Abuse and neglect of elderly and independence in instrumental and basic activities of daily living.

Introduction: One of the known risk factors for abuse and neglect of the elderly is the decrease in functional capacity, contributing to self care dependency of instrumental activities of daily living and basic activities of daily living (OMS, 2015). Methods: Cross-sectional study with non probabilistic sample of 333 elderly, performed in a hospital, homes and day centers for the elderly. The data collection protocol included socio-demographic data, Questions to elicit Elder Abuse (Carney, Kahan & Paris, 2003 adap. By Ferreira Alves & Sousa, 2005), scale of instrumental activities of daily living Lawton and Brody and Katz index to assess the level of independence in activities of daily living. Objectives: To evaluate the association between abuse and neglect in the elderly, instrumental activities of daily living and level of independence in activities of daily living. Results: Emotional abuse is significantly correlated with the level of independence in activities of daily living (p = 0.000), older people with less independence tend to have higher levels of emotional abuse. The total abuse is significantly correlated with the levels of independence in activities of daily living (p = 0.002), less independent elderly tend to suffer greater abuse and neglect. There were no statistically significant associations between abuse and neglect and instrumental activities of daily living. Conclusions: The less independent elderly are more vulnerable to situations of abuse and neglect, being more exposed to emotional abuse. These results point to the need for health professionals/ nurses develop prevention interventions, including strategies to support carers and early screening in less independent elderly.

Abuse and neglect of elderly and independence in instrumental and basic activities of daily living

Introduction: One of the known risk factors for abuse and neglect of the elderly is the decrease in functional capacity, contributing to self care dependency of instrumental activities of daily living and basic activities of daily living (OMS, 2015). Methods: Cross-sectional study with non probabilistic sample of 333 elderly, performed in a hospital, homes and day centers for the elderly. The data collection protocol included socio-demographic data, Questions to elicit Elder Abuse (Carney, Kahan & Paris, 2003 adap. By Ferreira Alves & Sousa, 2005), scale of instrumental activities of daily living Lawton and Brody and Katz index to assess the level of independence in activities of daily living. Objectives: To evaluate the association between abuse and neglect in the elderly, instrumental activities of daily living and level of independence in activities of daily living. Results: Emotional abuse is significantly correlated with the level of independence in activities of daily living (p = 0.000), older people with less independence tend to have higher levels of emotional abuse. The total abuse is significantly correlated with the levels of independence in activities of daily living (p = 0.002), less independent elderly tend to suffer greater abuse and neglect. There were no statistically significant associations between abuse and neglect and instrumental activities of daily living. Conclusions: The less independent elderly are more vulnerable to situations of abuse and neglect, being more exposed to emotional abuse. These results point to the need for health professionals/ nurses develop prevention interventions, including strategies to support carers and early screening in less independent elderly.

Social Representations of Violence against the Elderly

The repercussions of violence on the mental, social, and physical well-being of the elderly are some of the most challenging problems in public health today. Using a qualitative design, we conducted a study in Portugal and the United States that applied both descriptive and comparative methods in order to understand the social representations of violence against the elderly. Utilizing the Theory of Social Representations, we explored the perspectives of the elderly, their families, and healthcare professionals on the subject of violence against the elderly. The data on which the findings were based were obtained in two very different cultural contexts, yet the representations of violence against the elderly revealed no significant cross-cultural differences. However, conceptualizations regarding expectations of care and protection for the elderly proved to be distinct. We discussed concerns about the general attitudes of tolerance toward violence, including those of the elderly who self-identified as eventual victims. Violence against the elderly was portrayed as a part of old age and also somehow was justified by it. The results also indicated the need to better prepare healthcare professionals and society in general to deal with the consequences of the problem and not, as we would like to report, to prevent it from happening.

Does an In-Season Detraining Period Affect the Shoulder Rotator Cuff Strength and Balance of Young Swimmers?

Aims: To compare the physical activity, sedentary activity and health-related quality of life (HRQoL) in institutionalized vs. non-institutionalized elderly, and to establish a pattern of relationship and prediction of physical and sedentary activity with physical and mental components of HRQoL. Methods: The sample consisted of 383 elderly with ≥ 75 years old (n=187 institutionalized and n=196 non-institutionalized). Were administered the International Physical Activity Questionnaire (IPAQ) and Short Form 36 Health Survey (SF-36) for evaluated the physical and sedentary activity and HRQoL. Also was used the Mini Mental State Examination (MMSE) as exclusion criteria for cognitive problems in the elderly. Results: Differences between institutionalized and non-institutionalized elderly were found in moderate-intensity activities and walking, a favour of non-institutionalized. The institutionalized elderly remain more minutes in sedentary activity. Also, were observed differences between both groups in physical component of HRQoL, a favour of non-institutionalized elderly. The mental component remained unchanged. The multivariate regression analyses showed that physical activity predicted the physical (8 to 12%) and mental (5 to 8%) components of HRQoL for institutionalized and non-institutionalized elderly. Conclusions: Non-institutionalized elderly were more physically active, spent less time in sedentary activity and showed better perception physical component of HRQoL that institutionalized elderly. An important and encouraging result of this study was that physical activity is a predictor of improved physical and mental component of HRQoL for institutionalized and non-institutionalized elderly.

Cluster Analysis To Identify Elderly People's Profiles: A Healthcare Strategy Based On Frailty Characteristics.

The new social panorama resulting from aging of the Brazilian population is leading to significant transformations within healthcare. Through the cluster analysis strategy, it was sought to describe the specific care demands of the elderly population, using frailty components. Cross-sectional study based on reviewing medical records, conducted in the geriatric outpatient clinic, Hospital de Clínicas, Universidade Estadual de Campinas (Unicamp). Ninety-eight elderly users of this clinic were evaluated using cluster analysis and instruments for assessing their overall geriatric status and frailty characteristics. The variables that most strongly influenced the formation of clusters were age, functional capacities, cognitive capacity, presence of comorbidities and number of medications used. Three main groups of elderly people could be identified: one with good cognitive and functional performance but with high prevalence of comorbidities (mean age 77.9 years, cognitive impairment in 28.6% and mean of 7.4 comorbidities); a second with more advanced age, greater cognitive impairment and greater dependence (mean age 88.5 years old, cognitive impairment in 84.6% and mean of 7.1 comorbidities); and a third younger group with poor cognitive performance and greater number of comorbidities but functionally independent (mean age 78.5 years old, cognitive impairment in 89.6% and mean of 7.4 comorbidities). These data characterize the profile of this population and can be used as the basis for developing efficient strategies aimed at diminishing functional dependence, poor self-rated health and impaired quality of life.

Falls Among The Elderly: Risk Factors In A Population-based Study.

The aim of the present study was to identify factors associated with the occurrence of falls among elderly adults in a population-based study (ISACamp 2008). A population-based cross-sectional study was carried out with two-stage cluster sampling. The sample was composed of 1,520 elderly adults living in the urban area of the city of Campinas, São Paulo, Brazil. The occurrence of falls was analyzed based on reports of the main accident occurred in the previous 12 months. Data on socioeconomic/demographic factors and adverse health conditions were tested for possible associations with the outcome. Prevalence ratios (PR) were estimated and adjusted for gender and age using the Poisson multiple regression analysis. Falls were more frequent, after adjustment for gender and age, among female elderly participants (PR = 2.39; 95% confidence interval (95% CI) 1.47 - 3.87), elderly adults (80 years old and older) (PR = 2.50; 95% CI 1.61 - 3.88), widowed (PR = 1.74; 95% CI 1.04 - 2.89) and among elderly adults who had rheumatism/arthritis/arthrosis (PR = 1.58; 95% CI 1.00 - 2.48), osteoporosis (PR = 1.71; 95% CI 1.18 - 2.49), asthma/bronchitis/emphysema (PR = 1,73; 95% CI 1.09 - 2.74), headache (PR = 1.59; 95% CI 1.07 - 2.38), mental common disorder (PR = 1.72; 95% CI 1.12 - 2.64), dizziness (PR = 2.82; 95% CI 1.98 - 4.02), insomnia (PR = 1.75; 95% CI 1.16 - 2.65), use of multiple medications (five or more) (PR = 2.50; 95% CI 1.12 - 5.56) and use of cane/walker (PR = 2.16; 95% CI 1.19 - 3,93). The present study shows segments of the elderly population who are more prone to falls through the identification of factors associated with this outcome. The findings can contribute to the planning of public health policies and programs addressed to the prevention of falls.

Qualidade de vida e composição corporal : características do envelhecimento bem sucedido = Quality of life and body composition : characteristics of successful aging

Universidade Estadual de Campinas . Faculdade de Educação Física

Incorporation of Real-Time PCR into Routine Public Health Surveillance of Culture Negative Bacterial Meningitis in Sao Paulo, Brazil

Real-time (RT)-PCR increases diagnostic yield for bacterial meningitis and is ideal for incorporation into routine surveillance in a developing country. We validated a multiplex RT-PCR assay for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae in Brazil. Risk factors for being culture-negative, RT-PCR positive were determined. The sensitivity of RT-PCR in cerebrospinal fluid (CSF) was 100% (95% confidence limits, 96.0%-100%) for N. meningitidis, 97.8% (85.5%-99.9%) for S. pneumoniae, and 66.7% (9.4%-99.2%) for H. influenzae. Specificity ranged from 98.9% to 100%. Addition of RT-PCR to routine microbiologic methods increased the yield for detection of S. pneumoniae, N. meningitidis, and H. influenzae cases by 52%, 85%, and 20%, respectively. The main risk factor for being culture negative and RT-PCR positive was presence of antibiotic in CSF (odds ratio 12.2, 95% CI 5.9-25.0). RT-PCR using CSF was highly sensitive and specific and substantially added to measures of meningitis disease burden when incorporated into routine public health surveillance in Brazil.

Elderly online: Effects of a digital inclusion program in cognitive performance

There is little empirical data about the impact of digital inclusion on cognition among older adults. This paper aimed at investigating the effects of a digital inclusion program in the cognitive performance of older individuals who participated in a computer learning workshop named ""Idosos On-Line`` (Elderly Online). Forty-two aged individuals participated in the research study: 22 completed the computer training workshop and 20 constituted the control group. All subjects answered a sociodemographic questionnaire and completed the Addenbrooke`s cognitive examination, revised (ACE-R), which examines five cognitive domains: orientation and attention, memory, verbal fluency, language, and visuo-spatial skills. It was noted that the experimental group`s cognitive performance significantly improved after the program, particularly in the language and memory domains, when compared to the control group. These findings suggest that the acquisition of new knowledge and the use of a new tool, that makes it possible to access the Internet, may bring gains to cognition. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Peak torque and rate of torque development in elderly with and without fall history

Background Falls are one of the greatest concerns among the elderly A number of studies have described peak torque as one of the best fall-related predictor. No studies have comprehensively focused on the rate of torque development of the lower limb muscles among elderly fallers. Then, the aim of this study was to determine the relationship between muscle peak torque and rate of torque development of the lower limb joints in elderly with and without fall history It was also aimed to determine whether these parameters of muscle performance (i e, peak torque and rate of torque development) are related to the number of falls. Methods: Thirty-one women volunteered to participate in the study and were assigned in one of the groups according to the number of falls over the 12 months that preceded the present Then, participants with no fall history (Cl; n = 13; 67.6[7.5] years-old), one fall (GII; n = 8, 66 0[4 91 years-old) and two or more falls (GIII, n = 10; 67.8[8.8] years-old) performed a number of lower limb maximal isometric voluntary contractions from which peak torque and rate of torque development were quantified Findings. Primary outcomes indicated no peak torque differences between experimental groups in any lower limb joint. The rate of torque development of the knee flexor muscles observed in the non-fallers (Cl) was greater than that observed in the fallers (P < 0.05) and had a significant relationship with the number of falls (P < 0 05) Interpretation. The greater knee flexor muscles` rate of torque development found in the non-fallers in comparison to the fallers indicated that the ability of the elderly to rapidly reorganise the arrangement of the lower limb may play a significant role in allowing the elderly to recover balance after a trip. Thus, training stimulus aimed to improve the rate of torque development may be more beneficial to prevent falls among the elderly than other training stimulus, which are not specifically designed to improve the ability to rapidly produce large amounts of torque (C) 2010 Published by Elsevier Ltd

Women's health Australia: On the progress of the main cohort studies

More than 41,000 women aged 18-23, 45-50, and 70-75 years in 1996 are participating in the Australian Longitudinal Study on Women's Health (Women's Health Australia). Baseline surveys were conducted for all three cohorts in 1996, and the first follow-up survey of the mid-age group in 1998 has achieved a response rate exceeding 90%. The main findings so far reflect the large differences in the life experiences of the three cohorts. The young women report high levels of stress. The physical and mental health of those with young children is worse than for those without children, but confounding by sociodemographic characteristics may account for the differences. Two thirds of young women in the healthy weight or underweight range would like to weigh less, and early onset of dieting is associated with poorer physical and mental health. Most of the women in the mid-age group have multiple roles-in paid work, home duties, and caring for children and other dependents. The potential of the study to investigate the long-term impact of such busy lives on health outcomes is considerable. At this stage, the main health issues for these women relate to tiredness, weight gain, and menopause. The older cohort presents a picture of positive aging. These women are heavier users of health services than the mid-age and younger women, and they are also more satisfied with these services. Although their physical health is poorer, their mental health is better, and they report less stress than women in the other two cohorts. The follow-up survey of this group, planned for 1999, will focus on the coping strategies used by these women. An overall goal of the project is to understand the interactions among social roles, life events, and women's health in order to provide a basis for improved health policies and services. Analysis of these interactions, which relies on both quantitative and qualitative data, poses many challenges that will be addressed as the longitudinal data become available.

A comparative mental health literacy survey of psychiatrists and other mental health professionals in Singapore

Objective: The objectives of this study are, first, to replicate and extend an Australian approach to assessing mental health literacy by studying a sample of Singapore mental health professionals, and to focus on differences between judgements made by the psychiatrists in comparison with the other mental health professionals. Second, to compare the psychiatrists' judgements with those of Australian psychiatrists. Method: The Australian questionnaire, assessing responses in relation to vignettes of major depression and to schizophrenia was extended by adding a third vignette of mania, and by the addition of several region-specific response options. Nearly 500 questionnaires were distributed to representative staff (psychiatrists, nurses and allied health) of a large psychiatric institution in Singapore, with a response rate of 81%. Psychiatrists' judgements were compared with all other hospital staff, and with Australian psychiatrists' judgements. Results: The two principal contrast groups (Singapore psychiatrists and other Singapore mental health professionals) differed slightly in terms of diagnostic accuracy. The psychiatrists differed in favouring a more professionally focused model of intervention, while both professional groups viewed traditional healers and their practices as distinctly unhelpful. Direct comparison of psychiatrist ratings generated in Singapore and in Australia revealed quite similar response profiles. Conclusions: In addition to generating data of some intrinsic importance, comparison with Australian survey data allows the potential impact of regional and cultural differences, as well as of varying psychiatric practices, to be identified. Responses identified more similarities than differences in the judgements of the psychiatrists from the two countries.

Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys

Background Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries. Aims To examine one central aspect of illness burden, the association of serious mental illness with earnings, in the World Health Organization (WHO) World Mental Health (WMH) Surveys. Method The WMH Surveys were carried out in 10 high-income and 9 low- and middle-income countries. The associations of personal earnings with serious mental illness were estimated. Results Respondents with serious mental illness earned on average a third less than median earnings, with no significant between-country differences (chi(2)(9)=5.5-8.1, P=0.5-0.79). These losses are equivalent to 0.3-0.8% of total national earnings. Reduced earnings among those with earnings and the increased probability of not earning are both important components of these associations: Conclusions These results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.

The impact of perinatal and socioeconomic factors on mental health problems of children from a poor Brazilian city: a longitudinal study

Low birth weight and preterm birth, and social disadvantage may negatively affect mental health of children, but findings have been inconsistent. To assess the influence of perinatal and social factors on mental health problems in children aged 7-9 years. A random sample of 805 births in So Luis, Brazil was studied in 1997/1998 and again in 2005/2006. Perinatal, socioeconomic and demographic variables were assessed within 24 h after delivery. The Strengths and Difficulties Questionnaire (SDQ) was used to assess mental health problems in the children. Simple and multiple Poisson regressions were used for statistical analysis. The overall prevalence of mental health problems in the total sample was 47.7%. The prevalences of emotional and conduct problems were 58.2 and 48.8%, respectively. Only paternal age (< 20 years) was associated with mental health problems as measured by the full SDQ scale (prevalence ratio PR = 1.27). Children born to single mothers (PR = 1.31) and those with birth weight from 1,500 to 2,499 g (PR = 1.18) and from 2,500 to 2,999 g (PR = 1.17) had a higher risk of emotional problems, but those from low income families had a lower risk (PR = 0.80). Children with a father of less than 20 years had a higher risk of having problems with their peers (PR = 1.75). A maternal education of 9 years or over was inversely associated with peer (PR = 0.70) and conduct problems (PR = 0.73). Girls had a lower risk of conduct (PR = 0.77) and hyperactivity problems (PR = 0.68). A maternal education of 4 years or less increased the risk of hyperactivity (PR = 1.48). Socioeconomic and demographic conditions were better predictors of mental health problems in children than birth weight or preterm birth. However, since most effect sizes were small most mental health problems were, unexplained by the variables in the study.

Magnetic resonance imaging quantification of regional cerebral blood flow and cerebrovascular reactivity to carbon dioxide in normotensive and hypertensive rats

Hypertension afflicts 25% of the general population and over 50% of the elderly. In the present work, arterial spin labeling MRI was used to non-invasively quantify regional cerebral blood flow (CBE), cerebrovascular resistance and CO(2) reactivity in spontaneously hypertensive rats (SHR) and in normotensive Wistar Kyoto rats (WKY), at two different ages (3 months and 10 months) and under the effects of two anesthetics, alpha-chloralose and 2% isoflurane (1.5 MAC). Repeated CBE measurements were highly consistent, differing by less than 10% and 18% within and across animals, respectively. Under alpha-chloralose, whole brain CBE at normocapnia did not differ between groups (young WKY: 61 3 ml/100 g/min; adult WKY: 62 +/- 4 ml/100 g/min; young SHR: 70 +/- 9 ml/100 g/min: adult SHR: 69 8 ml/100 g/min), indicating normal cerebral autoregulation in SHR. At hypercapnia, CBE values increased significantly, and a linear relationship between CBE and PaCO(2) levels was observed. In contrast, 2% isoflurane impaired cerebral autoregulation. Whole brain CBE in SHR was significantly higher than in WKY rats at normocapnia (young SHR: 139 +/- 25 ml/100 g/min; adult SHR: 104 +/- 23 ml/100 g/min; young WKY: 55 +/- 9 ml/100 g/min; adult WKY: 71 +/- 19 ml/100 g/min). CBE values increased significantly with increasing CO(2): however, there was a clear saturation of CBF at PaCO(2) levels greater than 70 mm Hg in both young and adult rats, regardless of absolute CBE values, suggesting that isoflurane interferes with the vasoclilatory mechanisms of CO(2). This behavior was observed for both cortical and subcortical structures. Under either anesthetic, CO(2) reactivity values in adult SHR were decreased, confirming that hypertension, when combined with age, increases cerebrovascular resistance and reduces cerebrovascular compliance. Published by Elsevier Inc.