Influência de fatores biopsicossociais sobre a mortalidade de idosos no município de Santa Cruz/RN: um estudo prospectivo

The aging process if characterizes for a complex events network, from multidimensional nature, that encloses biological, social, psychic and functional aspects. The alteration of one or more aspects can speed up the aging process, anticipating limitations and until the death in the aged. For an adjusted confrontation of this question is necessary an interdisciplinary vision, in which the some areas of the knowledge can interact and with this to intervenes of the best possible form. Then, information derived from studies of aspects related to incidence, morbidity-mortality and transition patterns, involved in the health-illness process can more accurately identify risk groups thereby establishing links between social factors, illness, incapacity and death. Thus, this study aimed to identify, by a multidimensional vision, the risk factors of mortality in a coorth of elderly in a city in the interior of the state of Rio Grande do Norte (RN), Brazil. A prospective study carried out in Santa Cruz RN, where 310 elderly were randomly selected to form a baseline. The follow-up was 53 months. The predictive variables were divided into sociodemographic, physical health, neuropsychiatric and functional capacity. The statistical analysis carried out by bivariate analysis, survival analysis, followed by binary logistic regression and Cox regression, in the multivariate analysis, considering significant levels p < 0.05 and confidence interval (CI) of 95%. A total of 60 (19.3%) elderly died during the follow-up, where cardiovascular disease was the main cause. The survival was approximately 24.8 months. The study of general survival showed, at 12, 24, 36, and 48 months of observation, a survival rate of 97%, 54%, 31%, and 5% respectively, with a statistical difference in survival only observed for the variables of cognitive function and Basic Activities of Daily Living. In the logistic regression analysis, the risk factors identified were cognitive deficits (OR = 8.74), poor perception of health (OR = 3.89) and dependence for Basic Activities of Daily Living (OR = 3.96). In the Cox analysis, as well as dependence for Basic Activities of Daily Living (HR = 3.17), cognitive deficit (HR = 4.30) and stroke (CVA) (HR = 3.49) continued as independent risk factors for death. The risk factors found in the study can be interpreted as the primary predictors for death among elderly members of the community. Therefore, improvements in health conditions, with actions towards sustaining an autonomous life with special attention for elderly with cognitive impairment, could mean additional healthy quality of life, resulting in the reduction of premature mortality in this population

Atividade física na terceira idade: Uma análise de sua contribuições para o estilo de vida através das representações sociais

Temáticas emergentes e estratégicas da política de saúde em nível mundial têm suscitado reflexões para ações sócio educativas com idosos. Esta pesquisa questiona as aspirações desse segmento social face às experiências de qualidade proporcionadas pela atividade física. Objetivo: investigar as representações sociais da atividade física na terceira idade. Método: pesquisa de corte transversal com abordagem quanti-qualitativa. A amostra foi nãoprobabilística e por conveniência apoiada na Teoria das Representações Sociais e a Teoria do Núcleo Central. O estudo foi realizado com alunos de um projeto para a terceira idade com sede no Centro Federal de Educação Tecnológica do Rio Grande do Norte (CEFET), no município de Natal/RN, Brasil. Para a coleta dos dados utilizou-se de questionário semi-estruturado, composto de três partes: A Parte I, para a caracterização social da amostra e identificação da percepção da atividade física para a saúde; a Parte II, com evocação livre de palavras e a Parte III, com uma questão aberta. Análise dos dados: A exploração do material deu-se a partir dos seguintes softs: do SPSS para análise de freqüência simples (parte I); do EVOC (parte II) e do ALCESTE (parte III). Complementarmente, foi utilizada a análise de conteúdo a fim de inferir/corroborar sobre os núcleos de sentido da comunicação. Resultados: O núcleo central da representação foi composto por felicidade/saúde/dança e ginástica, revelando diferentes entendimentos e mostrando também que o conhecimento construído da atividade física assume um papel preponderante na vida de idosos, adquirindo gradativamente, a representação de vida com mais saúde e qualidade na velhice . A composição do núcleo central ao considerar elaborações mentais, emoções, práticas e explicações oriundas do cotidiano que se introduzem na constituição da representação social em foco, poderá influenciar as escolhas e estratégias de se desenvolver melhora nos padrões de saúde e na qualidade de vida dos idosos.

Representações sociais dos trabalhadores de saúde da atenção básica sobre envelhecimento e o atendimento ao idoso

This study aims to identify the social representations built on senior care health workers of Primary Care. This is an exploratory research within the subsidized social representations held in 100 Basic Health Units in the city of João Pessoa-PB, with a sample of n= 204 workers of both sexes, who agreed to participate. To collect the data used to set an interview in two parts: the first looked at the Test of Free Association of Words using the inductive stimulus "senior care". The interviews were analyzed with the help of a software for quantitative analysis of textual data ALCESTE (version 2010). The results were interpreted from the theoretical framework of social representations. The study included 178 women (87.25%) and 26 men (12.75%), working in Family Health Units in the city of João Pessoa, the majority are aged between 40-49 years of age ( 28.92%), and have higher education with 81.86%. The results of Alceste link to the term inducer six (6) where the hierarchical classes representing senior care workers as synonymous with care and attention, showing situations neglect of the elderly, for that patience is required to promote the increase of disease prevention and living with the elderly to generate humanization in health services. It is considered that the social representations of health workers on assistance to the elderly may support modeling of strategic actions in health services with health promotion programs for large groups, able to modify practices and behavior in elder care and strengthening the policy was directed at the elderly

Uma análise sociodemográfica dos cuidadores formais de idosos institucionalizados no município de Natal/RN, 2012

The aging population and individual have been the subject of a multitude of studies nowadays. This is probably due to the impact of this phenomenon in various sectors of society, like social security, social assistance and public health. The process of aging of the individual imply the demand for specific services, considering the limitations and vulnerabilities of the individual at that stage of life cycle. The growth of the elderly contingent in the last decades raises challenges for policymakers, the family and also for the society at large. In this scenario, long-stay institutions for the elderly (LSIEs) appear as an option to aid and support the elderly and their family, assisting in all or part in the activities of daily living and self-care. Inside these LSIEs we find the professional responsible for the direct care of the elderly, the formal caregiver. In this context, this dissertation presents two main objectives: an analysis of the phenomenon of population aging in a given brazilian municipality Natal / RN, based on the Demographic Censuses of 2000 e 2010; and a social, demographic and economic characterization of the Formal caregiver for the institutionalized elderly in the municipality, evaluating aspects of his quality of life and also analyzing the institutions where they are inserted. Furthermore, we intend to identify demographic, socioeconomic and quality of life factors that are correlated with caregivers quitting the job. The data used in the second part of this work comes from the research project named Long-Stay Institutions for Elderly: abandonment or a family need? . This survey interviewed 92 caregivers in eleven LSIEs in Natal/RN. In the data treatment logistic regressions, cluster analysis and statistical tests were used. The survey revealed that aging in Natal is more pronounced in the older, more traditional districts: Petrópolis, Lagoa Seca and Tirol. It also allowed a broad characterization of the formal caregivers in LSIEs. Most of these professionals are female. The educational level is predominantly complete high school and more. Most caregivers reported being married or in union, or have ever been in a union. Family monthly income is under three times the minimum wage. The mean age is of 37.4 years. The mean time of work as a caregiver was 5.93 years. The associations showed that being woman, not being single, having caregiving training and physical limitations (regarding quality of life) are related to wanting to quit the caregiving job. As for the characterization of the LSIEs, it was found that the philanthropic ones are older and have most (62.5%) of the institutionalized elderly. The institutions managers gave social interaction and affinity with the elderly as the main criteria with which to evaluate and hire caregivers. It is intended with this study to contribute to improving the quality of life of the elderly and their caregiver, providing information on aspects of institutionalization of elderly both in the philanthropic and particular institutions, in Natal/RN; this dissertation may also be used as a starting point for later works

Envelhecimento populacional: um diagnóstico dos idosos institucionalizados, em Natal/RN

The aging process lived by the Brazilian population concurred to the transformation in the family models, causing difficulties related to the elderly care on the Family environment, a fact that is one of the main reasons for their institutionalization. Facing this scenario, the need of investigating how the elderly lives on the long-term facilities (ILPI) has aroused. In this study, it has been conducted an analysis of the populational aging process, contrasting the Rio Grande do Norte to Brazil and the Northeast Region, between 1980 to 2010. Faced with the realization of this process, and the rising number of long-term facilities for the elderly (ILPI), it was needed to make a rescue of the abiding laws regarding elderly institutionalization, on the scope of Natal, which surged after the 1988 Federal Constitution, checking what were the impacts on the assistance of the institutionalized elderly. Lastly, it were investigated the possible determinants associated with the institutionalization, in Natal-RN, considering the aspects of the family structure, family relationship, economic, health and well being of the elderly. The results showed that Rio Grande do Norte, particularly Natal, follows the national scene, since between 1980 and 2000 its population passed the intermediate level in the process of population aging for, in 2010, to be considered elderly. Throughout this process, it was observed that Natal has been adapting to the federal legislation, through the creation of the municipal policy, City Council and other relevant standards for the elderly, promoting significant changes in ILPI.However, philanthropic institutions needs better resources for their maintenance. In research with the elderly, it was found that although the majority of the elderly have declared themselves satisfied with life, they had indicators of impairment of functional capacity and cognitive, isolated social behavior and depression, affecting the life quality of these elderly. These results reflect the need for greater investment of public power in the drafting, implementation and monitoring of public policies aimed at promoting changes that raise the level of life quality of this segment of the population

Histórias de idosos: sementes para cultivarmos uam educação para uma velhice bem-sucedida

We understand that the successful old age is not confined only in the analysis of quantitative aspects concerning the economic situation of the subject that gets old, but this special way of aging is related to other values, such as dignity, happiness, self-esteem, willingness, autonomy, independence, social involvement with family and friends, among others. Thus, this study aimed to investigate the human aging process, considering the history of life of ten seniors who fit the profile of successful old age, seeking to identify elements that contribute to educational thinking in order to get a successful aging. In this perspective, we argue in this study, the idea that we need to learn to engage in experiences that more than providing satisfaction and well-being in the moment in which we conducted, serve as a potentiating to a successful old age. Thus, throughout this thesis we question: what are the present indicative in the histories of life of elderly people, considered successful, which may contribute to an education that people experiencing their age more satisfactorily. This is a qualitative study, that took as universe a methodological oral history, in which we used as a technique of research a semistructured interview as a part of their life history, with emphasis on consideration of the following categories: diary routine, with emphasis on social harmony in the family, at work and in friendship groups of leisure and physical activity, self-knowledge and the learning experiences throughout life. To get the objectives outlined, as well as lectured on the categories analyzed, we support our reflection on the theory of the course of life, which includes human aging as a historical and cultural contextual reality. Our research revealed, among other things, that successful aging is coupled to an active lifestyle, where the involvement in physical activities, recreational and social experiences throughout life is important for increasing self-esteem, autonomy and joy of living, conditions that enable successful old age. Our study also revealed that the educationfor successful old age is linked with the consumption along the life, educational activities which broaden the possibilities of social interaction between people, even among different generations, since the interaction is important to learn and accept our possibilities and limits.

Representações Sociais do ser idoso e suas implicações na assistência e nas práticas educativas voltadas à população idosa residente em Natal/RN

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

A fragilidade e suas representações para idosos domiciliados no contexto da estratégia de Saúde da Família

This study aims to analyze social representations of elders to their fragile situation at home, with the presence of one or more characteristics, as defined by the Brazilian Ministry of Health. It is a descriptive and qualitative study, based on methodological -principles of the Theory of Social Representations. Setting was the homes of elderly residents in the area ascribed to a Family Health Unit (FHU) in the city of Natal. A total of 10 elderly subjects, whose choice was intentional and according to the need for USF home visit in a period of time, considering the saturation process of the information. As collection procedures were used the semi-structured interview and participant observation in accordance with the ethical rules of Resolution No. 196/96, with the assent of the Ethics and Research UFRN. To analyze the results, it was used the thematic content analysis in the aspect of preparation of representations, focusing on the totality of the discourse of the subjects. The results indicate that most study participants felt difficult to give meaning to the terms weakness and to be weak, although many present one or more aspects of the syndrome of frailty. From the content analysis of participants speeches in this study, we achieved the following categories: fragility as illness and disease as aging, aging and frailty as causes of changes and difficulties in daily life, the presence of family life in the fragile elderly, fragility as weakness and the risk for falls, the perception of being weak like a different person in addition to the absence of fragility in elderly life. Thus, through the processes of anchoring and objectification, the "fragile being" became familiar and concrete, showing that the meaning of weakness, besides the scientific definition found in the reified universes, can be reinterpreted and built within the consensus universes. About the care received by the staff of Family Health, from the viewpoint of older people there seems to be an understanding about the role of professional nurses; on the other hand, older people often mention the role of the Community Health Agent

Apoio social e síndrome da fragilidade em idosos residentes na comunidade

Introduction: The frailty in the elderly is the result of a complex interplay between many social and clinical factors involved in its genesis. Although there is an understanding of its association with increased risk of adverse clinical outcomes, still it is unclear whether this syndrome can be aggravated due to lack of social support. So, the objective of this study was to analyze the association between social support and frailty syndrome in elderly community residents. Materials and methods: Observational analytical cross-sectional study, with a sample of 300 elderly living in the city of Natal-RN. Were collected informations about socialdemographic, economics and physical health data. The Social support was assessed by the status of cohabitation; marital status; contact frequency and diversity rate; received and given attendance frequency rate; and Map Minimum Relations of the Elderly. The frailty was assessed using the following criteria: unintentional weight loss, weakness, low physical activity, exhaustion and Slowness. To observe any possible associations, we performed the Pearson chi-square test, the Student t test and multivariate analysis using binary logistic regression, adopting a significance level of 5%. Results: It was observed that there were no associations of frailty with the social support variables, except for housekeeping mode (p = 0.046) of the MMRI. For the sociodemographic, economic, physical health and social support data, only age (p <0.001), sedentary lifestyle (p = 0.002) and poor perceived health (p = 0.001) were the ones that remained in the logistic regression model, with strong association for the presence of frailty. Conclusion: Among the variables related to social support, only to help with housekeeping was significantly associated with frailty. However, more studies need to be developed to characterize the social vulnerability, as well as health services need to recognize the importance of social support as an integral part of care for the elderly

Produção e validação de um indicador de saúde bucal para idosos a partir de dados secundários do SB Brasil 2010

Dentre os vários aspectos da saúde do idoso, a saúde bucal merece atenção especial pelo fato de que, historicamente, nos serviços odontológicos, não se considera esse grupo populacional como prioridade de atenção. Por isso, se faz necessária a produção de um indicador multidimensional capaz de mensurar todas as alterações bucais encontradas em um idoso, facilitando a categorização da saúde bucal como um todo. Tal indicador representará um importante instrumento capaz de elencar prioridades de atenção voltadas à população idosa. Portanto, o estudo em questão propõe a produção e validação de um indicador de saúde bucal a partir dos dados secundários coletados pelo projeto SB Brasil 2010 referente ao grupo etário de 65 a 74 anos. A amostra foi representada pelos 7619 indivíduos do grupo etário de 65 a 74 anos que participaram da pesquisa nas 5 (cinco) regiões do Brasil. Tais indivíduos foram submetidos à avaliação epidemiológica das condições de saúde bucal, a partir dos índices CPO-d, CPI e PIP. Além disso, verificou-se o uso e necessidade de prótese, bem como características sociais, econômicas e demográficas. Uma análise fatorial identificou um número relativamente pequeno de fatores comuns, através da análise de componentes principais. Após a nomenclatura dos fatores, foi realizada a soma dos escores fatoriais por indivíduo. Por último, a dicotomização dessa soma nos forneceu o indicador de saúde bucal proposto. Para esse estudo foram incluídas na análise fatorial 12 variáveis de saúde bucal oriundas do banco de dados do SB Brasil 2010 e, também 3 variáveis socioeconômicas e demográficas. Com base no critério de Kaiser, observa-se que foram retidos cinco fatores que explicaram 70,28% da variância total das variáveis incluídas no modelo. O fator 1 (um) explica sozinho 32,02% dessa variância, o fator 2 (dois) 14,78%, enquanto que os fatores 3 (três), 4 (quatro) e 5 (cinco) explicam 8,90%, 7,89% e 6,68%, respectivamente. Por meio das cargas fatoriais, o fator um foi denominado dente hígido e pouco uso de prótese , o dois doença periodontal presente , o três necessidade de reabilitação , já o quarto e quinto fator foram denominados de cárie e condição social favorável , respectivamente. Para garantir a representatividade do indicador proposto, realizou-se uma segunda análise fatorial em uma subamostra da população de idosos investigados. Por outro lado, a aplicabilidade do indicador produzido foi testada por meio da associação do mesmo com outras variáveis do estudo. Por fim, Cabe ressaltar que, o indicador aqui produzido foi capaz de agregar diver sas informações a respeito da saúde bucal e das condições sociais desses indivíduos, traduzindo assim, diversos dados em uma informação simples, que facilita o olhar dos gestores de saúde sobre as reais necessidades de intervenções em relação à saúde bucal de determinada população

O atendimento ao idoso na unidade de saúde da família: um estudo de representações sociais

The attention to health issues in aging has increased and it becomes a challenge for public policies directed to the elderly. This study aimed at learning the social representations built by seniors about the service in the Family Health Unit. It is an exploratory study, funded by the Theory of Social Representations of Moscovici. It was held at the Health Unit of the Family Felipe Shrimp, located in the neighborhood Felipe Shrimp in the city of Natal / RN-Brazil. The participants were one hundred and two elderly / as, served by the Family Health Strategy. The data collection period was extended from July to September 2014. Data were collected through the Word Free Association Test and Interview semi-structured, and analyzed with the help of EVOC software. Interviews were conducted with 20 elderly and subjected to content analysis. The research was approved by the Ethics Committee of the University Hospital Research Onofre Lopes, in the opinion 704,323. It was possible to apprehend negative connotations regarding attendance, listing it as bad and disrespectful, and the limited hours of service, difficult to schedule appointments and tests and inadequate infrastructure, the most marked aspects. Seniors express satisfaction with the medical care, however, they understand that it is necessary that all services are properly integrated to a qualified service. The statements reveal that the service in the drive needs to implement new strategies host for users to participate more in educational and health promotion. It is noted, the need of integrated care, the host of qualified hearing in the health services that they address the elderly seeking care at the clinic of the family, so sticking to the principles of the Unified Health System.

Validação do instrumento dos indicadores observáveis da qualidade do cuidado em instituições de longa permanência para idosos

The Nursing Homes are an important alternative care in the world, but Brazil still has no valid instrument to monitor the quality these institutions. In the United States, the Observable Indicators of Nursing Home Care Quality Instrument (OIQ) is used to assess the quality of Nursing Home care using 30 indicators of structure (2 dimensions) and process (5 dimensions) related to quality person-centered care. The present study aimed at cross-culturally adapting the OIQ in order to evaluate the quality of Nursing Home care in Brazil. Conceptual and item equivalence were determined to assess the relevance and viability of OIQ in the Brazilian context, using the Content Validity Index (CVI) and a group of specialists composed of 10 participants directly involved in the object of study. Next, operational, idiomatic and semantic equivalence were carried out concurrently. This consisted of 5 phases: (1) two translations and (2) their respective back translations; (3) formal appraisal of referential and general meaning; (4) review by a second group of specialists; (5) application of the pretest at three Nursing Homes by different social entities: health professionals, sanitary surveillance regulators and potential consumers. Measurement equivalence was evaluated by the Cronbach’s alpha test to verify the internal consistency of the instrument. To measure inter-evaluator agreement, the General Agreement Index (ICG) and Kappa coefficient were used. Timely compliance and 95% Confidence Interval of indicators, dimensions and total construct were estimated. The CVI obtained high results for both relevance (95.3%) and viability (94.3%) in the Brazilian context. With respect to referential meaning, similarity was observed, ranging between 90-100% for the first back translation and 70-100% for the second. In relation to general meaning, version 1 was better, classified as “unchanged” in 80% of the items, whereas in version 2 it was only 47%. In the pretest, the OIQ was easy to understand and apply. The following outcomes were obtained: a high Cronbach’s alpha (0.93), satisfactory ICG (75%) and substantial agreement between the pairs of evaluators (health professionals, regulators from the Superintendency of Sanitary Surveillance –SUVISA-, and potential consumers), according to the Kappa coefficient (0.65). It´s possible take the operational equivalence held since it preserved the original layout in the Brazilian version from the maintenance in application mode, response options, number of items, statements and scores. The performance of nursing homes obtained approximate average scores of 87, a variation 55-111 considering a range from 30 to 150 points. The worst outcomes were related to process indicators with a mean of 2.8 per item, while structure was 3.75 on a scale of 1 to 5. The lowest score was obtained for the care dimension (mean 2). The OIQ version was deemed to be a valid and reliable instrument in the Brazilian context. It is recommended that health professionals, regulators and potential consumers adopt it to access and monitor the quality of Nursing Home care and demonstrating opportunities for improvement.

Desempenho físico em idosos com diferenciados perfis epidemiológicos: análise do estudo IMIAS International Mobility in Aging Study sob a perspectiva do curso da vida e de biomarcadores da inflamação e do estresse

O crescimento demográfico de idosos é um fenômeno mundial e exerce influência sobre o desenvolvimento e funcionamento das sociedades. Fatores sociais, econômicos, ambientais, biológicos e culturais influenciam o processo de envelhecimento, que pode vir acompanhado de contínua perda na capacidade de adaptação do indivíduo ao meio ambiente, de maior vulnerabilidade ao estresse, limitações funcionais e diminuição da qualidade de vida do indivíduo. Todavia, ao longo do curso da vida, o indivíduo vivencia múltiplas exposições adversas à saúde, e o declínio da mobilidade surge como um dos primeiros sinais do envelhecimento, repercutindo na saúde física e mental do indivíduo. Para contribuir com o conhecimento sobre os desfechos relacionados ao envelhecimento e mobilidade, o estudo IMIAS investiga idosos em quatro países com diferentes perfis epidemiológicos. O presente estudo abordou os possíveis fatores associados ao declínio físico em idosos de distintas sociedades, sobre a perspectiva epidemiológica do curso da vida e dos biomarcadores da inflamação e do estresse. Objetivos: 1) Analisar as relações entre as adversidades sociais e econômicas, vivenciadas durante a infância, a fase adulta e a velhice, com o baixo desempenho físico em populações idosas, de diferentes contextos sociais, econômicos e culturais. 2) Verificar a associação entre os níveis elevados da proteína c-reativa (PCR) com o desempenho físico em idosos de diferentes populações. 3) Avaliar se a desregulação nos níveis de cortisol diurno exerce influência sobre o desempenho físico em idosos com distintos perfis epidemiológicos. Métodos: Foram utilizados dados da linha de base do IMIAS – Estudo Internacional de Mobilidade no Envelhecimento, composto por 1.995 indivíduos entre 65 e 74 anos de idade, residentes em comunidades de quatro países (Albânia, Brasil, Canadá, Colômbia). O desempenho físico foi avaliado através do Short Physical Performance Battery (SPPB) e da força de preensão manual. As adversidades durante o curso da vida foram estimadas a partir de eventos e exposições sociais, econômicas e culturais ocorridas durante a infância, fase adulta e velhice. Para avaliar o percurso biológico e suas associações com a mobilidade, a proteína c-reativa e o cortisol foram considerados como biomarcadores da inflamação e do estresse, respectivamente. No sentido de responder as questões de investigações, foram conduzidas análises de estatística descritiva, bivariada e multivariada, mediante técnicas de distribuição de frequências, teste qui-quadrado, odds ratio e regressões logística, linear e multinível. Resultados: O desempenho físico foi menor nos participantes que vivem na Colômbia, Brasil e Albânia do que nos que vivem no Canadá, mesmo quando ajustados por idade, sexo e adversidades durante o curso da vida. O baixo nível de desempenho físico (SPPB < 8) foi associado a ter sofrido adversidade social e econômica na infância, ter tido ocupação semiqualificada na fase adulta, morar sozinho e possuir renda insuficiente na velhice. A PCR esteve associada com a baixa força de preensão manual e com o SPPB<8. Entretanto, a associação entre a PCR e a força de preensão manual não se manteve quando ajustada por fatores socioeconômicos e hábitos de saúde. As associações negativas entre SPPB e PCR permaneceram significativas mesmo após ajustes por idade, sexo, escolaridade, local de pesquisa e condições de saúde. O baixo desempenho físico (SPPB ≤ 8) foi associado com uma significativa diminuição nos níveis de cortisol ao acordar, em comparação com os níveis de cortisol de idosos com bom desempenho físico (SPPB > 8), mesmo após modelos controlados por local de estudo, sexo, depressão, hábitos de saúde, uso de psicotrópicos e índice de massa corporal. Conclusões: Os resultados evidenciaram associação entre a inflamação, o estresse e as desigualdades sociais e econômicas na infância, sobre o desempenho físico de idosos com diferenciados perfis epidemiológicos. Enfatizamos que a promoção do envelhecimento saudável requer considerar políticas e práticas que favoreçam o bem-estar econômico e social para crianças, adultos e idosos.

Efeitos de um programa de treino cognitivo e das técnicas de higiene do sono para as funções executivas e para a qualidade de sono em idosos saudáveis

The aging process causes changes in the elderly’s sleep/awake standard impairing their cognitive abilities, particularly executive functioning, which already suffers loss by aging. The literature suggests that executive function and preserved sleep quality are key to maintaining good quality of life and independence of older people, requiring interventions to minimize the impact of losses incurred by the aging process. This study evaluated the effect of a cognitive training program and sleep hygiene techniques for executive functions and sleep quality in healthy older people. The participants were 41 healthy older adults, of both sexes, who were randomly divided into four groups: control group [GC], cognitive training group [GTC], sleep hygiene group [GHS] and training group + hygiene [GTH]. The research was developed in three stages: 1st - initial assessment of cognition and sleep; 2nd - specific intervention to each group; 3rd - post-intervention revaluation. The results showed that GTC had significant improvements in cognitive tasks flexibility, planning, verbal fluency and some aspects of episodic memory, besides gains in sleep quality and decrease on daytime hypersomnolence. The GHS improved sleep quality and daytime sleepiness as well and had significant improvements in insights capacity, planning, attention and in all evaluated aspects of episodic memory. The GTH had significant gains in cognitive flexibility, problem solving, verbal fluency, attention and episodic memory. The CG showed significant worsening in excessive daytime sleepiness in capacity planning. Thus, we conclude that cognitive training interventions and sleep hygiene strategies are useful in improving cognitive performance and quality of healthy elderly sleep.

Caracterização do ritmo circadiano de atividade e repouso em saguis idosos (Callithrix Jacchus)

Advanced age may become a limiting factor for the maintenance of rhythms in organisms, reducing the capacity of generation and synchronization of biological rhythms. In this study, the influence of aging on the expression of endogenous periodicity and synchronization (photic and social) of the circadian activity rhythm (CAR) was evaluated in a diurnal primate, the marmoset (Callithrix jacchus). This study had two approaches: one with longitudinal design, performed with a male marmoset in two different phases: adult (three years) and older (9 y.o.) (study 1) and the second, a transversal approach, with 6 old (♂: 9.7 ± 2.0 y.o.) and 11 adults animals (♂: 4.2 ± 0.8 y.o.) (study 2). The evaluation of the photic synchronization involved two conditions in LD (natural and artificial illuminations). In study 1, the animal was subjected to the following stages: LD (12:12 ~ 350: ~ 2 lx), LL (~ 350 lx) and LD resynchronization. In the second study, the animals were initially evaluated in natural LD, and then the same sequence stages of study 1. During the LL stage in study 2, the vocalizations of conspecifics kept in natural LD on the outside of the colony were considered temporal cue to the social synchronization. The record of the activity was performed automatically at intervals of five minutes through infrared sensor and actimeters, in studies 1 and 2, respectively. In general, the aged showed a more fragmented activity pattern (> IV < H and > PSD, ANOVA, p < 0.05), lower levels of activity (ANOVA, p < 0.05) and shorter duration of active phase (ANOVA, p < 0.05) in LD conditions, when compared to adults. In natural LD, the aged presented phase delay pronounced for onset and offset of active phase (ANOVA, p < 0.05), while the adults had the active phase more adjusted to light phase. Under artificial LD, there was phase advance and greater adjustment of onset and offset of activity in relation to the LD in the aged (ANOVA, p < 0.05). In LL, there was a positive correlation between age and the endogenous period () in the first 20 days (Spearman correlation, p < 0.05), with prolonged  held in two aged animals. In this condition, most adults showed free-running period of the circadian activity rhythm with  < 24 h for the first 30 days and later on relative coordination mediated by auditory cues. In study 2, the cross-correlation analysis between the activity profiles of the animals in LL with control animals kept under natural LD, found that there was less social synchronization in the aged. With the resubmission to the LD, the resynchronization rate was slower in the aged (t-test; p < 0.05) and in just one aged animal there was a loss of resynchronization capability. According to the data set, it is suggested that the aging in marmosets may be related to: 1) lower amplitude and greater fragmentation of the activity, accompanied to phase delay with extension of period, caused by changes in a photic input, in the generation and behavioral expression of the CAR; 2) lower capacity of the circadian activity rhythm to photic synchronization, that can become more robust in artificial lighting conditions, possibly due to the higher light intensities at the beginning of the active phase due to the abrupt transitions between the light and dark phases; and 3) smaller capacity of non-photic synchronization for auditory cues from conspecifics, possibly due to reducing sensory inputs and responsiveness of the circadian oscillators to auditory cues, what can make the aged marmoset most vulnerable, as these social cues may act as an important supporting factor for the photic synchronization.