Redes sociais e funcionalidade em pessoas idosas: evidências do estudo Saúde, Bem-Estar e Envelhecimento (SABE)

Healthy aging meta-analyses and scoping review of risk factors across Latin America reveal large heterogeneity and weak predictive models

Models of healthy aging are typically based on the United States and Europe and may not apply to diverse and heterogeneous populations. In this study, our objectives were to conduct a meta-analysis to assess risk factors of cognition and functional ability across aging populations in Latin America and a scoping review focusing on methodological procedures. Our study design included randomized controlled trials and cohort, case-control and cross-sectional studies using multiple databases, including MEDLINE, the Virtual Health Library and Web of Science. From an initial pool of 455 studies, our meta-analysis included 38 final studies (28 assessing cognition and 10 assessing functional ability, n = 146,000 participants). Our results revealed significant but heterogeneous effects for cognition (odds ratio (OR) = 1.20, P = 0.03, confidence interval (CI) = (1.0127, 1.42); heterogeneity: I2 = 92.1%, CI = (89.8%, 94%)) and functional ability (OR = 1.20, P = 0.01, CI = (1.04, 1.39); I2 = 93.1%, CI = (89.3%, 95.5%)). Specific risk factors had limited effects, especially on functional ability, with moderate impacts for demographics and mental health and marginal effects for health status and social determinants of health. Methodological issues, such as outliers, inter-country differences and publication bias, influenced the results. Overall, we highlight the specific profile of risk factors associated with healthy aging in Latin America. The heterogeneity in results and methodological approaches in studying healthy aging call for greater harmonization and further regional research to understand healthy aging in Latin America.

Exploring the effect of the structural model of active aging on the self-assessment of quality of life among older people: A cross-sectional and analytical study

BACKGROUND

Although studies have examined the relationship between variables associated with active aging and quality of life (QoL), no studies have been identified to have investigated the effect of a structural model of active aging on QoL in a representative sample of older people in the community.

OBJECTIVE

To measure the domains and facets of QoL in older people and identify the effect of the structural model of active aging on the self-assessment of QoL.

DESIGN AND SETTING

This cross-sectional analytical study included 957 older people living in urban areas. Data were collected from households using validated instruments between March and June 2018. Descriptive, confirmatory factor, and structural equation modeling analyses were performed.

RESULTS

Most older people self-rated their QoL as good (58.7%), and the highest mean scores were for the social relationships domain (70.12 ± 15.4) and the death and dying facet (75.43 ± 26.7). In contrast, the lowest mean scores were for the physical domains (64.41 ± 17.1) and social participation (67.20 ± 16.2) facets. It was found that active aging explained 50% of the variation in self-assessed QoL and directly and positively affected this outcome (λ = 0.70; P < 0.001).

CONCLUSION

Active aging had a direct and positive effect on the self-assessment of QoL, indicating that the more individuals actively aged, the better the self-assessment of QoL.

Association of Social Support Network with Telomere Length: A Cross-Sectional Study with Community-Dwelling Older Adults

Considering that telomere length can be determined not only by issues related to cell biology but also by aspects related to social factors and environmental exposures, studies on the relationship between social aspects and telomere length can help to better understand the still scarcely known aspects of the human aging process. Thus, this research seeks to verify whether social support networks are associated with telomere length in older adults. This is a cross-sectional study conducted with 448 individuals aged at least 60 years living in the urban area of an inland Brazilian municipality. Relative quantification of telomere length was obtained through real-time qPCR. Social support was assessed through the Medical Outcomes Study Social Support Scale. Descriptive statistics and multiple logistic regression were used in data analysis. The evaluated social support networks for older adults consist in a mean of 16.4 people, and the percentage of older adults who reported up to five members in their network was 27.75%. Shorter telomere length was identified in 25% of the participants, and the older adults who reported having up to five members in their support network were more likely to have a shorter telomere length than those who reported more numerous networks (odds ratio: 1.89, p = 0.011) regardless of gender, age, household arrangement, cognitive decline, and dependence for basic and instrumental activities of daily living, which suggests that measures that stimulate the creation and maintenance of social support networks should be implemented to improve older adults' health.

Nursing Home Care Intervention Post Stroke (SHARE) 1 year effect on the burden of family caregivers for older adults in Brazil: A randomized controlled trial

The purpose of this study is to evaluate the effect of home-care nursing intervention on the burden of family caregivers for older adults surviving a stroke. A randomised clinical trial blinded for outcome evaluation. Forty-eight family caregivers of older adults surviving a stroke took part in the study. The intervention group (IG) received three home visits by nurses in 1 month after hospital discharge for guidance on the disease and care activities for the elderly people. The control group (CG) relied on the service network that had access. The Caregiver Burden Scale was applied to assess the burden outcome 1 week, 60 days and 1 year after hospital discharge. The caregivers of the intervention and CGs had no difference regarding baseline data. There was an interaction effect between the CG and the IG in the isolation domain (p = 0.037) and in the emotional involvement domain (p = 0.003) over time. These findings provide support for strengthening a care line for the elderly people after a stroke, with adequate discharge planning, indicating the importance of integrating care network services such as primary care, home care and hospital care with a view to achieving an effective care transition. It is also necessary to construct a specific instrument to evaluate other outcomes, such as the knowledge and learning of caregivers in relation to the care activities taught. This study is registered in the Clinical Trials with name Nursing Home Care Intervention Post Stroke (SHARE) and under number NCT02807012.

Factors associated with perceived social support in older people with cancer

OBJECTIVE: To analyze factors associated with perceived social support in older people with cancer. METHODOLOGY: This is a cross-sectional, analytical study conducted with a convenience sample of 134 older people seen at a specialist cancer treatment unit in a hospital located in a municipal district in the South of Minas Gerais state, Brazil. Data collection was conducted by interview and analysis of medical records. Social support was analyzed using the Medical Outcomes Study social support scale. The Mann-Whitney and Kruskal-Wallis tests were used to analyze differences between means. Linear regression was used for analysis of associations. RESULTS: The majority of the sample of older people with cancer analyzed were male, aged from 60 to 74 years, and reported high mean scores for material support; affective support; positive social interaction; and emotional/informational support. Factors with positive associations with social support were: not living alone; income one to three times the minimum wage; having a partner; rating health as good/very good; and presence of comorbidity. Factors with negative associations were: poor/very poor perceived income and polypharmacy use. CONCLUSIONS: This sample of older people reported high mean scores for material support; affective support; positive social interaction; and emotional/informational support. Factors associated with perceived social support were: living arrangements; family income; perceived sufficiency of income; marital status; health self-assessment; comorbidity; and polypharmacy.

Clima familiar e autopercepção de saúde de idosos(as)

Investigou-se a coesão, o apoio, a hierarquia e o conflito relativos ao clima familiar percebido por idosos em sua relação com a autopercepção de saúde. Participaram 134 idosos do Recôncavo Baiano, a maioria composta por negros e mulheres, entrevistados em domicílio, utilizando-se Questionário de doenças e de sinais e sintomas autorrelatados, Questionário de autoavaliação de saúde e o Inventário do Clima Familiar. Foram feitas análises estatísticas descritivas e bivariadas. Os dados desta pesquisa mostraram que a maioria dos idosos fez uma avaliação mais negativa do clima familiar e da autopercepção atual da saúde; maior apoio e coesão e menor hierarquia familiar estão associadas a uma melhor saúde percebida. Os dados podem ajudar a compreender como o clima familiar do idoso pode impactar na saúde subjetiva e como a deterioração da saúde pode moldar os relacionamentos na família bem como podem colaborar com intervenções clínicas e sociais.

The "SuperAgers" construct in clinical practice: neuropsychological assessment of illiterate and educated elderly

INTRODUCTION

The demographic transition is a global event intensified during the last decades that represents population aging. Thus, the studies directed to the elderly 80 years of age or more with preserved cognitive functions (named SuperAgers) emerges as a possible path to full comprehension of the health of those aging with acceptable levels of functionality and independency.

OBJECTIVE

To evaluate the cognitive performance of the elderly over 80 years old, associating the results to their educational level.

METHOD

We evaluated 144 healthy elders with 80 years or more through the following cognitive tests Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination (CAMCOG), Clock Drawing Test (CDT), and Verbal Fluency Test (VF) and compared the tests' scores with their educational level segmented in years of formal education, being the groups ILLITR (<1 year of schooling), 1TO4 (from 1 to 4 years of schooling), and 5MORE (>5 years of schooling).

RESULTS

There was positive influence of educational level on the cognitive tests' score, which indicates higher cognitive reserve of the elderly with higher educational levels.

CONCLUSION

The functionality and independence of the so-called SuperAgers is determined by the cognitive reserve acquired throughout life, mainly developed by the years of formal education.