Novas propriedades do SKTI (Inibidor de tripsina de soja): inibição para elastase neutrofílica humana e efeitos no processo de injúria pulmonar aguda

Seeds from legumes including the Glycine max are known to be a rich source of protease inhibitors. The soybean Kunitz trypsin inhibitor (SKTI) has been well characterised and has been found to exhibit many biological activities. However its effects on inflammatory diseases have not been studied to date. In this study, SKTI was purified from a commercial soy fraction, enriched with this inhibitor, using anion exchange chromatography Resource Q column. The purified protein was able to inhibit human neutrophil elastase (HNE) and bovine trypsin. . Purified SKTI inhibited HNE with an IC50 value of 8 µg (0.3 nM). At this concentration SKTI showed neither cytotoxic nor haemolytic effects on human blood cell populations. SKTI showed no deleterious effects on organs, blood cells or the hepatic enzymes alanine amine transferase (ALT) and aspartate amino transferase (AST) in mice model of acute systemic toxicity. Human neutrophils incubated with SKTI released less HNE than control neutrophils when stimulated with PAF or fMLP (83.1% and 70% respectively). These results showed that SKTI affected both pathways of elastase release by PAF and fMLP stimuli, suggesting that SKTI is an antagonist of PAF/fMLP receptors. In an in vivo mouse model of acute lung injury, induced by LPS from E. coli, SKTI significantly suppressed the inflammatory effects caused by elastase in a dose dependent manner. Histological sections stained by hematoxylin/eosin confirmed this reduction in inflammation process. These results showed that SKTI could be used as a potential pharmacological agent for the therapy of many inflammatory diseases

Qualidade de vida, funcionalidade e morbidade referida : avaliação em idosos na atenção básica de saúde

Demographic and epidemiological transformations have led to an increase in elderly populations in the world, and chronic diseases become the main health problem in this population, with consequences for the independence and autonomy, and interfering in the lifestyle and daily activities, and may decrease the welfare and quality of life. So, there is an urgent need for multidisciplinary research on the quality of life, understood as a multidimensional and subjective concept, as well as the associated factors, such as health habits, presence of chronic conditions and functional capacity. Thus, In qualitative terms, the Article 1 provides an assessment and perception of the elderly about their quality of life. Article 2, in turn, presents the results of more extensive quantitative research, which can be seen that age, presence of chronic diseases and depression were associated with the quality of life. Thus, we discuss the need for action was planning and health strategies, with interdisciplinary approach, considering the environmental context and reality of family elders, promoting quality in the process of aging

Atenção ao usuário em um centro de referência HIV/Aids: perspectiva de profissionais e usuários

We study the health care focused on care in an intercessor and dialogical relationship with the User, which involves the construction of therapeutic projects essential to the quality of the treatment of the user in health services, and it is necessary individual and collective actions. It is intended to acknowledge and analyze the perception of social subjects, users and professionals on the treatment given to a user of a Specialized Outpatient Service (Serviço Ambulatorial Especializado SAE) in STD/HIV/AIDS state reference in Natal, RN. The study is structured in a transdisciplinary vision of science and knowledge, theoretical and methodological principles that give meaning to the expression of the institutional features of care and health care reconnecting them to the social context. As a research strategy we seek the expressions of 56 subjects of social research, which agreed to participate in the sample, from a symbolic map of the attention, coupled with the techniques of observation and semi-structured interview. For the analysis of the results, five categories of analysis were established: the meaning of the service, care perception, process of communication and interaction, treatment perception and organization and evaluation of the service. It is argued that the attention and care are developed in a technical health care assistance to the disease, focusing on attention based on treatment, on diagnostic and drug therapy of antiretroviral drugs, reflecting the traditional biomedical paradigm of attention to the disease. This is also the mode of organization of practical actions in daily SAE: the therapy proves to be fragmented in several specialties, vertical and feeds the same model, generating tension and overload for professionals; showing impersonal care focused on structured and informative technology, unrelated to an interactive dialogic. From the speech of the subjects, the SAE is understood as the place of confrontation with the disease, but also enables greater elaboration of the illness by meeting their peers. Living with HIV and AIDS is living with concern, apprehension and fear, but mainly with the stigma, prejudice and exclusion, which require that the disease is kept in secret. There is a movement of forces and power, expressed in the knowledge-power of those who dominate the technical and administrative capabilities, devices that concentrate the maintenance of the medicalization of care, rapid consultations and with little attention, making it difficult to interact with and listen to, combined with structural failures, organizational and inadequate management of the service. We conclude that there are dimensions that are not considered in the internal dynamics of the care service multiple forms, characterized by care conflicting models, marked by individual interventions related to the disease. The subject is not considered together with his speech as technical discourse is imposed and care production based on material technology is observed

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

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.

Envelhecer entre pássaros e anjos: um estudo etnográfico sobre o processo saúde doença do idoso no contexto familiar

Study, a descriptive-like one, is guided by ethnographic principles which have analyzed the elderly within the familiar context in his/her process of health and aging, in the neighborhood called Felipe Camarão, located in the western administrative region of Natal, RN, a Northeastern city of Brazil. The participants are elders aging 61 to 84 years old, living in this referring neighborhood, whose majority is constituted of migrants from the rural region of the state of the RN, retired, including widows, widowers and married couples, with low school-educational degree. For the information gathering it was utilized a semi-structured interview, the participant observation and the field diary, being put into effect, in majority, in the houses and in the Family Health Unit, in a period between March and October of 2006. For the results discussion it was utilized an analysis of thematic content and the program ALCESTE (In Portuguese, Análise Léxica por Contexto de um Conjunto de Segmentos de Texto or Lexical Analysis by Context of a Set of Text Segments), which through have emerged two corpus: the corpus I, Family and the elderly, and corpus II, The elderly and the aging within society. The analysis of the results has permitted to conclude that the family, also used by the public policies as a strategy of their practices in health, it is a necessary base support for the elderly citizen in his/her process of aging and of health. The elders familiar contexts have allowed this study to identify the existence of minimal social conditions of life, of new rearrangements of the current families by means of the plurigenerational acquaintanceship and the active presence of the elderly woman as a maintainer of this family; also by means of conflicted relationships among one another but in a bearable level of acquaintanceship. Different conceptions about the aging and the elderly generate disagreement and divergency however the family support and help for the solving of these problems and the attention to health are proceeding from the family components. However, it is noticed that loneliness is something present in these elder s everyday lives. About the attention to health, in a basic level of it, it was noticed that there are still a lot of gaps, mainly concerning promotional and preventing actions, deserving a higher sensitization and effort by the local health institutions

O ensino de enfermagem gerontológica na formação do enfermeiro

At the current time of demographic changes in the world , it is observed that the health sector requires restructuring of its practices in caring for the elderly , in order to enable a comprehensive and humane care . In this sense, we identify the need for qualified professionals to assist the elderly and, therefore , it is important that training curricula are adequate to this reality . The study aims to analyze how it develops teaching gerontological nursing component in undergraduate nursing . This is a descriptive , exploratory study with a qualitative approach, in two higher education institutions in the city of Natal / RN . The population involved corresponded to the coordinators of graduate courses in nursing and teachers who teach content of health care for the elderly, a total of seven participants . The data collection instruments were used: a questionnaire containing questions related to the characterization of the participants and the teaching of gerontological nursing in undergraduate courses in nursing and a form with items of analysis for pedagogical projects . The results were presented descriptively in tables and analyzed from coming themes of the main themes of the instruments defined in: knowledge about the research participants , knowledge of teaching gerontological nursing component and knowledge of pedagogical projects , discussed under Resolution paragraph . 03 of 7/11/2001 , which establishes standards for the nursing program , the educational projects of educational institutions , the Theoretical Donald Shoon and thematically relevant literature . The results indicate that the majority of participants were female (four), all have graduate though , none of them stated in the qualification of aging or elderly health area; the organization of the contents of the component in the curriculum, workload theoretical- methodological and practical teaching strategies presented was heterogeneous and sometimes diverging at the same institution . On the definition of gerontological nursing component was identified that is not well defined along the pedagogical design of educational institutions surveyed . It was concluded that in the context of this study , teaching gerontological nursing is present in the course of nursing education, but needs reevaluation and updating in order to teach a wider range of driving and health practices

Abordagem da ergonomia para a análise da acessibilidade de uma instituição de longa permanência para idosos da cidade de Natal-RN

This dissertation presents and discusses the results of an applied research on the accessibility of residents in a Long Term Care Institution (LTCIs) in the city of Natal- RN. The main objective of this research is to suggest projectual improvements that maximize the accessibility in a LTCIs of Natal-RN, considering the aspects of mobility, safety, comfort and independence of elderly residents. Moreover, one should consider the specific characteristics of the user population, capabilities and limitations of the biological process of aging, which causes damage to the neurological system, musculoskeletal and cardiovascular and progressively affects on visual acuity, balance and locomotion of elderly people. This research has a qualitative approach and divided into four phases: exploratory, bibliographical and documentary research, mapping of the LTCIs of Natal-RN, case study. The phase of the mapping presented an overview of accessibility on LTCIs of Natal-RN. The institution of the case study was defined based on the overall assessment of accessibility and ergonomics criteria, preceded by an application of an Ergonomic Work Analysis to understand the accessibility of the elderly people. Interactional and observational methods were used to collect field data. To this end, an intense process of social construction was conducted, involving the elderly residents, caregivers, health professionals and general servants and LTCIs´ managers. It was found that the NBR 9050 is not comprehensive to solve the diversity of accessibility problems found in LTCIs. All LTCIs investigated were in disconformity to the NBR 9050. In the case study, it was found that the inappropriate design hinders the daily activities of the elderly people and is a source of risk of accidents. The environment, facilities and lack of assistive technologies hinder the autonomy of the elderly people, and this LTCI requires ergonomic intervention to improve the accessibility, autonomy and security of the elderly people

Efeitos do envelhecimento ambiental acelerado em compósitos poliméricos

The advantages of the use of vegetable fibers on the synthetic fibers, such as glass fibers, in the reinforcements in composites are: low cost, low density, good tenacity, good thermal properties and reduced use of instruments for their treatment or processing. However, problems related to poor performance of some mechanical natural fibers, have hindered its direct use in structural elements. In this sense, the emergence of alternative materials such as hybrids composites, involving natural and synthetic fibers, has been encouraged by seeking to improve the performance of structural composites based only on natural fibers. The differences between the physical, chemical and mechanical properties of these fibers, especially facing the adverse environmental conditions such as the presence of moisture and ultraviolet radiation, is also becoming a concern in the final response of these composites. This piece of research presents a comparative study of the strength and stiffness between two composite, both of ortoftalic polyester matrix, one reinforced with fibers of glass-E (CV) and other hybrid reinforced with natural fibers of curauá and fiberglass-E (CH). All the comparative study is based on the influence of exposure to UV rays and steam heated water in composites, simulating the aging environment. The conditions for the tests are accelerated through the use of the aging chamber. The composites will be evaluated through tests of uniaxial static mechanical traction and bending on three points. The composite of glass fiber and hybrid manufacturing industry are using the rolling manual (hand lay-up) and have been developed in the form of composites. All were designed to meet possible structural applications such as tanks and pipes. The reinforcements used in composites were in the forms of short fiber glass-E quilts (450g/m2 - 5cm) of continuous wires and fuses (whose title was of 0.9 dtex) for the curauá fibers. The results clearly show the influence of aging on the environmental mechanical performance of the composite CV and CH. The issues concerning the final characteristics of the fracture for all types of cargoes studied were also analyzed

Laminados compósitos de PRFV: efeitos da descontinuidade geométrica e do envelhecimento ambiental acelerado

The growing demand in the use of composite materials necessitates a better understanding of its behavior related to many conditions of loading and service, as well as under several ways of connections involved in mechanisms of structural projects. Within these project conditions are highlighted the presence of geometrical discontinuities in the area of cross and longitudinal sections of structural elements and environmental conditions of work like UV radiation, moisture, heat, leading to a decrease in final mechanical response of the material. In this sense, this thesis aims to develop studies detailed (experimental and semi-empirical models) the effects caused by the presence of geometric discontinuity, more specifically, a central hole in the longitudinal section (with reduced cross section) and the influence of accelerated environmental aging on the mechanical properties and fracture mechanism of FGRP composite laminates under the action of uniaxial tensile loads. Studies on morphological behavior and structural degradation of composite laminates are performed by macroscopic and microscopic analysis of affected surfaces, in addition to evaluation by the Measurement technique for mass variation (TMVM). The accelerated environmental aging conditions are simulated by aging chamber. To study the simultaneous influence of aging/geometric discontinuity in the mechanical properties of composite laminates, a semiempirical model is proposed and called IE/FCPM Model. For the stress concentration due to the central hole, an analisys by failures criteria were performed by Average-Stress Criterion (ASC) and Point-Stress Criterion (PSC). Two polymeric composite laminates, manufactured industrially were studied: the first is only reinforced by short mats of fiberglass-E (LM) and the second where the reinforced by glass fiber/E comes in the form of bidirectional fabric (LT). In the conception configurations of laminates the anisotropy is crucial to the final mechanical response of the same. Finally, a comparative study of all parameters was performed for a better understanding of the results. How conclusive study, the characteristics of the final fracture of the laminate under all conditions that they were subjected, were analyzed. These analyzes were made at the macroscopic level (scanner) microscope (optical and scanning electron). At the end of the analyzes, it was observed that the degradation process occurs similarly for each composite researched, however, the LM composite compared to composite LT (configurations LT 0/90º and LT ±45º) proved to be more susceptible to loss of mechanical properties in both regarding with the central hole as well to accelerated environmental aging

Sono e síndrome da fragilidade em idosos residentes em instituições de longa permanência

Introduction: The aging process causes quantitative and qualitative changes in sleeping. Such changes affects more than half of the adults above 65 years old, that live in the community and 70% of the institutionalized, a great negative impact in their quality of life. One of the pathological displays of aging, that share some characteristics with sleeping disorders and predict similar results, is the Frailty Syndrome, that characterize the most weakened and vulnerable elderly. The way sleeping disorders play a role in the frailty pathogeneses remains uncertain. Objective: Evaluate the relation between the sleeping and the frailty syndrome on institutionalized elderly. Methodology: A transversal study was performed with 69 elderly in institutions in the city of João Pessoa PB. Were used the Pittsburgh Sleeping Quality Index and actigraphy to subjective and objective variables, respectively, and questionnaires and specific tests to frailty phenotype variant (Fried Frailty Criteria). In the statistic analysis were used the Pearson correlation test, Chi Square and One-way ANOVA test, with Tukey-Krammer posttest. Subsequently, a Simple Linear Regression model was built. On every statistical analysis were considered a confidence interval of 95% and a p < 0,05. Results: The sample was characterized by the prevalence of the frail (49,3%), women (62,3%), single (50,7%) and 77,52 (±7,82).The frail elderly obtained the worst sleeping quality 10,37 (±4,31) (f = 4,15, p = 0,02), when compared with the non-frail. The sleep latency influenced more the frailty (R2 = 0,13, β standard = 1,76, β = 0,41, p = 0,001). Weren t found differences between the standard resting-activity variable and the frailty phenotype categories. Conclusion: Sleeping alterations, including bad sleeping quality, prolonged sleep latency, low sleep efficiency and day drowsiness, influenced the frailty in institutionalized elderly

Influência do método pilates na força e atividade elétrica dos músculos respiratórios de idosas - ensaio clínico controlado randomizado

The reduction of physiological capacity present in the process of aging causes a marked decline in lung function. The exercise does promote several positive changes in the physical health of people and protect the cardiorespiratory function. The aim of this study was to investigate the effects of a program of Pilates exercices on the strengh and electrical activity of respiratory muscles of elderly. This is a randomized, controlled clinical trial, evaluating 33 elderly aged 65 and 80 (70.88 ± 4.32), healthy, sedentary, without cognitive impairment and able the practice physical activity. The sample was divided into two groups, one experimental group with 16 elderly women who did Pilates exercises and a control group (17) that was not submitted to the exercises, but received educational booklets on aging and health care. The elderly were evaluated initially and after a period of three months, taking into account the Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP), obtained by Manovacuometry and intensity of EMG activity was measured using the values of Root Mean Square (RMS) for the diaphragm and rectus abdominis muscles, during the course of diaphragmatic breathing and MIP maneuver. Data were analyzed using SPSS version 17.0. For all tests, we used a significance level or p value < 0.05 and confidence interval 95%. RMS in diaphragm and rectus abdominis muscles in both tests increased, but the data were significant for the rectus abdominis during diaphragmatic breathing (p = 0.03) and the diaphragm during the MIP maneuver (p = 0.01). There was no significant variation of the MIP and MEP. Pilates exercises were responsible for increasing the electrical activation of the diaphragm and rectus abdominis muscles in a group of healthy elderly, but had no influence on changes in strength of respiratory muscles

Efeitos da senescência no núcleo supraquiasmático do sagui (Callithrix Jacchus): plasticidade morfológica e neuroquímica

The circadian timing system (CTS) is responsible for the generation and synchronization and the suprachiasmatic nucleus (SCN) of the hypothalamus has been described as the major circadian pacemaker in many mammalian species. The internal temporal organization managed by SCN is disturbed with aging bringing many pathological disorders that range from loss of complex cognitive performance to simple physiological functions. Therefore, our aim was perform a comparative study of the morphological aspects and neurochemical composition in the SCN of marmosets (Callithrix jacchus) adults and older using immunohistochemical techniques. We found morphometric and neurochemical changes in th SCN o folder animals in comparison to adults, among these a possible decreased in retinal projection to the SCN of older animals, found through a decline in CTB immunostaining, which can occur due atrophy and/or decreasing of fibers from the retinohypothalamic tract (RHT). The Klüver-Barrera histological technique strongly suggests a decrease in those fibers from RHT. Also, by means of a morphometric study, it is found a atrophy and numerical decline of neurons in SCN of aged animals, investigated by Nissl technique, and immunostaining with NeuN and calbindin. Relative optical density (ROD) analysis were used to evaluate the expression of some neurochemical components in SCN, such as GFAP expression, which was increased in older, result that indirectly reinforces that morphological changes occurs due the aging; the vasoactive intestinal polipeptide (VIP) showed no expression alteration in SCN of older animals; the serotonin (5-HT) was descreased in the dorsomedial portion of the SCN, and neurpeptide Y (NPY) apparently also decrease due to the increase of age. Many of these modifications were seen in other animals, such as rodents, human primates and non-human primates. These data about marmoset comes to add new information of the effect of aging on structures responsibles for the circadian rhytmicity, and that some behavioral changes controlled by th SCN, and founded in aged animals, may be caused by these morphological and neurochemical changes. Although some results have been quantitatively negative, qualitatively all analysis show significant change comparing adult and older animals, perhaps due to a low sampling number. In conclusion, the marmoset presents several morphological and neurochemical changes in the SCN of aged animals compared to adults, which may result in behavioral changes that favor pathology aging related

Histórias de vida de mulheres idosas :um estudo sobre o bem-estar subjetivo na velhice

The elderly population growth in Brazil and in the world is an incontestable reality, arising from a significant declining rate in mortality and fertility, resulting from the remarkable improvements in the quality of life of the people. Associated with the introduction of new technologies in the medical area, these issues have been highly contributing for the increase of the population longevity. The numbers of the elderly in Brazil and in the world show female population predominance within the aging segment, a phenomenon known as the feminisation of the old-age . Aging, therefore, is nowadays one of the primary issues and that has been mobilizing the Brazilian s society, since the development raised from this new reality brought with it enormous challenges and complex social implications which are already felt in the daily lives of the societies. My work experience among some age groups has shown that aging is a much differentiated process which has instigated my interest in understanding why aging has to face an overwhelming and painful experience for some people and enriched and full of signification for others. Overviewing, this research aimed to understand the aging development through the analysis of the processes of signification and production of meaning that permeate the aging and the subjective well-being of three aged women participants of the Project Health and Citizenship on Third Age /CEFET-RN, that evidenced attitudes and behaviors concerning the integration and the activity toward the elderly population. The methodological strategy used was History of Life, starting from collecting data based on deep interviews. The analysis of data evidenced that the elderly well-being is a unique and distinct meaningful experience for each person, concerning each story of their lives within differentiated social, cultural, economic context, from this perspective one can demystify the concept of that aging occurs in a homogeneous way for everyone, everywhere and with the same rhythm. The narratives presented in this research showed the human development as being a dialectic, discursive and interactionist process which extends throughout the adult life and continues to the aging life. The guarantee that development and aging are a parallel phenomenon always in interdependence on the preceding phases of live, are corroborated within the studies. This present study confirms that the elderly population can be a phase of growth, personal realization and continued development, without disrespecting the heterogeneous and the subjectivity of the person who ages. Notifying those healthy and well-succeeded aging experiences, this issue has the intention to contribute to demystify the concept of aging as a social problem, illness needed to be treated, and the stereotypy of the elderly being dependent and unproductive