A controlled clinical trial on the effects of motor intervention on balance and cognition in institutionalized elderly patients with dementia

Purpose: To analyse the effects of two interventions on the cognition and balance of institutionalized elderly people with mixed dementia.Methods: Fifty-four participants were allocated into three groups. Group 1 was assisted by an interdisciplinary programme comprising physiotherapy, occupational therapy and physical education. A physiotherapist alone carried out the intervention in group 2. Group 3 was considered as control. Assessors were blinded to guarantee the absence of bias. Cognitive functions were analysed with the Mini-Mental State Examination and the Brief Cognitive Screening Battery. Balance was assessed with the Berg Balance Scale and the Timed Get-Up-and-Go Test. Multiple analysis of variance (MANOVA) was used to test possible main effects of the interventions.Results: The results showed benefits on the balance of subjects in both groups 1 (F=3.9, P < 0.05) and 2 (F= 3.1, P < 0.05), compared with group 3. MANOVA did not indicate benefits on the cognitive functions between groups 1 and 3 (F= 1.1, P > 0.05) and groups 2 and 3 (F= 1.6, P > 0.05). However, univariate analysis indicated some benefits of the interdisciplinary intervention on two specific domains measured by the Brief Cognitive Screening Battery (F=26.5, P < 0.05; F= 4.4, P < 0.05).Conclusion: Six months of multidisciplinary or physiotherapeutic intervention were able to improve a person's balance. Although global cognition did not improve through treatment, when the intervention was carried out on a multidisciplinary basis we observed an attenuation in the decline of global cognition on two specific cognitive domains. Exercises applied in different contexts may have positive outcomes for people with dementia.

Depression severity levels and cognitive functions in institutionalized elderly patients

Depression is a highly prevalent illness among institutionalized aged and assumes peculiar characteristics such as the risk for progressing to dementia. The aims of this study was to assess the cognitive functions of institutionalized elderly with clinical diagnosis of depression and compare the severity of depressive symptoms with cognitive performance. From 120 residents at a nursing home in Rio Claro, Brazil, we study 23 individuals (mean age: 74.3 years; mean schooling: 4.0 years) with diagnosis of depression. At first, a clinical diagnosis of depression and measurement of its symptoms using the Geriatric Depression Scale were performed. The patient then underwent a neuropsychological assessment based on the following tests: Mini-Mental Examination, Verbal Fluency, Visual Perception, Immediate Memory, Recent Memory, Recognition, Clock Drawing Test. The patients were divided into two groups: those with less severe depression symptoms (Group 1: N=9) and more severe symptoms (Group 2: N=14). The significant difference between symptom severity of the two groups was p=0.0001. Patients with more severe symptoms revealed a slightly inferior cognitive performance in most of the tests when compared to those with less severe symptoms (p>0.05). In relation to Verbal Fluency, patients with more severe depression symptoms presented a significantly inferior cognitive performance when compared to those with less severe symptoms (p=0.0082). Verbal Fluency revealed to be a more sensitive test for measuring early cognitive alterations in institutionalized aged with depression, and appears to be a useful resource in monitoring the cognitive functions of patients faced with the risk of dementia. © Copyright Moreira Jr. Editora.

Use of Medicines Among a Brazilian Elderly Sample: A Cross-sectional Study

Background: The use of multiple medicines is very frequent among the elderly, allowing them to perceive more often adverse side effects from drugs and present undesirable drug interactions.Methods: This article presents a cross-sectional survey about the use of medicines among 300 elderly Brazilians, equally divided into institutionalized and community-dwelling groups.Results: The average daily intake of medicines is 3.2 among institutionalized elderly, a higher (p < 0.001) number when compared with community-dwelling elderly, who takes an average of 1.8 medicines daily. The most commonly used medications are antihypertensives (58.0%), diuretics (23.0%), nonsteroidal anti-inflammatory drugs (22.7%), supplements (21.7%), antidiabetics (16.3%), and antiulcerants (14.0%). Antiulcerants, diuretics, supplements, and central nervous system drugs are more frequently used by institutionalized than by community-dwelling elderly.Conclusion: In this Brazilian elderly sample, the most widely used medicines were antihypertensives, diuretics, and nonsteroidal anti-inflammatory drugs, and institutionalized used more medications than community-dwelling elderly. Copyright (C) 2011, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.

Potentially inappropriate medications used by the elderly: Prevalence and risk factors in Brazilian care homes

Abstract. Background: The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. Methods. We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. Results: Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). Conclusions: The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency. © 2013 Lima et al.; licensee BioMed Central Ltd.

Equilíbrio postural e risco para queda em idosos da cidade de Garça, SP

OBJETIVOS: Avaliar o equilíbrio postural e o risco de quedas em idosos institucionalizados e não-institucionalizados. MÉTODOS: Foram incluídos no estudo 45 idosos institucionalizados e 43 idosos não-institucionalizados. O equilíbrio e o risco de quedas foram avaliados através da Escala de Equilíbrio de Berg. A comparação do equilíbrio entre os grupos foi feita por meio do teste de Mann-Whitney. Foi avaliado o risco para queda entre as populações. Adotou-se um valor de p ≤ 0,05 como significante. RESULTADOS: Houve diferença entre os escores da Escala de Berg nas populações estudadas (p < 0,0001). Os resultados mostraram que a população institucionalizada apresenta nove vezes mais risco de cair do que idosos da comunidade (p=0,0001). CONCLUSÕES: Os resultados indicam que o equilíbrio postural é menor na população institucionalizada, aumentando seu risco de cair.

Estudo comparativo da classificação do grau de perda auditiva em idosos institucionalizados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comportamento e barreiras

Este estudo analisa as barreiras percebidas à prática de atividade física e os estágios de mudança de comportamento de idosos institucionalizados preservados cognitivamente. Trinta participantes responderam ao Mini-Exame do Estado Mental, ao Questionário sobre Estágios de Mudança de Comportamento e ao Questionário sobre Barreiras à Prática de Atividade Física. Os resultados mostraram que poucos idosos institucionalizados apresentam uma alta percepção de descrença nos benefícios da atividade física. Entretanto, muito poucos praticam atividades físicas e a maioria não pretende incluí-las em seu estilo de vida. O estágio de comportamento no qual se encontram pode estar sendo mediado pela percepção de barreiras. Conclui-se, coerentemente com as principais barreiras reportadas, que a promoção de atividade física para o idoso institucionalizado deve, prioritariamente, enfatizar a conscientização sobre os riscos do sedentarismo e os benefícios da prática mesmo na presença de doenças, bem como preparar um ambiente seguro e sem gasto financeiro individual.

Caracterização e análise do estado mental e funcional de idosos institucionalizados em instituições públicas de longa permanência

Background: This study had as objective to characterize the institutionalized elderly residents in three long-term care facilities, about their functional capacity and mental state, and to evaluate if there is a correlation between both. Methods: To do so, three instruments were used: an identification form, the Mini-Mental State Examination (MMSE) and Barthel's Index. For statistical analysis the Person's Correlation and ANOVA Test were used. Results: The population studied consisted of 115 elders with ages between 62 and 104 years old, 40.66% females and 59.13% males. 49.56% are literate and 50.43% illiterate. Regarding the marital status, singles (46.65%) and widows (21.8%) were predominant. About the mental and functional state, there was a high rate of elders showing cognitive decline (76.72%) and functionally independent (75.65%). Conclusions: According to the results, one can notice that there is a mild degree of correlation between the Barthel's Index and MMSE (r = 0.441; p < 0.000), and the variables of gender and age are not influenced in the results of these instruments. There is a significant statistical relation (p < 0.0001) between education and mental and/or functional state of the individual.

Identificação de espécies fúngicas nas onicomicoses do idoso institucionalizado

BACKGROUND: Superficial fungal infections are caused by dermatophytes, yeasts or filamentous fungi. They are correlated to the etiologic agent, the level of integrity of the host immune response, the site of the lesion and also the injured tissue. OBJECTIVE: The purpose of this study is to isolate and to identify onychomycosis agents in institutionalized elderly (60 years old +). METHODS: The identification of the fungi relied upon the com-bined results of mycological examination, culture isolation and micro cultures observation under light microscopy from nail and interdigital scales, which were collected from 35 elderly with a clinical suspicion of onychomycosis and a control group (9 elderly with healthy interdigital space and nails). Both groups were insti-tutionalized in two nursing homes in Sao Bernardo do Campo, SP, Brazil. RESULTS: The nail scrapings showed 51.40% positivity. Of these, dermatophytes were found in 44.40% isolates, 27.78% identified as Trichophyton rubrum and 5.56% each as Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum gypseum. The second more conspicuous group showed 38.89% yeasts: 16.67% Candida guilliermondii, 11.11% Candida parapsilosis, 5.56% Candida glabrata, and 5.56% Trichosporon asahii. A third group displayed 16.70% filamen-tous fungi, like Fusarium sp, Aspergillus sp and Neoscytalidium sp (5.56% each). The interdigital scrapings pre-sented a positivity rate of 14.29%. The agents were coincident with the fungi that caused the onychomycosis. In the control group, Candida guilliermondii was found at interdigital space in one person. CONCLUSION: Employing a combination of those identification methods, we found no difference between the etiology of the institutional-ized elderly onychomycosis from that reported in the literature for the general population. © 2013 by Anais Brasileiros de Dermatologia.

Caracterização e classificação da deglutição orofaríngea do idoso institucionalizado: avaliaçao clínica fonoaudiológica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Influência da prática regular de atividade física sobre sintomas depressivos em idosos institucionalizados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Vigilância nutricional em idosos: proposta para cuidadores sem específica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação nutricional de estresse oxidativo e ocorrência de infecção em indivíduos institucionalizados do Asilo Padre Euclides de Botucatu-SP

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Qualidade de vida de idosos institucionalizados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)