Safety assessment of essential medicines for elderly people: a bibliographic survey

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.

Mental health of the elderly: perceptions related to aging

To understand the elderly's perception of their current condition. Methodology. Study undertaken in 2012 using the qualitative method of Minayo and the thematic analysis according to Bardin's suggestions. Data were collected through semi-structured interviews that took place in the homes of the elderly people. The guiding question was: At this point in your life, how do you feel? Tell me. Results. The elderly who were satisfied stated that this was due to the good relationship with their family, spouse, to the fact of having autonomy and respect from the society. Those who were shown to be dissatisfied reported lack of family support, physical limitations imposed by age and the presence of illnesses as the main causes. Conclusion. The adult population requires the use of care technologies that cover all the stages of life, including old age. Nursing professionals should be prepared for the increasing care demand of these people.

Voice disorders in teachers: clinical, videolaryngoscopical, and vocal aspects

Dysphonia is more prevalent in teachers than among the general population. The objective of this study was to analyze clinical, vocal, and videolaryngoscopical aspects in dysphonic teachers. Ninety dysphonic teachers were inquired about their voice, comorbidities, and work conditions. They underwent vocal auditory-perceptual evaluation (maximum phonation time and GRBASI scale), acoustic voice analysis, and videolaryngoscopy. The results were compared with a control group consisting of 90 dysphonic nonteachers, of similar gender and ages, and with professional activities excluding teaching and singing. In both groups, there were 85 women and five men (age range 31-50 years). In the controls, the majority of subjects worked in domestic activities, whereas the majority of teachers worked in primary (42.8%) and secondary school (37.7%). Teachers and controls reported, respectively: vocal abuse (76.7%; 37.8%), weekly hours of work between 21 and 40 years (72.2%; 80%), under 10 years of practice (36%; 23%), absenteeism (23%; 0%), sinonasal (66%; 20%) and gastroesophageal symptoms (44%; 22%), hoarseness (82%; 78%), throat clearing (70%; 62%), and phonatory effort (72%; 52%). In both groups, there were decreased values of maximum phonation time, impairment of the G parameter in the GRBASI scale (82%), decrease of F0 and increase of the rest of acoustic parameters. Nodules and laryngopharyngeal reflux were predominant in teachers; laryngopharyngeal reflux, polyps, and sulcus vocalis predominated in the controls. Vocal symptoms, comorbidities, and absenteeism were predominant among teachers. The vocal analyses were similar in both groups. Nodules and laryngopharyngeal reflux were predominant among teachers, whereas polyps, laryngopharyngeal reflux, and sulcus were predominant among controls.

Disseminated cutaneous histoplasmosis in elderly patients. An uncommon presentation

Background: Human fungal infections have increased at an alarming rate in recent years, particularly in immunocompromised individuals. Cryptococcosis is the second most prevalent systemic fungal infection worldwide, and the most prevalent systemic infection in immunocompromised individuals, representing more than 70% of cases. The incidence of cryptococcosis is high in people with HIV/acquired immunodefi- ciency syndrome (AIDS), with recent estimates indicating that there are one million cases of cryptococcal meningitis globally per year in AIDS patients. Aims: The aim of this research was to develop a rapid flow cytometric antifungal susceptibility test and to compare the results with the standard methods. Methods: A reference strain and clinical isolates of Cryptococcus neoformans and Cryptococcus gattii were tested for susceptibility to amphotericin B by flow cytometry using propidium iodide as indicator of viability. Flow cytometry (FC) results were compared with the minimum inhibitory concentration (MIC) values determined by microdilution. Results: The antifungal activity of amphotericin B ranged from MICs of 0.06 to 2 g/ml for the 11 isolates studied. The same results were found by FC. Conclusions: The FC method allows same-day results, assisting in the selection of appropriate antifungal therapies. These results demonstrate an excellent correlation between FC and the classic methods of testing for susceptibility to antifungal agents. This rapid diagnosis method makes it possible to quickly administer effective therapeutic interventions, often saving lives.

Resolution of tremor fluoxetine-induced in an elderly patient

Aim: To report a possible case of tremor fluoxetine-induced treated as Parkinson’s disease in an elderly female patient noncompliant with the pharmacotherapy, with uncontrolled hypertension and using fluoxetine to treat depression. Presentation of Case: Patient complained of sleepiness in the morning, agitation, anxiety, insomnia and mental confusion. Her greatest concern was about bilateral hand tremors which, in her view became, worse after biperiden was prescribed. Therefore, she stopped taking it. The initial medication was: omeprazole, losartan, biperiden, fluoxetine, atenolol + chlorthalidone, acetylsalicylic acid, atorvastatin and diazepam. Pharmacotherapeutic follow up was performed in order to check the necessity, safety and effectiveness of treatment. Discussion: During the analysis of pharmacotherapy, the patient showed uncontrolled blood pressure and had difficulty complying with the treatment. Thus, in view of the complaints expressed by the patient, our first hypothesis was a possible serotonin syndrome related to fluoxetine use. We proposed a change in the fluoxetine regime and discontinuation of biperiden. As tremors persisted, we suggested the replacement of fluoxetine by sertraline, since a possible tremor fluoxetine-induced could explain the complaint. This approach solved the drug-related problem identified. Conclusion: Tremors reported by the patient was identified as an iatrogenic event related to fluoxetine, which was solved by management of serotonin-reuptake inhibitors.

Longitudinal effects of physical activity on self-efficacy and cognitive processing of active and sedentary elderly women

Previous studies support that regular physical activity in aging contributes as a protective factor against cognitive decline and improves mood states. However, there is a lack of longitudinal studies in this area. Objective: To observe possible changes in cognition related with physical activity. METHODS: This study reassessed, after one-year period, 31 elderly women divided into two groups, sedentary versus active, using behavioral scales and cognitive tests. RESULTS: The active group exhibited significantly enhanced performance in general cognitive function, particularly on tasks of episodic memory and praxis, and also on the mood states scale compared to the sedentary group. The active women also reported higher self-efficacy. CONCLUSION: Long-term physical activity promoted improvement on quality of life in the elderly women.

Estudo de microscopia eletronica de varredura e transmissão de pregas vocais de idosos

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

Polipharmacy and the elderly: Interndisciplinary action in primary care (resumo)

Estudo resultado de Pet-Saude envolvendo 12 academicos do curso médico e dois preceptores da rede municpal da saude.

A voz do idoso: características clínicas, endoscópicas, vocais e morfológicas

Pós-graduação em Bases Gerais da Cirurgia - FMB

A Pilot Study to Determine the Effectiveness of Probiotic Use in Elderly Patients with Antibiotic-Associated Diarrhea

Long-term care settings have the majority of their patients on multiple antibiotics, and outbreaks of antibiotic-associated diarrhea and Clostridium difficile are common. Probiotics have been used with these patients to reduce these side effects. Probiotics can re-establish the composition of intestinal microflora, enhance immune response, and clear pathogens from the host which may reduce the symptoms of antibiotic-associated diarrhea. Therefore, the goal of this study was to conduct a retrospective study of the effectiveness of using probiotic in elderly patients in a long-term care facility in a Midwestern city who suffered from antibiotic-associated diarrhea. The probiotic, CulturelleTM had been administered once a day to eight males and twelve female patients who were taking antibiotics and stool consistency and number were recorded. Out of the original group, seven of the patients receiving the probiotic appeared to have positive effects while two patients had negative effects on stools. Thirteen patients showed no change in stool consistency and number. It was difficult to determine the effects of the probiotic due to the use by the facility of a bowel movement protocol for preventing constipation and impaction, and the lack of dietary records. Published studies in patients in long-term facilities vary greatly in terms of trial design, type and dose of probiotic and duration of treatment, which may explain why probiotics work for some patients and not for others. Probiotic use is becoming more accepted with antibiotic-associated diarrhea but due to the lack of definitive evidence about efficacy and the safety of probiotic use, more studies need to be conducted. Advisors: Kaye Stanek Krogstrand and Julie Albrecht

A Voice for the People

This presentation addresses pieces of my educational endeavors to form and give voice within the intellectual arena. The underlying working premise of the paper is that of preparing one's voice in a liberatory way that not only serves oneself but is one that works in service for marginalized peoples and the greater global community

A voz do idoso: características clínicas, endoscópicas, vocais e morfológicas

Pós-graduação em Bases Gerais da Cirurgia - FMB

Anemia and dementia among the elderly: the Sao Paulo Ageing & Health Study

Background: Anemia and dementia are common diseases among the elderly, but conflicting data are available regarding an association between these two conditions. We analyzed data from the Sao Paulo Ageing & Health Study to address the relationship between anemia and dementia. Methods: This cross-sectional observational study included participants aged 65 years and older from a deprived area of the borough of Butantan, Sao Paulo, Brazil. Data about demographics, education, income, and cognitive and daily life function were collected, as well as blood samples. Anemia and dementia were defined according to WHO and DSM-IV criteria, respectively. Results: Of the 2267 subjects meeting the inclusion criteria, 2072 agreed to participate in the study; of whom 1948 had a valid total blood count and were included in the analysis. Anemia was diagnosed in 203 (10.2%) participants and dementia in 99 (5.1%). The frequency of anemia was higher in patients with dementia according to univariate analysis (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17-3.41, p = 0.01), but this association was not present after adjusting for age (OR = 1.33, 95% CI = 0.76-2.33, p = 0.32). Further multivariate adjustment did not change the results. Conclusion: Although anemia and dementia are frequent disorders in older people, we found their relationship to be mediated exclusively by aging in this low-income population from Sao Paulo.

Prevalence and Predictors of Potential Drug-Drug Interactions in the Elderly: A Cross-Sectional Study in the Brazilian Primary Public Health System

Purpose. The primary objective of this study was to investigate the prevalence of clinically important potential drug-drug interactions (DDIs) in elderly patients attending the public primary health care system in Brazil. The secondary objective was to investigate possible predictors of potential DDIs. Methods. A cross-sectional study was carried out in 5 Brazilian cities located in the Ourinhos Micro-region, Sao Paulo State, between November 2010 and April 2011. The selected sample was divided according to the presence (exposed) or absence (unexposed) of one or more potential DDIs (defined as the presence of a minimum 5-day overlap in supply of an interacting drug pair). Data were collected from medical prescriptions and patients' medical records. Potential DDIs (rated major or moderate) were identified using 4 DDI-checker programs. Logistic regression analysis was used to study potential DDI predictors. Results. The prevalence of clinically important potential DDIs found during the study period was 47.4%. Female sex (OR = 2.49 [95% CI 2.29-2.75]), diagnosis of = 3 diseases (OR = 6.43 [95% CI 3.25-12.44]), and diagnosis of hypertension (OR = 1.68 [95% CI 1.23-2.41]) were associated with potential DDIs. The adjusted OR increased from 0.90 [95% CI 0.82-1.03] in patients aged 60 - 64 years to 4.03 [95% CI 3.79 - 4.28] in those aged 75 years or older. Drug therapy regimens involving = 2 prescribers (OR = 1.39 [95% CI 1.17-1.67]), = 3 drugs (OR = 3.21 [95% CI 2.78-3.59]), = 2 ATC codes (OR = 1.19 [95% CI 1.12-1.29]), = 2 drugs acting on cytochrome P450 (OR = 2.24 [95% CI 2.07-2.46]), and ATC codes B (OR = 1.89 [95% CI 1.05-2.08]) and C (OR = 4.01 [95% CI 3.55-4.57]) were associated with potential DDIs. Conclusion. Special care should be taken with the prescription and therapeutic follow-up of patients who present characteristics identified as predictors. Knowledge of potential DDI predictors could aid in developing preventive practices and policies that allow public health services to better manage this situation.