos testes físicos realizados. Com o processo de envelhecimento é notório uma avaliação inferior nas diferentes áreas da qualidade de vida por parte dos idosos assim como um pior desempenho nos testes físicos. Verificou-se também que existem correlações significativas entre as áreas da qualidade de vida avaliadas e os parâmetros de aptidão física funcional considerados, estando estes interrelacionados. ABSTRACT: Introduction: Already in the antiquity Man was dealing with the aging topic, however the years passed and this issue is as one of the topics on the agenda that covers everyone, because we all want to experience the pleasure of growing old, like of our ancestors. Although they sought the elixir of eternal life and we are aiming the elixir of long life with quality. Aim: To evaluate the quality of life and functional fitness of elderly aged over 75 years, residents of the Municipality of Évora in the network institutions in their households. Methods: After random selection and based on the exclusion criteria (no cognitive impairment assessed by MMS and no conditions that hamper them from performing functional tests) agreed to participate in the study 396 elderly from Évora's Municipality of which 196 are institutionalized in nursing homes network of solidarity and 200 reside in their homes. The assessment instruments used were the EASYcare and battery of tests Rikly Jones- Senior Fitness Test. Conclusions: The non-institutionalized elderly have a better quality of life and functional fitness in relation to the institutionalized elderly. The levels of disability in the elderly group are low, indicating that this is a group mostly independent. ln tum the men have better self-perception of their quality of life and better performance in physical tests performed. With the aging process is an assessment of less known in different areas of life quality for elderly people as well as a poorer performance in physical tests. There was also that there are significant correlations between the areas of quality of life and evaluated the parameters of functional fitness considered and these interrelated.

THE TEACHING ABOUT THE CARE OF THE ELDERLY IN NURSING TRAINING: THE SITUATION IN PORTUGAL

This paper aims to look at the teaching situation of the nursing undergraduate degree’s courses about eldercare in Portugal. A documentary research on the teaching programs in 39 nursing schools, 26 schools presented syllabus units related to the topic ‘eldercare’ and in eight of these schools the contents of the units were identified. Using textual analysis and from the categories we concluded that the teaching regarding eldercare for the nurse training in Portugal is focused on hospital care; it is directed to the adult/elderly/family; it explores the definitions related to the aging process; it explores community issues, legislation and research. People responsible for the design/monitoring of teaching programs should include teaching regarding eldercare in the nurse training, considering that the elder population is increasing in Portugal.

Prevention of falls in the elderly in the home: promoting active ageing

Objective: To determine the frequency of falls and identify risk factors in the homes of the elderly under the Home Care Service of a village in Alentejo (Portugal). Method: Exploratory, descriptive study. The target group were elderly persons under the Home Care Service (23). The questionnaire consists of open and closed questions, and was based on the Jefferson Area Board for Aging Safety in the Home Assessment; Instrument to Assess the Risk of Falls and Adaptations to Prevent Falls at Home. Results: Of the 23 seniors, 13 were men; the mean age was 85; 10 widowers; 11 live alone; 12 cannot read or write; 17 have experienced falls, loss of balance being the main cause. They report changes in vision (21), hearing (14) and rheumatic diseases (14); hypertension (19); they use 4 or more drugs on a daily basis (16). Conclusion: The physiological changes associated with ageing may increase the risk of falls. Due to the consequences, it is a priority field in community intervention.

Prevention of falls in the elderly in the home: promoting active ageing

To determine the frequency of falls and identify risk factors in the homes of the elderly under the Home Care Service of a village in Alentejo (Portugal). Method: Exploratory, descriptive study. The target group were elderly persons under the Home Care Service (23). The questionnaire consists of open and closed questions, and was based on the Jefferson Area Board for Aging Safety in the Home Assessment; Instrument to Assess the Risk of Falls and Adaptations to Prevent Falls at Home. Results: Of the 23 seniors, 13 were men; the mean age was 85; 10 widowers; 11 live alone; 12 cannot read or write; 17 have experienced falls, loss of balance being the main cause. They report changes in vision (21), hearing (14) and rheumatic diseases (14); hypertension (19); they use 4 or more drugs on a daily basis (16). Conclusion: The physiological changes associated with ageing may increase the risk of falls. Due to the consequences, it is a priority field in community intervention.

The daily life of informal caregivers of elderly

Objectives: To identify the reasons why the informal caregivers to take care of the elderly; to identify enjoyed support and the problems/needs senses. Methods: A descriptive, exploratory and cross study. The sample was 366 informal caregivers of the elderly residents in the District of Évora (Alentejo). Applied a questionnaire, which identified the reasons that led to cohabitation, the difficulties experienced by caregivers, experienced changes in their health and support they receive. Results: Most caregivers are women, with a mean age of 54 years. The main reason of care was elderly disease. These caregivers have changed in relaxation and leisure activities, on the organization of day-to-day and on economic aspects. They receive support from health institutions, social security and firemen’s. Conclusions: Family is the support in the disease, despite the difficulties, particularly in relaxation and leisure activities, organization of day-to-day and economic matters. They requested support in healthcare, transportation and economic aid.