Cuidadores informais de idosos em pós-operatório de cirurgia de fêmur proximal: prevenção de novas quedas

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

Qualidade de vida e atividade física em idosos

The aims of this literature review were to analyze the relationship between elderly quality of life - by means of the verification of the major measure instruments - with the physical activity, the sensibility of these questionnaires to the physical activity and the relationship between the type of physical activity and the quality of life in older persons. Comparisons of papers selected by the key words quality of life, exercise, and aging, reveal the components of quality of life assessed by the WHOQOL-BREF and SF-36 questionnaires. Based on the searched literature, we can conclude that: (i) active elderly seems to have better subjective perception of their quality of life than non active older persons; (ii) experimental studies did not showed strong evidence about the effects of physical exercise in the subjective perception of quality of life; (iii) none of the questionnaires is sensible to the practice of physical activity; (iv) the studies' results about the relationship between the type of physical activity and the elderly quality of life are inconclusive

Community Life and Housing in Rural Nebraska: 2005 Nebraska Rural Poll Results

Many rural communities are experiencing population decline. However, rural residents have continued to show a strong attachment to their communities. How do rural Nebraskans feel about their community? Are they satisfied with the services provided? Do they own their home? What is the condition of their home? This report details 2,851 responses to the 2005 Nebraska Rural Poll, the tenth annual effort to understand rural Nebraskans’ perceptions. Respondents were asked a series of questions about their community and housing. Trends for some of these questions are examined by comparing data from the nine previous polls to this year’s results. For all questions, comparisons are made among different respondent subgroups, that is, comparisons by age, occupation, region, etc. Based on these analyses, some key findings emerged: Rural Nebraskans’ views of the change in their community are similar to those expressed last year. This year, 28 percent believe their community has changed for the better, compared to 26 percent last year. And, in 2005, only 20 percent think their community has changed for the worse, compared to 22 percent last year. The proportion of expected movers who plan to leave the state decreased this year. Last year, 56 percent of the persons planning to move from their community expected to leave the state. That proportion decreased to 47 percent this year. Rural Nebraskans living in or near the largest communities are more likely than persons living in or near the smaller communities to say their community has changed for the better. Thirty-nine percent of persons living in or near communities with populations of 10,000 or more believe their community has changed for the better during the past year, but only 15 percent of persons living in or near communities with less than 500 people share this opinion. The community services and amenities that rural Nebraskans are most dissatisfied with include: entertainment, retail shopping and restaurants. At least one-third of rural Nebraskans express dissatisfaction with these three services. They are most satisfied with parks and recreation, library services, basic medical care services, highways and bridges, and education (K - 12). At least one-half of rural Nebraskans are satisfied with the following items in their community: appearance of residential areas (66%), crime control (61%), maintenance of sidewalks and public areas (57%) and noise (54%). Rural Nebraskans generally have positive views about their community. Sixty percent agree that their community is an ideal place to live and 52 percent say their community has good business leaders. Rural Nebraskans have mixed opinions about the future of their community. Fortyfour percent agree that their community’s future looks bright, but 42 percent disagree with this statement. Fourteen percent have no opinion. Rural Nebraskans living in or near the larger communities are more likely than residents of the smaller communities to think their community’s future looks bright. Fifty-nine percent of persons living in or near communities with populations of 10,000 or more agree with this statement, compared to only 25 percent of residents living in or near communities with less than 500 people. Further, 61 percent of the residents of the smallest communities disagree with this statement, compared to only 28 percent of the residents of the largest communities. Over three-quarters of rural Nebraskans disagree that younger residents of their community tend to stay there after completing high school. Seventy-six percent disagree with this statement, 16 percent have no opinion and eight percent agree that younger residents stay after completing high school. When comparing responses by age, younger persons are more likely than older persons to agree that younger residents stay in their community after high school. Sixteen percent of persons age 19 to 29 agree with this statement, compared to only six percent of persons age 50 to 64. Younger persons are more likely than older persons to be planning to move from their community next year. Fifteen percent of persons between the ages of 19 and 29 are planning to move next year, compared to only two percent of persons age 65 and older. An additional 17 percent of the younger respondents indicate they are uncertain if they plan to move. Most rural Nebraskans own their home. Eighty-four percent of rural Nebraskans own their home. Older persons are more likely than younger persons to own their home. Eighty-eight percent of persons over the age of 50 own their home, compared to only 52 percent of persons age 19 to 29. Housing in rural Nebraska has an average age of 50 years. Twenty-four percent of residences were built before 1930. Another 24 percent were built between 1930 and 1959. Twenty-nine percent were built between 1960 and 1979 and the remaining 24 percent were built in 1980 or later. The housing stock in smaller communities is older than the housing located in larger communities. Over one-third (35%) of the residences in communities with less than 1,000 people were built before 1930. Only 12 percent of the homes in communities with populations of 10,000 or more were built in this time period. Most rural Nebraskans appear satisfied with their home. Only 24 percent say the current size of their home does not meet their needs. The same proportion (24%) say their home is in need of major repairs. Thirty-eight percent agree that their home needs a lot of routine maintenance, but 87 percent like the location (neighborhood) of their home. One-third of rural Nebraskans living in or near the smallest communities say their home is in need of major repairs. Only 19 percent of persons living in or near communities with populations of 5,000 or more are facing this problem. Home ownership is very important to most rural Nebraskans. Eighty-two percent believe it is very important to own their home. An additional 12 percent say it is somewhat important and six percent say it is not at all important. However, persons who do not currently own their home do not feel it is important for them to do so. Only 32 percent of renters say it is very important to own their home, compared to 91 percent of home owners. And, 35 percent of renters say it is not at all important to own their home.

Rural Nebraska: Looking Back at a Decade of Change and Progress: 2005 Nebraska Rural Poll Results

To commemorate the 10th anniversary of the Nebraska Rural Poll, rural Nebraskans were asked about changes they may have experienced during the past ten years. Where have they lived during the past decade? In what types of business activities have they been involved? Have they received any education or training during that time period? What has been their experience with the Internet? This report details 2,851 responses to the 2005 Nebraska Rural Poll, the tenth annual effort to understand rural Nebraskans’ perceptions. Respondents were asked a series of questions about changes they have experienced during the past ten years. For all questions, comparisons are made among different respondent subgroups, that is, comparisons by age, occupation, region, etc. Based on these analyses, some key findings emerged: One quarter of rural Nebraskans have lived somewhere other than their current community during the past ten years. Of those who have lived elsewhere, they have moved their primary residence an average of 2.2 times. Younger rural Nebraskans are more likely than older residents to have lived elsewhere during the past decade. Sixty-six percent of persons between the ages of 19 and 29 have lived in a different location, compared to only 12 percent of persons age 65 and older. Many rural Nebraskans who have lived in a different community during the past ten years have lived in another state. Forty-one percent of persons who have lived elsewhere during the past decade have lived in a different state. Forty-five percent have lived in a larger community (18% have lived in either Omaha or Lincoln and 27% have lived in or near a Nebraska community larger than their current one - other than Lincoln or Omaha). Thirty-six percent have lived in or near a Nebraska community smaller than their current one. Twenty percent of rural Nebraskans currently own a business. Thirteen percent started operating a business during the past ten years, 10 percent closed or stopped operating a business during this time period and four percent tried unsuccessfully to start a business. Persons living in or near the smallest communities are more likely than persons living in or near larger communities to currently own a business. Twenty-nine percent of persons living in or near communities with less than 500 people currently own a business, compared to 15 percent of persons living in or near communities with at least 10,000 persons. In general, rural Nebraskans have favorable opinions about self-employment but they also recognize the hardships and risks involved with this type of employment. Sixtyone percent agree that self-employment is desirable because they can be their own boss. Forty-four percent agree that self-employment provides a better quality of life than being an employee. However, 74 percent agree that self-employed individuals work longer hours than traditional employees and 70 percent agree that the cost of health insurance makes self-employment unappealing. Younger persons are more likely than older persons to agree that the cost of health insurance makes self-employment unappealing. Eighty percent of persons age 19 to 29 agree with that statement, compared to 55 percent of persons age 65 and older. One-half of rural Nebraskans have participated in formal education courses, workshops or other training activities during the past ten years. Sixty-nine percent of rural Nebraskans have Internet access either at home or at work. Sixty-six percent have acquired Internet access either at home or at work during the past ten years. An additional three percent had acquired access more than ten years ago. Persons with higher levels of income are more likely than persons with lower incomes to have acquired Internet access. Sixty-six percent of persons with household incomes of $60,000 or more have acquired Internet access at both home and work during the past ten years, compared to only 11 percent of persons with household incomes less than $20,000. Information searches and email are the most important reasons for having an Internet connection. Eighty-nine percent of rural Nebraskans with access to the Internet at either home or work say that information searches are an important or very important reason for having an Internet connection. Eighty-three percent say email is an important reason. In general, rural Nebraskans say their satisfaction with various features of their Internet connection has increased during the past ten years. Fifty-five percent of rural Nebraskans with an Internet connection at home say their satisfaction with the availability of service has increased during the past ten years and 50 percent report an increase in their satisfaction with the speed of their connection. Persons living in or near the larger communities are more likely than persons living in or near the smaller communities to say their satisfaction with the speed of their Internet connection has increased during the past ten years. Fifty-four percent of persons living in or near communities with populations of 5,000 or more say their satisfaction with the speed of their connection has increased over the past decade, compared to 43 percent of persons living in or near communities with less than 1,000 people.

Gender differences in incidence and determinants of disability in activities of daily living among elderly individuals: SABE study

Determining the groups that are most susceptible to developing disability is essential to establishing effective prevention and rehabilitation strategies. The aim of the present study was to determine gender differences in the incidence of disability regarding activities of daily living (ADL) and determinants among elderly residents of Sao Paulo, Brazil. In 2000, 1634 elderly with no difficulties regarding ADL (modified Katz Index) were selected. These activities were reassessed in 2006 and disability was the outcome for the analysis of determinants. The following characteristics were analyzed at baseline: sociodemographic, behavioral, health status, medications, falls, hospitalizations, depressive symptoms, cognition, handgrip, mobility and balance. The incidence density was 42.4/1000 women/year and 17.5/1000 men/year. After adjusting for socioeconomic status and health conditions, women with chronic diseases and social vulnerability continued to have a greater incidence of disability. The following were determinants of the incidence of disability: age and depressive symptoms in both genders; stroke and slowness on the sit-and-stand test among men; and osteoarthritis and sedentary lifestyle among women. Better cognitive performance and handgrip strength were protective factors among men and women, respectively. Adverse clinical and social conditions determine differences between genders regarding the incidence of disability. Decreased mobility and balance and health conditions that affect the central nervous system or lead to impaired cognition disable men more, whereas a sedentary lifestyle, reduction in muscle strength and conditions that affect the osteoarticular system disable women more. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Service Use and Mental Impairment Among the Elderly: Arguments for Consultation and Education

Compared the service use patterns of older adults with varying levels of mental impairment, and assessed the effects of services received on their mental health status over a 1-yr period. Data were obtained from a US General Accounting Office (1977, 1979) study of 531 elderly persons (mean age 76.1 yrs), which included administration of a modified version of the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Ss were interviewed twice, 1 yr apart. 174 Ss were classified as having a mild psychiatric impairment, and 118 Ss had a severe psychiatric impairment. The existence of mental impairment was related to marital status, race, and level of education. Usage of mental health services was low, although mentally impaired Ss were more likely than unimpaired Ss to use social and medical services. Results also suggest that such services can have an important effect on the mental health of older persons.

Geriatric Pain Measure short form: development and initial evaluation

OBJECTIVES: To develop and evaluate a short form of the 24-item Geriatric Pain Measure (GPM) for use in community-dwelling older adults. DESIGN: Derivation and validation of a 12-item version of the GPM in a European and an independent U.S. sample of community-dwelling older adults. SETTING: Three community-dwelling sites in London, United Kingdom; Hamburg, Germany; Solothurn, Switzerland; and two ambulatory geriatrics clinics in Los Angeles, California. PARTICIPANTS: European sample: 1,059 community-dwelling older persons from three sites (London, UK; Hamburg, Germany; Solothurn, Switzerland); validation sample: 50 persons from Los Angeles, California, ambulatory geriatric clinics. MEASUREMENTS: Multidimensional questionnaire including self-reported demographic and clinical information. RESULTS: Based on item-to-total scale correlations in the European sample, 11 of 24 GPM items were selected for inclusion in the short form. One additional item (pain-related sleep problems) was included based on clinical relevance. In the validation sample, the Cronbach alpha of GPM-12 was 0.92 (individual subscale range 0.77-0.92), and the Pearson correlation coefficient (r) between GPM-12 and the original GPM was 0.98. The correlation between the GPM-12 and the McGill Pain Questionnaire was 0.63 (P<.001), similar to the correlation between the original GPM and the McGill Pain Questionnaire (Pearson r=0.63; P<.001). Exploratory factor analysis indicated that the GPM-12 covers three subfactors (pain intensity, pain with ambulation, disengagement because of pain). CONCLUSION: The GPM-12 demonstrated good validity and reliability in these European and U.S. populations of older adults. Despite its brevity, the GPM-12 captures the multidimensional nature of pain in three subscales. The self-administered GPM-12 may be useful in the clinical assessment process and management of pain and in pain-related research in older persons.

[Active and healthy living in old age--results from a representative survey of community-dwelling senior citizens in Hamburg]

BACKGROUND: The majority of community-dwelling people 60 years and older are independent and live actively. However, there is little information about elderly persons' views on aging, health and health promotion. METHODS: Therefore, an anonymous, written questionnaire survey was performed in a representative sample of inhabitants from a section of the city of Hamburg, 60 years and older; 5 year intervals, 14 subsamples according to 7 age groups of females and males. RESULTS: Questionnaires from 950 participants (29% response) could be evaluated: mean age 71.5 years, 58% women, 34% living alone, 5% with professional healthcare needs as indicated by status according to German nursing care insurance. Senior citizens' positive attitudes towards aging and health were predominant: 69% of respondents felt young, 85% worried about loss of autonomy in old age. CONCLUSIONS: The results provide evidence indicating potential for improving health-promoting lifestyles in parts of the older population by evaluating and strengthening older persons' competencies and by considering their concerns seriously. These results provide valuable information for future plans in the public-health sector in the city of Hamburg where particular health-promoting actions for elderly persons will be considered.

Adapting a driving simulator to study pedestrians' street-crossing decisions: A feasibility study

The decision when to cross a street safely is a challenging task that poses high demands on perception and cognition. Both can be affected by normal aging, neurodegenerative disorder, and brain injury, and there is an increasing interest in studying street-crossing decisions. In this article, we describe how driving simulators can be modified to study pedestrians' street-crossing decisions. The driving simulator's projection system and the virtual driving environment were used to present street-crossing scenarios to the participants. New sensors were added to measure when the test person starts to cross the street. Outcome measures were feasibility, usability, task performance, and visual exploration behavior, and were measured in 15 younger persons, 15 older persons, and 5 post-stroke patients. The experiments showed that the test is feasible and usable, and the selected difficulty level was appropriate. Significant differences in the number of crashes between young participants and patients (p = .001) as well as between healthy older participants and patients (p = .003) were found. When the approaching vehicle's speed is high, significant differences between younger and older participants were found as well (p = .038). Overall, the new test setup was well accepted, and we demonstrated that driving simulators can be used to study pedestrians' street-crossing decisions.

The feasibility of self-report advance directives among elderly patients with cognitive impairment

The central objective of this dissertation was to determine the feasibility of self-completed advance directives (AD) in older persons suffering from mild and moderate stages of dementia. This was accomplished by identifying differences in ability to complete AD among elderly subjects with increasing degrees of dementia and cognitive incompetence. Secondary objectives were to describe and compare advance directives completed by elders and identified proxy decision makers. Secondary objectives were accomplished by measuring the agreement between advance directives completed by proxy and elder, and comparing that agreement across groups defined by the elder's cognitive status. This cross-sectional study employed a structured interview to elicit AD, followed by a similar interview with a proxy decision maker identified by the elder. A stratified sampling scheme recruited elders with normal cognition, mild, and moderate forms of dementia using the Mini Mental-State Exam (MMSE). The Hopkins Competency Assessment Test (HCAT) was used for evaluation of competency to make medical decisions. Analysis was conducted on "between group" (non-demented $\leftrightarrow$ mild dementia $\leftrightarrow$ moderate dementia, and competent $\leftrightarrow$ incompetent) and "within group" (elder $\leftrightarrow$ family member) variation.^ The 118 elderly subjects interviewed were generally male, Caucasian, and of low socioeconomic status. Mean age was 77. Overall, elders preferred a "trial of therapy" regarding AD rather than to "always receive the therapy". No intervention was refused outright more often than it was accepted. A test-retest of elders' AD revealed stable responses. Eleven logic checks measured appropriateness of AD responses independent of preference. No difference was found in logic error rates between elders grouped by MMSE or HCAT. Agreement between proxy and elder responses showed significant dissimilarity, indicating that proxies were not making the same medical decisions as the elders.^ Conclusions based on these data are: (1) Self reporting AD is feasible among elders showing signs of cognitive impairment and they should be given all opportunities to complete advance directives, (2) variation in preferences for advance directives in cognitively impaired elders should not be assumed to be the effects of their impairment alone, (3) proxies do not appear to forego life-prolonging interventions in the face of increasing impairment in their ward, however, their advance directives choices are frequently not those of the elder they represent. ^

Aprendizaje motor en adultos mayores

Esta investigación consiste en una lectura crítica de la bibliografía acerca de la temática del aprendizaje motor en personas adultas mayores y sus implicancias con las prácticas de la Educación Física. Se redefinen y conceptualizan algunos conceptos de primordial interés con relación a la vejez, el proceso de envejecimiento humano y los sujetos que lo transitan. Se intenta poner de relieve que algunas teorías aún vigentes en nuestro medio homologan el concepto de desarrollo humano con el de crecimiento físico, en detrimento de las capacidades de las personas adultas mayores y subestimando las distintas posibilidades motrices que poseen. Se presentan sucintamente las reflexiones elaboradas a partir del registro bibliográfico: se advierte que la fuerza de los mitos y creencias circulantes en nuestro medio enfatizan el alejamiento de muchas personas adultas mayores de las prácticas corporales de la Educación Física, acentuando aun más la exclusión de este grupo de las estructuras sociales

Aprendizaje motor en adultos mayores

Esta investigación consiste en una lectura crítica de la bibliografía acerca de la temática del aprendizaje motor en personas adultas mayores y sus implicancias con las prácticas de la Educación Física. Se redefinen y conceptualizan algunos conceptos de primordial interés con relación a la vejez, el proceso de envejecimiento humano y los sujetos que lo transitan. Se intenta poner de relieve que algunas teorías aún vigentes en nuestro medio homologan el concepto de desarrollo humano con el de crecimiento físico, en detrimento de las capacidades de las personas adultas mayores y subestimando las distintas posibilidades motrices que poseen. Se presentan sucintamente las reflexiones elaboradas a partir del registro bibliográfico: se advierte que la fuerza de los mitos y creencias circulantes en nuestro medio enfatizan el alejamiento de muchas personas adultas mayores de las prácticas corporales de la Educación Física, acentuando aun más la exclusión de este grupo de las estructuras sociales

Aprendizaje motor en adultos mayores

Esta investigación consiste en una lectura crítica de la bibliografía acerca de la temática del aprendizaje motor en personas adultas mayores y sus implicancias con las prácticas de la Educación Física. Se redefinen y conceptualizan algunos conceptos de primordial interés con relación a la vejez, el proceso de envejecimiento humano y los sujetos que lo transitan. Se intenta poner de relieve que algunas teorías aún vigentes en nuestro medio homologan el concepto de desarrollo humano con el de crecimiento físico, en detrimento de las capacidades de las personas adultas mayores y subestimando las distintas posibilidades motrices que poseen. Se presentan sucintamente las reflexiones elaboradas a partir del registro bibliográfico: se advierte que la fuerza de los mitos y creencias circulantes en nuestro medio enfatizan el alejamiento de muchas personas adultas mayores de las prácticas corporales de la Educación Física, acentuando aun más la exclusión de este grupo de las estructuras sociales

Performance of Long-Term Care Systems in Europe. ENEPRI Research Report No. 117, 21 December 2012

This report evaluates the performance of long-term care (LTC) systems in Europe, with a special emphasis on four countries that were selected in Work Package 1 of the ANCIEN project as representative of different LTC systems: Germany, the Netherlands, Spain and Poland. Based on a performance framework, we use the following four core criteria for the evaluation: the quality of life of LTC users, the quality of care, equity of LTC systems and the total burden of LTC (consisting of the financial burden and the burden of informal caregiving). The quality of life is analysed by studying the experience of LTC users in 13 European countries, using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Older persons with limitations living at home have the highest probability of receiving help (formal or informal) in Germany and the lowest in Poland. Given that help is available, the sufficiency of the help is best ensured in Switzerland, Italy and the Netherlands. The indirectly observed properties of the LTC system are most favourable in France. An older person who considers all three aspects important might be best off living in Belgium or Switzerland. The horizontal and vertical equity of LTC systems are analysed for the four representative countries. The Dutch system scores highest on overall equity, followed by the German system. The Spanish and Polish systems are both less equitable than the Dutch and German systems. To show how ageing may affect the financial burden of LTC, projections until 2060 are given for LTC expenditures for the four representative countries. Under the base scenario, for all four countries the proportions of GDP spent on public and private LTC are projected to more than double between 2010 and 2060, and even treble in some cases. The projections also highlight the large differences in LTC expenditures between the four countries. The Netherlands spends by far the most on LTC. Furthermore, the report presents information for a number of European countries on quality of care, the burden of informal caregiving and other aspects of performance. The LTC systems for the four representative countries are evaluated using the four core criteria. The Dutch system has the highest scores on all four dimensions except the total burden of care, where it has the second-best score after Poland. The German system has somewhat lower scores than the Dutch on all four dimensions. The relatively large role for informal care lowers the equity of the German system. The Polish system excels in having a low total burden of care, but it scores lowest on quality of care and equity. The Spanish system has few extreme scores. Policy implications are discussed in the last chapter of this report and in the Policy Brief based on this report.

The history of Josiah, the young king of Judah /

Bound with: The youth's book on natural theology ; illus. in familiar dialogues, with numerous engravings, and The child's book on repentence ; designed, also, for older persons/T.H. Gallaudet.