Analyse des facteurs biodémographiques, sociéconomiques et familiaux de la longévité exceptionnelle

La recherche des facteurs de longévité gagne en intérêt dans le contexte actuel du vieillissement de la population. De la littérature portant sur la longévité et la mortalité aux grands âges, un constat émerge : bien que les déterminants associés à la survie humaine soient multiples, l'environnement familial aurait un rôle déterminant sur la mortalité et sur l'atteinte des âges avancés. Dès lors, l'objectif de cette thèse est d'évaluer les déterminants de la survie exceptionnelle et d'examiner le rôle des aspects familiaux, en début de vie et à l'âge adulte, dans les différentiels de durée de vie. Plus spécifiquement, elle vise à : (1) examiner la similarité des âges au décès entre frères, soeurs et conjoints afin d'apprécier l'ampleur de la composante familiale de la longévité; (2) explorer, d'un point de vue intrafamilial, les conséquences à long terme sur la survie des variables non partagées issues de la petite enfance tels l'âge maternel à la reproduction, le rang de naissance et la saison de naissance; et (3) s'interroger sur le rôle protecteur ou délétère de l’environnement et du milieu familial d'origine dans l’enfance sur l'atteinte des grands âges et dans quelle mesure le statut socioéconomique parvient à médiatiser la relation. Cette analyse s'appuie sur le jumelage des recensements canadiens et des actes de décès de l’état civil québécois et emploie des données québécoises du 20e siècle issues de deux échantillons distincts : un échantillon aléatoire représentatif de la population provenant du recensement canadien de 1901 ainsi qu’un échantillon de frères et soeurs de centenaires québécois appartenant à la même cohorte. Les résultats, présentés sous forme d'articles scientifiques, ont montré, en outre, que les frères et soeurs de centenaires vivent plus longtemps que les individus appartenant aux mêmes cohortes de naissance, reflétant la contribution d'une robustesse commune, mais également celle de l'environnement partagé durant la petite enfance. Ces analyses ont également témoigné d'un avantage de survie des conjoints des centenaires, soulignant l'importance d'un même environnement à l'âge adulte (1er article). De plus, nos travaux ont mis de l'avant la contribution aux inégalités de longévité des variables biodémographiques issues de l'environnement non partagé telles que l'âge maternel à la reproduction, le rang de naissance et la saison de naissance, qui agissent et interagissent entre elles pour créer des vulnérabilités et influer sur l'atteinte des âges exceptionnels (2e article). Enfin, une approche longitudinale a permis de souligner la contribution du milieu social d'origine sur la longévité, alors que les individus issus d’un milieu socioéconomique défavorisé pour l'époque (milieu urbain, père ouvrier) vivent moins longtemps que ceux ayant vécu dans un environnement socioéconomique favorable (milieu rural, fermier), résultat d'une potentielle accumulation des avantages liée à la reproduction du statut social ou d'une programmation précoce des trajectoires de santé. L’influence est toutefois moindre pour les femmes et pour les frères de centenaires et s'exprime, dans ce cas, en partie par l'effet de la profession à l'âge adulte (3e article).

Recerca sobre les necessitats socials de la gent gran de 80 i més anys que viuen soles a la ciutat d'Olot

Investigació socioeducativa que estudia les necessitats socials de les persones de més de 80 anys que viuen soles a la ciutat d’Olot. Els objectius de la recerca són descriure, explicar i comprendre les característiques i les necessitats socials d’aquesta població i contribuir a millorar les pràctiques de les polítiques locals referents als plans d’atenció a gent gran i Serveis Socials. La principal tècnica per recollir les dades ha estat un qüestionari d’elaboració expressa per aquesta investigació, contestat per 400 persones

The evidence that exercise during growth or adulthood reduces the risk of fragility fractures is weak

There has never been, and will never be, a randomized double-blind placebo-controlled trial demonstrating that exercise in youth, adulthood or old age reduces fragility or osteoporosis-related fractures in old age. The next level of evidence, a randomized, controlled but unblinded study with fractures as an end-point is feasible but has never been done. The basis for the belief that exercise reduces fractures is derived from lower levels of ‘evidence’, namely, retrospective and prospective observation cohort studies and case–control studies. These studies are at best hypothesis generating, never hypothesis testing. They are all subject to many systematic biases and should be interpreted with extreme scepticism. Surrogate measures of anti-fracture efficacy are the next level of evidence, such as the demonstration of a reduction in risk factors for falls, a reduction in falls, a reduction in fractures due to falls, an increase in peak bone size and mass, prevention of bone loss in midlife and restoration of bone mass and structure in old age.

Older adults' neuromuscular adaptations to resistence training and effects on challenging gait tasks

Community locomotion is threatened when older individuals are required to negotiate obstacles, which place considerable stress on the musculoskeletal system. The vulnerability of older adults during challenging locomotor tasks is further compromised by age-related strength decline and muscle atrophy. The first study in this investigation determined the relationship between the major muscle groups of the lower body and challenging locomotor tasks commonly found in the community environment of older adults. Twenty-nine females and sixteen males aged between 62 and 88 years old (68.2 ±6.5) were tested for the maximal voluntary contraction (MVC) strength of the knee extensors and 1-RM for the hip extensors, flexors, adductors, abductors, knee extensors and flexors and ankle plantar flexors. Temporal measurements of an obstacle course comprising four gait tasks set at three challenging levels were taken. The relationship between strength and the obstacle course dependent measures was explored using linear regression models. Significant associations (p≤0.05) between all the strength measures and the gait performances were found. The correlation values between strength and obstructed gait (r = 0.356-0.554) and the percentage of the variance explained by strength (R2 = 13%-31%), increased as a function of the challenging levels, especially for the stepping over and on and off conditions. While the difficulty of community older adults to negotiate obstacles cannot be attributed to a single causal pathway, the findings of the first study showed that strength is a critical requirement. That the magnitude of the association increased as a function of the challenging levels, suggests that interventions aimed at improving strength would potentially be effective in helping community older adults to negotiate environmental gait challenges. In view of the findings of the first study, a second investigation determined the effectiveness of a progressive resistance-training program on obstructed gait tasks measured under specific laboratory conditions and on an obstacle course mimicking a number of environmental challenges. The time courses of strength gains and neuromuscular mechanisms underpinning the exercise-induced strength improvements in community-dwelling older adults were also investigated. The obstructed gait conditions included stepping over an obstacle, on and off a raised surface, across an obstacle and foot targeting. Forty-three community-living adults with a mean age of 68 years (control =14 and experimental=29) completed a 24-week progressive resistance training program designed to improve strength and induce hypertrophy in the major muscles of the lower body. Specific laboratory gait kinetics and kinematics and temporal measures taken on the obstacle course were measured. Lean tissue mass and muscle activation of the lower body muscle groups were assessed. The MVC strength of the knee extensors and 1-RM of the hip extension, hip flexion, knee extension, knee flexion and ankle plantar flexion were measured. A 25% increase on the MVC of the knee extensors (p≤0.05) was reported in the training group. Gains ranging between 197% and 285% were recorded for the 1-RM exercises in the trained subjects with significant improvements found throughout the study (p≤0.05). The exercise-induced strength gains were mediated by hypertrophic and neural factors as shown by 8.7% and 27.7% increases (p≤0.05) in lean tissue mass and integrated electromyographic activity, respectively. Strength gains were accompanied by increases in crossing velocity, stride length and reductions in stride duration, stance and swing time for all gait tasks except for the foot targeting condition. Specific kinematic variables associated with safe obstacle traverse such as vertical obstacle heel clearance, limb flexion, horizontal foot placements prior to and at post obstacle crossing and landing velocities resulted in an improved crossing strategy in the experimental subjects. Significant increases in the vertical and anterior-posterior ground reaction forces accompanied the changes in the gait variables. While further long-term prospective studies of falls rates would be needed to confirm the benefits of lower limb enhanced strength, the findings of the present study provide conclusive evidence of significant improvements to gait efficiency associated with a systematic resistance-training program. It appears, however, that enhanced lower body strength has limited effects on gait tasks involving a dynamic balance component. In addition, due to the larger strength-induced increases in voluntary activation of the leg muscle compared to relatively smaller gains in lean tissue mass, neural adaptations appear to play a greater contributing role in explaining strength gains during the current resistance training protocol.

Metal-catalyzed oxidative damage and oligomerization of the amyloid-β peptide of Alzheimer’s disease

The most common form of dementia in old age is Alzheimer’s disease (AD). The presence in the brain of senile plaque is the major pathological marker of AD. The plaques are primarily composed of aggregated amyloid-β peptide (Aβ). Aβ is a 40–42 amino acid peptide that is a proteolytic product derived from the β-amyloid precursor protein. The function of Aβ and the exact mechanism of Aβ aggregation and neurotoxicity are unclear. However, metal coordination by Aβ plays an important role in inducing aggregation and the generation of reactive oxygen species, which appears to be at least partially responsible for Aβ neurotoxicity. In this review we examine the role of copper and zinc ions in Aβ neurotoxicity, especially with regards to the generation of free radicals. We discuss the role of copper or zinc ions in oxidative damage and Aβ conformational changes and the relationship of these metals to AD.

Household structure and consumption insurance of the elderly

This paper examines the role of household formation in providing consumption insurance to the elderly. Using data from the Consumer Expenditure Surveys, raw tabulations of per adult equivalent consumption indicate that the elderly who live alone have higher levels of well-being relative to those who live with others. This is misleading, however, because the decision to live alone is clearly endogenous. The empirical estimation accounts for this endogeneity using data from the Panel Study of Income Dynamics. The results provide evidence that household formation plays a significant role in maintaining consumption levels. Without the opportunity to live with others, the welfare gap measured by the difference between per adult equivalent consumption levels of dependent and independent livers would be even larger. These findings suggest that co-residing with others effectively supplements social security, pensions, and private savings and helps the elderly to smooth consumption in old age.

Constipation, laxative use and diet

This study found that constipation estimates varied considerably from 9-42%, depending on the criteria used, and there was extensive laxative use. Those who were constipated reported a significantly poorer quality-of-life. Participants could not achieve current dietary recommendations and therefore managing constipation through dietary modification is impractical for many older people.

Fall risk management intervention : a feasibility and validation study

A fall risk management intervention was undertaken by staff caring for older people in nursing homes. Its acceptability and usefulness was tested. 'High risk times' and 'at risk' individuals were found, thereby identfying times when staff should be vigilant, and specific residents to be targeted with fall prevention strategies.

O idoso e as ações sociais em prol desse grupo etário: um estudo sobre a qualidade de vida na Terceira Idade e o Projeto Saúde e Cidadania na Melhor Idade

The present study regards an applied qualitative social research (descriptive) which approaches the matter between old age and Brazilian social actions performed in social projects, aiming a qualified life and citizenship for this group of age. The objective of the study is to evaluate the contribution of Project Health and Citizenship in Old Age regarding social actions from the government directed to old age individual treatment for life quality improvement. The theoretical fundamentals of this work is, in a first moment, about old age and certain existing theories about aging process, as well as the differences and perspectives that come up throughout this process. In a second moment, some reflections are developed about the relation between life quality and leisure regarding old age, with the conception and historical rescue about these questions, as well as the evidence of leisure as an instrument of well-being feasibility and a better life quality in old age. Then the study contextualizes Brazilian government treatment to old age individuals, cutting off the Constitution of Republic from 1988 and some social attitudes taken by the government in a try to reach this specific group. Finally, the study presents the Project Health and Citizenship in Old Age , as a social program which belongs to extension activities from Federal Center of Technological Education of Rio Grande do Norte (CEFET-RN), which aims old age treatment and their citizenship and life quality. After the application of a semi-structured interview using the technique of Analysis of content for the Analysis and Discussion of Results, it is possible to conclude that the Project Health and Citizenship in Old Age fulfils its objective regarding contribution, through offered leisure activities, for old age well-being and life quality improvement. Hence, on this regard, it is possible to observe the importance and value of government actions, social projects and programs assisting old age individuals, for they are able to provide this group the opportunity to live out activities that allow their citizenship and socialization, regarding well-being and life quality improvement.

Efeito do treinamento resistido na pressão arterial e capacidade funcional de idosas hipertensas

The results of studies about the ideal resistance training intensity for reduction of resting blood pressure levels, as well as this type of training to increase the functional capacity of hypertensive older women are still unclear, since the few investigations usually analyze young individuals normotensive, and the literature lacks precise information in elderly hypertensive subjects. Objectives: To determine the effect of two resistance training intensities on resting blood pressure and the effect of resistance training on functional capacity in elderly women with systemic arterial hypertension, analyzing these variables before and after eight weeks of intervention. Methods: Patients underwent eight weeks of resistance training, with a frequency of three times per week on alternate days, in the afternoon. The exercises performed were: leg press, bench press, knee extension, lat pull-down, knee flexion, shoulder abduction, standing cable hip abduction and biceps curl. Results: It was found that patients who underwent training with moderate resistance, showed a reduction on resting values of diastolic blood pressure (DBP) p<0.03 and of mean arterial pressure (MAP) p<0.03. Patients who underwent mild resistance training showed reduction in resting values of MAP (p<0.03) and a tendency to decrease in DBP (p<0.06). With regard to functional capacity, the results showed significant increase in the strength of arms and legs, agility and aerobic endurance (p<0.001) and maintaining flexibility (p>0.05). Conclusion: The data indicated that both mild and moderate resistance training, even when started in old age, promoted cardiovascular benefits and also improve the functional capacity of hypertensive older women.

A produção das perdas dentárias: narrativas de usuários do SUS

For a complete comprehension of the effect of tooth loss is necessary to listen to the patients that have it. This study, of qualitative approach, investigate, in the dental history of users of SUS, listening to his/her experiences with the services of dental care, the reason that lead his/her to dental lost and the repercussion of this in his/her life. The collect of data was made by narrative interview, obeying to a pre-defined schema. The subjects interviewed were six (three of urban zone and three of rural zone), all of them were users of Family Health Units. The criterions of inclusion were the followings: the presence of tooth lost (total lost in both dental arch or in one of them, or partial lost in at least six elements in one of the arches); age between 25 and 59; male or female; to live in municipal district of São Tomé/RN or Natal/RN. Based on previous interviews was elaborated the odontological history of each patient. Such narratives, systemized in odontological history, were analyzed taking as base the studies of Souza71 and the proposal of Schutze, suggested for Jovchelovitch, Bauer34. The results show that toothache was the main reason for the search of odontological care. The patients confront the ache with home-made medicaments, allopathic ones, and searching for dental care. The searching for exodontics was stimulated for geographic access difficulties or for repressed demand, which as a result produced the aggravation of the lesions and the discredit in restoration s treatment. The self-care practice of tooth-brush with juá or toothpaste and the controlled ingestion of sugar was not sufficient to avoid dental lost. Guilty sentiments were identified in relation with lack of care with teeth. The acceptance of dental lost as a natural factor is an important motivation in lack of pain and in the belief that it was a simple part of life in old age. Life with dental prosthesis makes clear the difference between which was natural and which was unnatural, and difficulties with the prosthesis appeared. The limitation of the prosthesis in its functional aspect can be compensated by esthetic restitution, making possible smiling expression. Starting with this study and considering the high number of dental lost, mainly in low-rent population, which live with toothless limitations or bad-quality prosthesis which do not rehabilitate adequately, we suggested the realization of qualitative researches which include, also, another actors in heath care services such as professionals and administrators

Avaliação da alimentação de idosos de município paulista: aplicação do Índice de Alimentação Saudável

OBJETIVO: avaliar a qualidade da dieta da população idosa do município de Avaré (SP) através do Índice de Alimentação Saudável (IAS) MÉTODOS: trata-se de um estudo de corte transversal de base populacional realizado por meio de entrevista domiciliar. A amostra constou de 73 indivíduos, sorteados aleatoriamente dos idosos integrados ao Sistema Público de Saúde do Município. O consumo alimentar foi medido por meio de 3 Recordatórios de 24 horas. Para avaliação, foi aplicado o IAS adaptado para a população brasileira. Parte-se do princípio que o presente estudo constitui o primeiro no Brasil a aplicar o IAS utilizando 3 inquéritos do tipo recordatório de 24 horas em população idosa. Optou-se por esta metodologia, pois como descrito na literatura, um único dia não representa a ingestão habitual de um indivíduo devido à elevada variabilidade intrapessoal do consumo. RESULTADOS: Foram encontrados 32,9% de idosos com uma dieta de má qualidade; 60,3% necessitando de melhorias e 6,8% com uma dieta de boa qualidade. CONCLUSÃO: Pode-se concluir que os idosos estudados precisam de melhorias na alimentação, o que ressalta a importância de política de incentivo voltado à alimentação saudável na terceira idade.

Envejecimiento, derechos humanos y políticas públicas

Incluye Bibliografía

Estilo de vida na velhice: Samira Cristina Jóia. -

Pós-graduação em Saúde Coletiva - FMB

Função cognitiva e capacidade funcional são preditoras de qualidade de vida em pacientes idosos com insuficiência cardíaca

Pós-graduação em Fisiopatologia em Clínica Médica - FMB