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.

Determination of pharmocotherapeutical complexity in institutionalized elderly

The phenomenon of aging is nowadays society as acquired the status of a social problem, with growing attention and concern, leading to an increase number of studies dedicated to the elderly. The lack of domestic, familiar or social support often lead elderly to nursing homes. Institutionalization is in many cases the only opportunity to have access to health care and life quality. Aging is also associated with a higher prevalence of chronic diseases that require long term medication sometimes for life. Frequently the onset of multiple pathologies at the same time require different therapies and the phenomenon of polypharmacy (five ou more drugs daily) can occur. Even more, the slow down of physiological and cognitives mechanisms associated with these chronic diseases can interphere, in one hand, with the pharmacocinetic of many medications and, on the other hand, with the facility to accomplish the therapeutical regimen. All of these realities contribute to an increase of pharmacotherapeutical complexity, decreasing the adherence and effectiveness of treatment. The pharmacotherapeutical complexity of an individual is characterized by the conciliator element of different characteristics of their drug therapy, such as: the number of medications used; dosage forms; dosing frequency and additional indications. It can be measured by the Medication Regimen Complexity Index (MRCI), originally validated in English.

Determination of airborne nanoparticles in elderly care centres

According to numerous studies, airborne nanoparticles have a potential to produce serious adverse human health effects when deposited into the respiratory tract. The most important parts of the lung are the alveolar regions with their enormous surface areas and potential to transfer nanoparticles into the blood stream. These effects may be potentiated in case of the elderly, since this population is more susceptible to air pollutants in general and more to nanoparticles than larger particles. The main goal of this investigation was to determine the exposure of institutionalized elders to nanoparticles using Nanoparticle Surface Area Monitor (NSAM) equipment to calculate the deposited surface area (DSA) of nanoparticles into elderly lungs. In total, 193 institutionalized individuals over 65 yr of age were examined in four elderly care centers (ECC). The occupancy daily pattern was achieved by applying a questionnaire, and it was concluded that these subjects spent most of their time indoors, including the bedroom and living room, the indoor microenvironments with higher prevalence of elderly occupancy. The deposited surface area ranged from 10 to 46 μm2/cm3. The living rooms presented significantly higher levels compared with bedrooms. Comparing PM10 concentrations with nanoparticles deposited surface area in elderly lungs, it is conceivable that living rooms presented the highest concentration of PM10 and were similar to the highest average DSA. The temporal distribution of DSA was also assessed. While data showed a quantitative fluctuation in values in bedrooms, high peaks were detected in living rooms.

Determination of airborne nanoparticles in elderly care centres

According to numerous studies, airborne nanoparticles have a potential to produce serious adverse human health effects when deposited into the respiratory tract. The most important parts of the lung are the alveolar regions with their enormous surface areas and potential to transfer nanoparticles into the blood stream. These effects may be potentiated in case of the elderly, since this population is more susceptible to air pollutants in general and more to nanoparticles than larger particles. The main goal of this investigation was to determine the exposure of institutionalized elders to nanoparticles using Nanoparticle Surface Area Monitor (NSAM) equipment to calculate the deposited surface area (DSA) of nanoparticles into elderly lungs. In total, 193 institutionalized individuals over 65 yr of age were examined in four elderly care centers (ECC). The occupancy daily pattern was achieved by applying a questionnaire, and it was concluded that these subjects spent most of their time indoors, including the bedroom and living room, the indoor microenvironments with higher prevalence of elderly occupancy. The deposited surface area ranged from 10 to 46 mu m(2)/cm(3). The living rooms presented significantly higher levels compared with bedrooms. Comparing PM10 concentrations with nanoparticles deposited surface area in elderly lungs, it is conceivable that living rooms presented the highest concentration of PM10 and were similar to the highest average DSA. The temporal distribution of DSA was also assessed. While data showed a quantitative fluctuation in values in bedrooms, high peaks were detected in living rooms.

Diagnostic performance of visual screening tests in the elderly

This study aimed to determine and evaluate the diagnostic accuracy of visual screening tests for detecting vision loss in elderly. This study is defined as study of diagnostic performance. The diagnostic accuracy of 5 visual tests -near convergence point, near accommodation point, stereopsis, contrast sensibility and amsler grid—was evaluated by means of the ROC method (receiver operating characteristics curves), sensitivity, specificity, positive and negative likelihood ratios (LR+/LR−). Visual acuity was used as the reference standard. A sample of 44 elderly aged 76.7 years (±9.32), who were institutionalized, was collected. The curves of contrast sensitivity and stereopsis are the most accurate (area under the curves were 0.814−p = 0.001, C.I.95%[0.653;0.975]— and 0.713−p = 0.027, C.I.95%[0,540;0,887], respectively). The scores with the best diagnostic validity for the stereopsis test were 0.605 (sensitivity 0.87, specificity 0.54; LR+ 1.89, LR−0.24) and 0.610 (sensitivity 0.81, specificity 0.54; LR+1.75, LR−0.36). The scores with higher diagnostic validity for the contrast sensibility test were 0.530 (sensitivity 0.94, specificity 0.69; LR+ 3.04, LR−0.09). The contrast sensitivity and stereopsis test's proved to be clinically useful in detecting vision loss in the elderly.

Drug therapy complexity: the importance of pharmacotherapeutic follow-up

Nowadays, the phenomenon of population ageing represents an worldwide problem, which assumes particular significance in Portugal. As they get older, individuals present more comorbidities and consequently consume an increasing number of drugs, which contributes to a growing drug therapy complexity. The institutionalized elders are particularly affected by this occurrence. Drug therapy complexity is defined as the conciliator of several characteristics of the pharmacotherapy and can affect patient’s safety and medication adherence. It can be measured with Medication Regimen Complexity Index (MRCI). This study aims to determine the drug therapy complexity of institutionalized elders in order to assess the need of pharmacotherapeutic follow-up.

Qualidade de vida e espiritualidade em idosos institucionalizados e em comunidade

Mestrado em Fisioterapia.

Fungal contamination assessment in Portuguese elderly care centers

Individuals spend 80-90% of their day indoors and elderly subjects are likely to spend even a greater amount of time indoors. Thus, indoor air pollutants such as bioaerosols may exert a significant impact on this age group. The aim of this study was to characterize fungal contamination within Portuguese elderly care centers. Fungi were measured using conventional as well as molecular methods in bedrooms, living rooms, canteens, storage areas, and outdoors. Bioaerosols were evaluated before and after the microenvironments' occupancy in order to understand the role played by occupancy in fungal contamination. Fungal load results varied from 32 colony-forming units CFU m(-3) in bedrooms to 228 CFU m(-3) in storage areas. Penicillium sp. was the most frequently isolated (38.1%), followed by Aspergillus sp. (16.3%) and Chrysonilia sp. (4.2%). With respect to Aspergillus genus, three different fungal species in indoor air were detected, with A. candidus (62.5%) the most prevalent. On surfaces, 40 different fungal species were isolated and the most frequent was Penicillium sp. (22.2%), followed by Aspergillus sp. (17.3%). Real-time polymerase chain reaction did not detect the presence of A. fumigatus complex. Species from Penicillium and Aspergillus genera were the most abundant in air and surfaces. The species A. fumigatus was present in 12.5% of all indoor microenvironments assessed. The living room was the indoor microenvironment with lowest fungal concentration and the storage area was highest.

Consumo de benzodiazepinas por idosos institucionalizados: inapropriação, qualidade de sono e contributo para a segurança na medicação

A racionalização do uso de medicamentos constitui-se como um fator contribuinte para a melhoria da segurança do doente, particularmente no que respeita à segurança na medicação, tendo-se tornado prioritária para as organizações e instituições de saúde. A avaliação do uso de medicamentos inapropriados no idoso constitui-se como uma medida que concorre para evitar, prevenir ou corrigir eventos adversos associados ao seu uso. As benzodiazepinas são uma das classes de medicamentos mais prescritas em idosos. No entanto, e apesar de sua utilidade clínica, algumas benzodiazepinas são consideradas inapropriadas nesta faixa etária por potenciarem o efeito sedativo e aumentar a incidência de quedas e fraturas. A longo prazo, na promoção da qualidade do sono, a sua efetividade é discutível já que a toma de uma benzodiazepina para a resolução de um problema como o sono, muitas vezes pontual, passa a ser um problema crónico de exigência de toma contínua, sem que a qualidade deste seja restabelecida, pondo em risco a segurança do doente. Este estudo tem como objetivo caracterizar o consumo de benzodiazepinas por idosos institucionalizados, numa instituição de longa permanência do concelho de Sesimbra, sua inapropriação e a relação com a qualidade de sono. Foi desenvolvido um estudo descritivo e transversal, assente no paradigma qualitativo, com a recolha de dados a decorrer em três momentos: registo de informação em grelha própria da caracterização sociodemográfica e da caracterização do consumo de benzodiazepinas; aplicação do índice de Katz para determinar a funcionalidade dos participantes; aplicação do questionário adaptado do Pittsburgh Sleep Quality Index para avaliação da qualidade do sono. A inapropriação foi avaliada pela aplicação dos critérios de Beers. Após aplicação dos critérios de inclusão (idade superior a 65 anos e capacidade funcional) aos 97 utentes da instituição, a amostra foi constituída por 51 utentes. Foi recolhido consentimento informado de todos os participantes. Os resultados obtidos mostram que 46% das benzodiazepinas consumidas são de duração intermédia de ação, observando-se ainda um valor considerável de consumo de benzodiazepinas de longa duração de ação (36%). Estes valores correspondem a um grau elevado de inapropriação, potenciando os riscos para a segurança do doente nesta faixa etária. O lorazepam 2,5mg é a benzodiazepina mais utilizada como hipnótico. Mas, apesar do consumo deste grupo de medicamentos 81,6% dos idosos que consumem benzodiazepinas não apresentam boa qualidade de sono (PSQI>5), enquanto 77% dos idosos que não consomem benzodiazepinas apresentam boa qualidade de sono (PSQI≤5). Nos idosos que consomem benzodiazepinas, a média de tempo despendido na cama até adormecer foi de cerca de 55 minutos, valor superior ao grupo que não consome benzodiazepinas, onde a média é de 27 minutos. Neste grupo de idosos, o consumo de benzodiazepinas não só é inapropriado como não contribuiu para uma melhoria na qualidade de sono nem para a segurança do doente, como são os consumidores de benzodiazepinas que apresentam uma pior qualidade de sono, nas suas várias dimensões.

Efeitos de um programa de exercício físico na capacidade funcional de idosos institucionalizados no Lar da 3ª idade Beiral: projeto de intervenção

Mestrado em Fisioterapia

Influência de um programa de exercício na aptidão física e equilíbrio em idosos institucionalizados: projeto de intervenção

Mestrado em Fisioterapia

Impact of Sahara dust transport on Cape Verde atmospheric element particles

The objectives of this study were to (1) conduct an elemental characterization of airborne particles sampled in Cape Verde and (2) assess the influence of Sahara desert on local suspended particles. Particulate matter (PM10) was collected in Praia city (14°94'N; 23°49'W) with a low-volume sampler in order to characterize its chemical composition by k0-INAA. The filter samples were first weighed and subsequently irradiated at the Portuguese Research Reactor. Results showed that PM10 concentrations in Cape Verde markedly exceeded the health-based air quality standards defined by the European Union (EU), World Health Organization (WHO), and U.S. Environmental Protection Agency (EPA), in part due to the influence of Sahara dust transport. The PM10 composition was characterized essentially by high concentrations of elements originating from the soil (K, Sm, Co, Fe, Sc, Rb, Cr, Ce, and Ba) and sea (Na), and low concentrations of anthropogenic elements (As, Zn, and Sb). In addition, the high concentrations of PM measured in Cape Verde suggest that health of the population may be less affected compared with other sites where PM10 concentrations are lower but more enriched with toxic elements.

Environmental mycology in public health: fungi and mycotoxins risk assessment and management

Fungi are essential to the survival of our global ecology, but they might pose a significant threat to the health of occupants when they grow in our buildings. The exposure to fungi in homes is a significant risk factor for a number of respiratory symptoms. Well-known illnesses caused by fungi include allergy and hypersensitivity pneumonitis. Environmental monitoring for fungi and their disease agents are important aspects of exposure assessment, but few guidelines exist for interpreting their health impacts. This book answers the questions: How does one detect and measure the presence of indoor fungi? What is an acceptable level of indoor fungi? How do we relate this information to human health problems?

Exposure assessment to ionizing radiation in the manufacture of phosphate fertilizer

Present study develops and implements a specific methodology for the assessment of health risks derived from occupational exposure of workers to ionizing radiation in the fertilizer manufacturing industry. Negative effects on the health of exposed workers are identified, according to the types and levels of exposure to which they are subject, namely an increase of the risk of cancer even with long term exposure to low level radiation. Ionizing radiation types, methods and measuring equipment are characterized. The methodology developed in a case study of a phosphate fertilizer industry is applied, assessing occupational exposure to ionizing radiation caused by external radiation and the inhalation of radioactive gases and dust.

Naturally occurring radioactive materials: a method for assessing the risk of exposure

Naturally Occurring Radioactive Materials (NORM) are materials that are found naturally in the environment and contain radioactive isotopes that can cause negative effects on the health of workers who manipulate them. Present in underground work like mining and tunnel construction in granite zones, these materials are difficult to identify and characterize without appropriate equipment for risk evaluation. The assessing methods were exemplified with a case study applied to the handling and processing of phosphoric rock where one found significant amounts of radioactive isotopes and consequently elevated radon concentrations in enclosed spaces containing these materials. © 2015 Taylor & Francis Group, London.