Avaliação do estado nutricional de idosos institucionalizados

Incidence of hospital-acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo, Brazil

This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.

Supply of enteral diets in the Espirito Santo state public health system in Brazil

Introduction

Background: Brazil includes food as a social right, making the State responsible to the courts for the sufficient and adequate supply of enteral food. Objectives: to evaluate the supply of enteral diets in pharmacies in the state of Espirito Santo. Methods: to do this, we used the forms filled out by patients or legal representatives, containing medical records, to analyze the nutritional and social profiles of the users over two years, and the compliance of the administrative processes with the ordinance that instituted enteral food supplies was verified. Results: the sample was comprised of 204 patients receiving enteral nutrition, and the administrative procedures required to supply these patients were surveyed in seven (7/9) pharmacies. The data showed that the most common group was that of women (51 %), who were white (51 %), legally represented (91 %), and 73.5 years old (11 to 109 years). Information regarding missing anthropometric data, use of terms and calculations for obtaining enteral food other than those recommended, incomplete documents, alterations to the physical examinations suggestive of error, and nonobservance of inclusion and exclusion criteria were collected for this study. Conclusions: this study revealed that there were gaps in the process of enteral diet supply by the Espírito Santo pharmacies, both concerning compliance with the protocol and patient follow-up by the professional who assists both the patient and the pharmacist who provides the input.

Nutritional and hematological factors associated with the progression of Alzheimer's disease: a cohort study

SUMMARY OBJECTIVE: We studied the users of the Specialized Drug Distribution Program of the public health network. METHODS: A prospective cohort examined the elderly at two intervals of three years and included 30 patients in phase I and 16 in phase II. The methodology was composed of home visits, anthropometric, nutritional and hematological evaluation. For the progression of AD, the Clinical Dementia Rating (CDR) scale was used. RESULTS: According to the CDR, the disease evolved, since in 2014 most of the patients were in CDR 3. In the analysis of the micronutrients, only the B vitamins (B1, B2, B3, B5, B6) presented a significant reduction in 2014. The consumption of carbohydrates and lipids increased in the 2014 evaluation, and protein consumption decreased. As for the average weight of the elderly, there was an increase in 2014, 65.9 (± 15.6) Kg, with a BMI of 26.75 (± 4, 5), in 2011 the average weight was 62.44 kg (± 14, 36), BMI 24.64 (± 4.97). CONCLUSION: The hypothesis that patients are likely to be overweight or obese before the development of AD and that this may be associated with an increased risk of dementia is suggested.

Autoavaliação negativa de saúde em idosos de cidades com diferentes níveis de bem-estar econômico: dados do Estudo FIBRA

Resumo Nesta pesquisa comparativa e de corte transversal foram investigadas relações entre autoavaliação negativa da saúde, variáveis sociodemográficas e indicadores de saúde em idosos de 65 anos e mais, sem déficit cognitivo sugestivo de demência, residentes em Belém (n = 571) e em Campinas (n = 676), cidades com diferentes condições de desenvolvimento econômico, que integraram um estudo multicêntrico sobre fragilidade (Estudo Fibra Unicamp). Análises de regressão multivariada mostraram que, em ambas as cidades, autoavaliação negativa de saúde associou-se com baixa escolaridade, três ou mais doenças crônicas e déficits visuais. Em Belém, foram também observadas associações adicionais com fadiga, três ou mais sinais e sintomas e uso de serviços públicos de saúde; em Campinas, associou-se, também, com sintomas depressivos. As associações encontradas sugerem que más condições de saúde na velhice resultam da acumulação de déficits devido à escassez de recursos socioeconômicos ao longo da vida, e que os déficits não são suficientemente compensados pelos serviços de saúde na velhice.

The prevalence of and factors associated with constipation in elderly residents of long stay institutions

Objective : Constipation is a frequent motility disorder and while a common complaint among the overall population, is particularly prevalent among the elderly. The increase of this population group is creating a growing demand for long term care institutions. The present study aims to investigate the prevalence of and factors associated with constipation in elderly residents of long stay care institutions. Method : The study involved 87 individuals. The data collected from each participant included gender, daily intake of water and fiber, physical activity, family history of constipation and nutritional status. The diagnosis of constipation was based on Roma III criteria. Statistical analysis was performed with the SPSS software program (version 18.0) with a level of significance of 5% (p≤0.05). The Student t, Mann-Whitney, Pearson's chi-square or Fischer's exact tests were employed. Results : The sample was predominantly female (80.5%), with a mean age of 79.4(±9.6) years. A 42.52% prevalence of constipation was observed. Among affected individuals, the condition was more frequent among women (89.2%), those aged over 80 years (67.6%), those who did not engage in physical activity (56.8%), those with below the recommended intake of water and fiber, those who had a family history of constipation, and those who were diagnosed with eutrophia (56.3%). Among the factors analyzed, only age (p=0.049) and low fiber intake (p=0.019) were significantly linked to constipation. Conclusion : The results show that constipation is a multifactorial disease that is significantly related to age and low fiber intake.

Baixo peso e dependência funcional em idosos institucionalizados de Uberlândia (MG), Brasil

O objetivo deste artigo é identificar a associação entre estado nutricional e dependência funcional dos idosos institucionalizados de Uberlândia (MG). Estudo transversal, com 233 idosos. Foram avaliadas variáveis sociodemográficas, estado nutricional e o grau de dependência dos idosos. Realizou-se análise multivariada pela Regressão de Poisson com variância robusta, para verificar a associação entre o estado nutricional e dependência funcional. O baixo peso pelo Índice de Massa Corporal se associou à dependência funcional após controle para variáveis socioeconômicas e demográficas, os idosos com baixo peso tinham uma razão de prevalência de dependência de 1,20 vezes àquela dos eutróficos. Como bem reportado pela literatura, a idade também se associou à dependência, com razão de prevalência de 1,19, para os longevos. O baixo peso constituiu importante fator associado à incapacidade funcional. Dessa forma, ressalta-se a necessidade de avaliação, monitoramento e recuperação do estado nutricional de idosos institucionalizados, que além de reduzir morbimortalidade por diversas doenças e melhorar a qualidade de vida, ainda pode prevenir e retardar a dependência funcional.

Nutritional assessment of institutionalized elderly

Objective:

To define the nutritional profile of institutionalized elderly individuals.

Methods:

Comparative correlation and quantitative field study conducted in a Long-Stay Institution in Sao Paulo (SP), Brazil, between December 2010 and January 2012. To define nutritional diagnosis, data were collected from patient files, such as body mass index, circumferences, triceps skinfold, muscle area of the arm, thickness of the adductor pollicis, handgrip strength, and biochemical test results. The anthropometric variables were presented as mean, standard deviation, and percentages, and were grouped by gender and stratified by age. The level of statistical significance was p<0.05.

Results:

One hundred and two elderly individuals were selected, and 84 were females. Excess weight was the most common anthropometric diagnosis in men (n=11; 61%), with the detection of protein depletion in those aged 70 years, and possible cases of sarcopenic obesity. All women were in good health conditions (n=84; 100%). However, in 27% (n=23) of them, protein depletion was evident.

Conclusion:

More anthropometric studies are necessary which would allow a definition of local reference standards, stratified by gender and age group. The difference between populations and factors, such as inclusion and exclusion criteria, and methodological characteristics, limit the use of international standards, interfering in the reliability of the nutritional diagnosis.

Perfil antropométrico dos idosos residentes em Campina Grande-PB

O objetivo deste estudo foi descrever o perfil antropométrico dos idosos residentes em Campina Grande - PB. Este estudo é populacional, transversal e domiciliar. Os dados são apresentados sob a forma de média, desvio-padrão e percentil (P5, P10, P25, P50, P75, P90 e P95) do peso, estatura, índice de massa corporal (IMC), perímetro do braço (PB), dobra cutânea tricipital (DCT), circunferência muscular do braço (CMB), perímetro da panturrilha (PP) e perímetro da cintura (PC). Foi realizado o teste t Student para verificar a diferença dos valores médios das variáveis entre os sexos. Foi realizada a análise de variância (ANOVA) para verificar o efeito da idade nas variáveis. Foram avaliados 806 idosos (60 anos ou mais). Os valores médios de todas as variáveis apresentaram diferença estatisticamente significativa entre os sexos. As médias das variáveis peso, estatura, CMB, PP e PC foram significativamente maiores entre os homens, enquanto que as médias de IMC, PB e DCT foram significativamente maiores entre as mulheres. Todas as variáveis apresentaram tendência de declínio entre os grupos etários mais avançados. Os resultados mostram que o padrão antropométrico dos idosos deste estudo segue a tendência de outros estudos, no entanto, os valores diferem. Dessa forma, sugere-se que estes possam ser usados para auxiliar na avaliação antropométrica de idosos.

Mini-Mental State Examination performance in frail, pre-frail, and non-frail community dwelling older adults in Ermelino Matarazzo, São Paulo, Brazil

BACKGROUND

Frailty in older adults is a multifactorial syndrome defined by low metabolic reserve, less resistance to stressors, and difficulty in maintaining organic homeostasis due to cumulative decline of multiple physiological systems. The relationship between frailty and cognition remains unclear and studies about Mini-Mental State Examination (MMSE) performance and frailty are scarce. The objective was to examine the association between frailty and cognitive functioning as assessed by the MMSE and its subdomains.

METHODS

A cross-sectional population-based study (FIBRA) was carried out in Ermelino Matarazzo, a poor subdistrict of the city of São Paulo, Brazil. Participants were 384 community dwelling older adults, 65 years and older who completed the MMSE and a protocol to assess frailty criteria as described in the Cardiovascular Health Study (CHS).

RESULTS

Frail older adults had significantly worse performance on the MMSE (p < 0.001 for total score). Linear regression analyses showed that the MMSE total score was influenced by age (p < 0.001), education (p < 0.001), family income (p < 0.001), and frailty status (p < 0.036). Being frail was associated more significantly with worse scores in Time Orientation (p < 0.004) and Immediate Memory (p < 0.001).

CONCLUSIONS

Our data suggest that being frail is associated with worse cognitive performance, as assessed by the MMSE. It is recommended that the assessment of frail older adults should include the investigation of their cognitive status.

Análise do desempenho motor associado ao estado nutricional de idosos cadastrados no Programa Saúde da Família, no município de Vitória de Santo Antão-PE

Investigar a associação entre o estado nutricional, e o desempenho das habilidades motoras, de idosos, cadastrados no Programa Saúde da Família, zona urbana, do município de Vitória de Santo Antão (PE). Estudo epidemiológico, transversal de campo do tipo descritivo-analítico. Participaram desta pesquisa 235 idosos com idade superior ou igual a 60 anos, do gênero masculino e feminino, residentes em Vitória (PE) e cadastrados nas unidades de saúde da família da zona urbana da cidade. O estado nutricional foi avaliado segundo o Índice de Massa Corporal e a Circunferência de Panturrilha. Para análise do desempenho motor foram utilizados quatro testes motores: Time Up&Go, Índice de Tinetti, Alcance Funcional e Apoio Unipodal. As associações foram verificadas segundo a correlação de Spearman. A associação do estado nutricional com os testes motores foi estatisticamente significativa entre os gêneros masculino* e feminino** (time up&go rho = 0,290*, 350**, alcance funcional rho = 0,232*, 352**, índice de Tinetti rho = 243*, 363** e apoio unipodal rho = 221*, 475**) não apresentando distinção entre sexo. A avaliação dos resultados mostrou associação entre o estado nutricional e a capacidade funcional entre os idosos independente do sexo; tendo sido a obesidade apontada como a condição nutricional limitante ao desempenho adequado nos testes.

Nutritional status and epidemiological profile of elderly people

We intended to identify and evaluate the association between the socio-demographic and epidemiological characteristics of elderly people with their nutritional characteristics. This is a transversal study PMTI (from the Portuguese name of "Programa Municipal da Terceira Idade"), conducted at Viçosa, MG, Brazil. We analyzed 93 records of elderly people registered since 2006 and who underwent nutritional care. After having analyzed the questionnaire, we performed the descriptive and association analyses in the Epi Info (version 6.04) and Minitab softwares. Of the 93 analyzed records, most elderly people were women (80.4%), with an average of 72 years of age, of which 13.0% were long-lived people. The mean body mass index (BMI) was 27.4 kg/m(2), and 50.5% were overweight. We have found 26.8% elderly patients with hypertension, and 31.6% took antihypertensives. Elderly patients who were overweight are 4.54 times more likely to have arterial hypertension (odds ratio (OR)=4.54; 95% confidence interval (CI)=1.2-2.45). Only 7.5% smoked, 30.1% were alcoholics and 60.2% made physical activities. Inadequacies were found regarding the servings of fruits, dairy products, vegetables and sugars consumed. However, the servings of cereals, leguminous, meat and fat consumed were appropriate. This study showed that the nutritional diagnosis and the epidemiological and socio-demographic studies are critical tools to understand this population group, in addition to being important to the planning of health actions.

Estado nutricional e capacidade funcional na úlcera por pressão em pacientes hospitalizados

OBJETIVO: Correlacionar a incidência de úlcera por pressão com o estado nutricional e a capacidade funcional de pacientes internados. MÉTODOS: Estudo de corte transversal realizado em dois hospitais, totalizando 130 pacientes (idade mediana = 52 (14-85) anos, 77 (59,2%) homens e 53 (40,8%) mulheres), sendo 72 (55,4%) internados para tratamento clínico, 40 (30,8%) para tratamento cirúrgico e 18 (13,8%) em terapia intensiva. Os pacientes foram avaliados pela avaliação subjetiva global e classificados, de acordo com sua capacidade funcional, em acamados e não acamados. Registrou-se a presença e número de úlceras, e sua gravidade. A classificação das úlceras foi estabelecida como grave, para lesões de 3º e 4º graus, e leve, para os graus 1 e 2. RESULTADOS: A incidência de úlcera por pressão na população estudada foi de 19,2% (n=25). Não houve associação significativa com o sexo, a idade e tipo de tratamento do paciente. Os pacientes acamados apresentaram 7,5 vezes mais chance de apresentar úlceras (19/50; 38,0%) do que os que deambulavam (6/80; 7,5%; OR=7,5; IC95%: 2,7-20,7; p<0,001). A incidência de úlcera nos pacientes gravemente desnutridos (20/49; 40,8%) foi 10 vezes maior que nos pacientes considerados não gravemente desnutridos (5/81; 6,1%; OR=10,4 IC95%: 3,6-30,5; p<0,0001) Pela análise multivariada, tanto a capacidade funcional (acamado, OR=9,2; IC95%: 2,8-30,1; p<0,001) quanto o estado nutricional (desnutrido grave, OR=3,8; IC95%: 1,0-13,9; p=0,04) associaram-se com a úlcera por pressão. CONCLUSÃO: A incidência de úlcera por pressão está diretamente correlacionada com a desnutrição e com a restrição ao leito dos pacientes internados.

Anthropometric parameters of nutritional assessment as predictive factors of the Mini Nutritional Assessment (MNA) of hospitalized elderly patients

OBJECTIVE

The objective of this study was to identify nutritional indicators that predict MNA (mini nutritional assessment) classification in hospitalized elderly patients.

METHOD

This cross-sectional study assessed the nutritional status of 109 elderly patients at the beginning of their hospital stay with anthropometric and laboratory indicators and the MNA. Habitual energy intake (HEI) was also determined. The assessed nutritional indicators were investigated by univariate and multivariate logistic regression analysis to verify if they can predict MNA classification. The odds ratio (OR) and its respective confidence interval (CI) of 95% were also calculated, and the significance level was set at 5% (p < 0.05).

RESULTS

The nutritional status of most patients (61.47%) was appropriate but 30.28% were at risk of malnourishment and 8.26% were malnourished. Statistical differences were found for those aged more than 70 years and for arm circumference, body mass index, calf circumference, triceps skinfold thickness and mid-arm muscle circumference. Initially, the predictive factors identified by univariate logistic regression were body mass index (BMI) (p=0.0001; OR=0.825), calf circumference (CC) (p=0.0026; OR=0.832), arm circumference (AC) (p < 0.0001; OR=0.787), triceps skinfold thickness (TST) (p=0.0014; OR=0.920) and mid-arm muscle circumference (MAMC) (p=0.0003; OR=0.975); later, multiple logistic regression analyses revealed that first AC (p=0.0025; OR=0.731 (0.597 - 0.895)), then BMI (p= < 0.0001; OR=10.909 (3.298 - 36.085)) and finally TST (p=0.0040; OR=0.924 (0.876 - 0.975)) and MAMC (p=0.0010; OR=0.976 (0.962 - 0.990)) were factors that predict MNA classification.

CONCLUSION

In the conditions of this study, first AC, then BMI and finally TST and MAMC together were capable of predicting MNA classification.

Avaliação antropométrica de idosos residentes em Instituições de Longa Permanência de Fortaleza-CE

OBJETIVO: Avaliar as variáveis antropométricas de idosos residentes em instituições de longa permanência (ILP) de Fortaleza/CE. MATERIAL E MÉTODOS: Foram investigados idosos (60 anos ou mais), de ambos os sexos, residentes em seis instituições de longa permanência da cidade de Fortaleza. As variáveis antropométricas avaliadas foram: índice de massa corporal (IMC), dobra cutânea tricipital (DCT) e circunferência muscular do braço (CMB). Para análise do IMC, DCT e CMB, foram utilizados os valores propostos por Kuczmarski et al. (2000), que são apresentados em percentis. RESULTADOS: Foram avaliados 305 idosos (69,2% mulheres), cuja média etária foi 75,9 anos (DP=9,5 anos). Os resultados indicaram que, quanto ao IMC, 66% dos homens apresentaram baixo peso. As mulheres apresentaram maior prevalência de excesso de peso (12,3%), quando comparadas aos homens (7,4%). Quanto ao grupo etário, os idosos do grupo 60-69 anos apresentaram maior prevalência de baixo peso (58,4%). De acordo com a DCT, as mulheres apresentaram maior prevalência de reduzida reserva adiposa (31,5%), em relação aos homens. Os idosos com 80 anos ou mais apresentaram elevada proporção de indivíduos com excesso de reserva adiposa (35,6%), quando comparados aos demais grupos etários. A proporção de idosos desnutridos, quanto à CMB, foi elevada em ambos os sexos (91,7% e 77,2% dos homens e mulheres, respectivamente). Em todos os grupos etários, os idosos apresentaram elevadas prevalências de desnutrição. CONCLUSÕES: De acordo com estes resultados, conclui-se que os idosos residentes em instituições de longa permanência da cidade de Fortaleza apresentam risco nutricional, o que implica a necessidade de intervenções.

Antropometria de idosos residentes no município de Joinville-SC, Brasil

OBJETIVO: Fornecer dados antropométricos de idosos residentes na área urbana do município de Joinville, SC. Metodologia: Foram analisados 218 idosos com idade igual ou superior a 60 anos, de ambos os sexos, não institucionalizados e residentes na área urbana da cidade de Joinville-SC, no ano de 2002. Os idosos foram apresentados segundo sexo e grupo etário: 60-69 anos, 70-79 anos e 80 e mais. As variáveis antropométricas foram apresentadas sob a forma de média, desvio-padrão e percentil (P5, P10, P25, P50, P75, P90 e P95). RESULTADOS: Dos 218 idosos, 130 (59,6%) foram mulheres e 88 (40,4%) homens. Apesar de os valores médios da maioria das variáveis investigadas sugerirem uma tendência a diminuir com o aumento da idade, não houve diferença estatisticamente significativa dos valores médios entre os grupos etários para ambos os sexos (p>0,05). Quando comparados por sexo, os valores médios de IMC, CQ e DCT das mulheres foram significativamente superiores aos dos homens. Estes, em contrapartida, apresentaram valor médio da CC significativamente superior ao das mulheres (p<0,05). CONCLUSÃO: A maioria dos estudos realizados com idosos em outros países tem investigado esta categoria considerando pessoas com idade igual ou superior a 65 anos, o que dificulta a comparação com os dados brasileiros. Somado a outros estudos realizados com idosos no Brasil, os dados obtidos neste estudo podem contribuir para a construção de um padrão antropométrico da população idosa brasileira, ainda inexistente no país.

The impact of hip fracture (HF) on the functional status (FS) of older persons in Rio de Janeiro, Brazil: results of a prospective cohort study

There is no prospective study investigating the impact of hip fracture (HF) on functional status (FS) in Brazil. The objective of this study was to investigate the impact of a HF on the FS of older persons 1 year after the fracture and the factors associated with decline in FS 1 year after the fracture. Two hundred and forty-six patients who were admitted to one of four hospitals after HF participated. The sample for this study consisted of 160 patients who were still alive and had information on functional limitations after 1 year. The Brazil Old Age Schedule (BOAS) was used to assess FS before and 1 year after HF. Logistic regression analyses were used to identify predictors of decline 1 year after fracture. Of the patients, 46.3% did not achieve their prior FS. Older age, being underweight, total length of stay and the use of psychotics/sedatives and anxiolitics were associated in multivariate analyses with decline in FS. Working before the fracture was protective of decline in FS. We conclude that HF severely compromised the FS of older persons in Rio de Janeiro, Brazil.