AIM: Chronic obstructive pulmonary disease (COPD) is a pro-inflammatory condition leading to wasting states such as sarcopenia. We aimed to describe the effect of COPD and sarcopenia on mortality in Costa Rican older adults in the Costa Rican Longevity and Healthy Aging Study (CRELES).
METHOD: This is a secondary analysis of the CRELES, a cohort study consisting of three waves of interviews. For the current study, data from the first and third waves were used. The dependent variable was survival status. COPD and sarcopenia were independent variables. Bivariate analyses were used to compare mortality curves for each group. Association with 3-year mortality was tested with Cox regression models, and hazard ratios (HR) with 95% confidence intervals (CI) were estimated as a measure of the strength of association.
RESULTS: Of a total of 2704 participants, 54.29% (n = 1468) were women. Overall mortality was 9.05%. Sarcopenic older adults had the strongest association with mortality (HR = 2.65; 95%CI, 1.81–3.90; p < 0.001), followed by those with both COPD and sarcopenia (HR = 2.59; 95%CI, 1.37–4.92; p = 0.003). The weakest association with mortality was found in patients with neither COPD nor sarcopenia. CONCLUSIONS: The synergistic effect of sarcopenia and COPD has been shown to independently increase mortality in older patients. Our results may be applicable to both Latin American residents and subjects of Hispanic descent living in developed countries. Sarcopenia should be assessed in all patients with COPD since the latter is not a disease limited to the lungs, but rather a systemic disease.

Keywords: sarcopenia; chronic obstructive pulmonary disease; mortality; aged.

There has been an increasing number of human aging studies evaluating chronic degenerative diseases and how they interfere with the ability to perform activities of daily living (ADLs). Parkinson's disease (PD) is a condition whose symptoms may deteriorate the quality of ADL performance, especially in terms of impaired coordinated hand movements. Regarding aspects of usability in the interaction with products, specifically clothing items, scholarly research has not yet delved into the possible relationships between variables involved in this process. The variables include characteristics of strength manipulation and performance associated with perceived effort and discomfort while dressing-undressing, and whether such variables are associated with gender and health status of older people. Different interface designs are known to possibly have a negative influence on the action of opening and closing clothing fasteners, limiting the autonomy to perform a basic ADL independently. Thus, the study primarily aimed to understand aspects of the management of clothing fasteners as well as the influence of motor and functional impairment based on simulation activities, which may clarify features of the user-activity-product relationship. An experimental method of descriptive, exploratory, quantitative, and laboratory nature was used to assess activities with buttons and zippers. The study included 40 participants and results showed that strength variables had no influence on the performance of manipulating clothing fasteners and that PD leads to poor performance in the coordinated activity, compromising its conclusion. Furthermore, poor performance in manipulating clothing fasteners and fastener design were found to negatively influence the ability to open and close detachable buttons and zippers. These results emphasize the need of raising awareness of clothing companies to the importance of developing products that can promote user independence and satisfaction, contributing thus to an improved user-activity-product interaction.

Keywords: ergonomics; aged; Parkinson disease; activities of daily living; clothing.

OBJECTIVE: To measure the prevalence of and identify factors associated with the occurrence of urinary incontinence (UI) in older adults (aged 60 years or older) living in the rural area of the municipality of Rio Grande, southern Brazil.
METHOD: In a single-visit approach, interviewers systematically visited 80% of the households in the rural area of this municipality between April and October 2017. A standardized questionnaire was administered to older adults for information on demographic characteristics, socioeconomic characteristics, lifestyle habits, and morbidity pattern. Prevalence ratio (PR) was used as the effect measure. The c² test was used to compare proportions. Poisson regression models with robust variance were used in the multivariate analysis.
RESULTS: Of 1028 respondents (90.9% of the total), 15.9% (95%CI 13.6–18.1) reported having UI. Adjusted analysis showed that the risk of UI increases with age and is 3 times hig her in women (PR = 3.72; 95%CI 2.66–5.21). Perception of health status as fair, poor, or very poor had a PR = 1.68 (95%CI 1.25–2.26) and having 2 or more comorbidities had a PR = 1.73 (95%CI 1.17–2.55).
CONCLUSION: In this study, the prevalence of UI was 15.9%, being significantly more prevalent in women, in older adults aged 65 years or older, in those with 2 or more morbidities, and in those perceiving their health status as fair, poor, or very poor.

Keywords: aged; rural areas; urinary incontinence.

OBJECTIVE: To evaluate adherence to medication treatment and possible associated factors in elderly patients interviewed during medical appointments in primary care units.
METHOD: This was a cross-sectional, population-based study of 57 older patients aged 60 to 99 years living in the municipality of Ponto dos Volantes, state of Minas Gerais, including rural and urban areas. Data were collected during medical appointments, using a structured electronic script. The association between the parameters and the level of adherence to treatment was assessed using the χ² test, with a 95% confidence interval.
RESULTS: Among the elderly patients interviewed, 45 (78.9%) responded about adherence to treatment. Of these, 11 (24.4%) were included in the low adherence group. None “ of the parameters evaluated showed a statistically significant association with the classification of drug adherence.
CONCLUSION: The present study identified that 1 in every 4 patients had low adherence to drug treatment. Among the variables studied, notably sex, age, schooling, number of comorbidities, number of medications, and income, no statistically significant relationship was observed.

Keywords: aged; treatment adherence and compliance; disease; volunteers.

BACKGROUND: Existing instruments for the diagnosis of frailty are limited by their focus on mobility evaluation, failure to incorporate comorbidities, and dichotomous classification of patients as frail or non-frail, which hinders adequate identification of frail older adults.
OBJECTIVE: To evaluate the frailty profile of outpatients seen at a secondary geriatric care service in Belo Horizonte, Brazil, as measured by the Visual Scale of Frailty, and describe the five levels of health status proposed by this instrument in terms of function, disabilities, and comorbidities.
METHODS: The medical records of patients who attended the clinic between February 2011 and February 2014 were evaluated, and the patients classified in accordance with the Visual Scale of Frailty. Continuous variables were analyzed by ANOVA or the Kruskal-Wallis test, and categorical variables, by the χ² test. Analyses were performed in SPSS Version 19.0.
RESULTS: A total of 813 medical records were evaluated. Among these patients, 5.2% were considered robust, 31% at risk of frailty, 24.6% as frail, 34.8% as highly complex frail, and 4.4% as frail individuals in the final stage of life. Analysis of the health status categories demonstrated an association between these categories, greater functional impairment, and greater presence of disabilities and comorbidities.
CONCLUSION: The Visual Scale of Frailty is a useful tool in assessing the health status of older adults and indicated a high prevalence of frailty in the studied population.

Keywords: aging, comorbidity, frail elderly, health of the elderly, health vulnerability.

INTRODUCTION: Delirium is an acute change in cognition and attention, common in the postoperative period in older patients, associated with increased costs and longer hospital stay.
OBJECTIVE: To evaluate the frequency, risk factors, and influence of postoperative delirium in older patients submitted to elective noncardiac surgery.
METHOD: This was a cross-sectional, observational study of older adults (65 years or older) hospitalized for elective noncardiac surgery. During the immediate preoperative period (24 hours), risk factors such as age, sex, cognition (MiniCog), functional status (Katz and Timed Up and Go), medications, and clinical aspects were evaluated. Delirium, in the immediate postoperative period (up to 72 hours), was evaluated using the Confusion Assessment Method (CAM).
RESULTS: A total of 83 patients were included in the study. Of these, 44.6% (n = 37) had undergone orthopedic surgery, 42.16% (n = 35), general surgery, and 13.3% (n = 11), urological surgery. Most participants were men (53%), with a mean age of 73 (65–94) years. Overall, 9.6% (n = 8) had postoperative delirium: 6% of the hyperactive subtype (n = 5), 2.4% of the hypoactive subtype (n = 2), and 1.2% of the mixed subtype (n = 1). These patients were older (p = 0.02), had greater cognitive decline (p = 0.01), anemia (p = 0.04), and prolonged hospital stay (p = 0.001).
CONCLUSION: Postoperative delirium was more commonly observed in the older old with cognitive decline and anemia, with an impact on hospital length of stay, highlighting the importance of a more comprehensive preventive evaluation in the preoperative period.

Keywords: delirium; postoperative period; health of the elderly.

OBJECTIVE: To compare results of prebiotic, probiotic and synbiotic supplementation for the control of diarrhea in older patients receiving enteral nutritional therapy during hospitalization at a school hospital in Curitiba, state of Paraná. METHODS: The study was retrospective, by analysis of medical records corresponding to the visits performed between 2014 and 2018.
RESULTS: A total of 75 patients were analyzed. The time of occurrence of diarrhea ranged from 1 to 16 days, with a mean of 2.69 days after the onset of therapy for reestablishment of the intestinal microbiota. As for the therapies introduced, 8 possible prescriptions of isolated and / or combined supplements were found as the first choice. Of the patients analyzed, 52% switched from supplementation during the occurrence of diarrhea; some using up to 5 different products. Of the 48% of patients who used a single product / combination from the beginning to the end of diarrhea, they generally started with a higher dose and decreased over time, with those starting at a lower dose having to increase it to stop diarrhea. In addition, there was statistical significance when comparing the time of diarrhea between patients who received a single product / combination and those who did supplemental exchanges throughout the treatment.
CONCLUSION: Establishing a single prescription, whether of isolated or combined products and sticking to it, besides starting with a higher dose, seems more effective in controlling diarrhea in hospitalized geriatric patients, reinforcing the importance of establishing a protocol for prescription.

Keywords: older adults; enteral nutrition; diarrhea; probiotics; symbiotics.

OBJECTIVES: To identify and evaluate the effect of cognitive stimulation (CS) interventions for older adults with dementia on caregivers' health.
METHOD: This systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) guidelines. A search was performed by two independent researchers in May 2018, using Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Science Literature Database (LILACS), Physiotherapy Evidence Database (PEDro), PsycINFO, and PubMed databases. The terms used were “dementia” AND “cognitive stimulation” and their equivalents in Portuguese and Spanish. For inclusion, articles should have been experimental, published from January 2007 to April 2018, with CS delivered to older adults with dementia by a professional or by a caregiver, and outcome measured in the caregiver. Quality of selected studies was assessed using the PEDro scale.
RESULTS: The sample consisted of 10 studies, and only two reported CS benefits to the health of caregivers of older adults with dementia.
CONCLUSION: This study found no consistent evidence of actual benefits of CS in older adults with dementia to their caregivers' health.

Keywords: caregivers; rehabilitation research; aged; dementia.

The invisibility of lesbian, gay, bisexual, and transgender people (LGBT) aging is a reality. These individuals suffer from ageism, from various forms of discrimination, and from the assumption that all are heterosexual and cisgender. They are also at higher risk of living alone, being childless, and having no one to call in an emergency. Few studies have addressed the subject, especially in the Brazilian medical literature. Additionally, geriatricians and gerontologists may encounter challenging situations when caring for LGBT older adults who are healthy, or have dementia, or are even at the end of life. Thus, this review article aimed to investigate the aging process of the LGBT population; to reinforce appropriate terminology; and to discuss the discrimination that they face in health care services, measures for health promotion, and the specific care of the LGBT older person with dementia, at the end of life, or living in a long-term care facility.

Keywords: sexual and gender minorities; aging; dementia; palliative care.