Aos meus pais, Edson e Maria Ophelia, que me deram a vida e formaram meu caráter e personalidade. À minha esposa, Heico, companheira valorosa, com quem divido os prazeres e as agruras da vida. Aos meus filhos, Fábio e Carolina, a quem ajudei a dar a vida e duas das grandes razões do meu viver. À Ligia Py e à Tomiko Born, amigas estimadas, que lutam em prol da Gerontologia vida afora. Aos idosos, motivo do meu caminhar profissional, que muito me ensinam a respeito da vida. ? À minha querida família. Gratíssimo pela paciência, compreensão, carinho, suporte e espera. escala de Likert necessitará de reformulação. Numa etapa posterior, a lista de itens, agora modificada, será reduzida através de duas técnicas, impacto clínico e análise fatorial. A distribuição dos itens resultantes em dimensões comporá o instrumento, cujo formato já está desenhado: Satisfação

ResumoIntrodução: As redes de atenção à saúde são fundamentais para assistir a população idosa em seus diversos aspectos. A assistência domiciliar, o Programa Acompanhante de Idosos da Secretaria Municipal da Saúde da cidade de São Paulo e as instituições de longa permanência para idosos compõem as redes de assistência à pessoa idosa. Fazse necessário analisar como a rede entre esses serviços se estabelece e contempla essa demanda de cuidado. Objetivo: Descrever e comparar os serviços assistência domiciliar, Programa Acompanhante de Idosos e instituições de longa permanência para idosos quanto às possíveis diferenças e semelhanças, demanda dos usuários, fluxo assistencial e gestão de serviços. Metodologia: Realizou-se uma revisão bibliográfica não exaustiva da literatura nacional publicada nas bases eletrônicas de dados SciELO e LILACS, em referências literárias e eletrônicas, no período de 1997 a 2012. Resultados: No total, 32 estudos foram incluídos na revisão. Observou-se que a população atendida é predominantemente do sexo feminino, com idade avançada, e recebe assistência multiprofissional. Os serviços de assistência domiciliar e o Programa Acompanhante de Idosos valorizam a manutenção da família e da comunidade como ambiente terapêutico, postergando a institucionalização. A presença do cuidador mostrouse como um dos fatores de maior influência para a permanência dos cuidados domiciliares. Conclusão: Conclui-se que os serviços revisados possuem objetivos que contemplam as demandas dos idosos. Espera-se que a integração dos equipamentos de saúde estabeleça suas ações de acordo com o perfil dos idosos e as características de cuidado oferecidas em cada serviço.

INTRODUCTION: Substantial medical research has established an inverse relationship between quality of life and illness. However, there exists minimal evidence for such a connection in the context of stable and controlled diseases. OBJECTIVE: We wished to correlate multimorbidity with quality of life for elderly patients who suffer from stable chronic diseases. METHODS: We used a tool to evaluate quality of life, namely World Health Organization quality of life-BRIEF, together with a scale of multimorbidity known as the Cumulative Illness Rating Scale - Geriatric Version. Furthermore, the quality of life data were correlated with scores recorded on the Cumulative Illness Rating Scale - Geriatric Version, the number of drugs used, and individual perceptions of health and age. RESULTS: We studied 104 elderly patients who suffered from chronic diseases. The patients had exhibited neither acute events nor secondary complications, their cognition was intact, and they were functionally independent. The Cumulative Illness Rating Scale - Geriatric Version showed an inverse correlation with the physical domain (p= 0.008) and a tendency toward an inverse correlation with the psychological domain (p= 0.052). Self-perception of health showed a high correlation with the physical domain (p= 0.000), psychological domain (p= 0.000) and environmental domain (p= 0.000). The number of drugs used correlated only with the physical domain (p= 0.004). Age and social domain showed a tendency toward a positive correlation (p= 0.054). DISCUSSION: We uncovered an inverse relationship between quality of life and multimorbidity in a group of patients who suffered from stable chronic diseases, with no functional limitations, pain or complications. Our data suggest that a patient’s knowledge that they have a certain clinical condition changes their subjective assessment of quality of life in the related domain. CONCLUSION: The perceived quality of life of the sample was affected by multimorbidity in the physical domain, with a tendency toward commensurate effects in the psychological domain.

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ResumoIntrodução: Quedas são um problema clínico comum nos idosos, que pode reduzir sua mobilidade e independência. O uso de instrumentos simples para detecção do risco de quedas é fundamental para prevenção e tratamento de tais eventos. Não há, porém, consenso quanto aos testes mais adequados para cada situação. A revisão mostrou que os dois testes podem ser bons preditores de quedas, mas os artigos diferiram quanto à definição de queda e caidor, tipo de estudo, quantidade e característica da amostra e avaliação de quedas, levando a diferentes resultados quanto a nota de corte, sensibilidade, especificidade e predição de quedas. Há controvérsias quanto à capacidade de predição em perfis específicos, como os idosos ativos. Conclusão: Os testes avaliados são eficazes para predição de quedas, desde que adaptados para cada perfil. Novos estudos devem ser realizados com metodologia homogênea, a fim de favorecer a comparação de resultados sobre a eficácia desses testes. AbstractIntroduction: Fall is a common problem in the elderly and it can reduce their mobility and independence. The use of simple tools to detect risk of falls is essential to prevent and treat such events. However, there is no consensus about the most appropriate tools for each situation. Objective: To review studies about efficacy, sensitivity and specificity of Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS) in order to ascertain which is the most appropriate to predict falls in the elderly. Methods: We performed a literature review from MEDLINE, PubMed, ISI, LILACS and Portal de Periódicos

Paschoal SMP, Jacob Filho W, Litvoc J. Development of an Elderly Quality of Life Index-EQoLI: Theoretical-conceptual framework, chosen methodology, and relevant items generation. Clinics. 2007;62(3):279-88. PURPOSE:To describe the initial steps of the construction process of a quality of life evaluation instrument for the elderly-the theoretic-conceptual framework for the construct, Quality of Life in Old Age; the construction methodology; and the generation of relevant items. METHODS: The first step was to conceptualize and define the construct, determining how much the elderly are able to perform of what they believe to be important in their lives and whether they are satisfied with what was possible to perform. The next step was to select and describe the construction methodology (the Clinical Impact Method) and the phase of generation of relevant items for the research object. The necessary procedures were delineated through a pilot study, which helped to establish all phases of the used methodology. The viability of the construction of the Quality of Life in Old Age evaluation instrument was demonstrated along with the needed adaptations. RESULTS: From 1032 answers by older people, 138 relevant items for the construct were identified by the items generation process. The pilot study demonstrated the suitability of the application of the methodology and established modifications to the preliminary items list, resulting in a new 139-item list. DISCUSSION: Now that the theoretical-conceptual framework of the construct as well as the construction methodology and the items generation are established, the next step will consist of administering the resulting list to a sample of elderly people for item reduction and distribution of items into dimensions.

BackgroundFalling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people.Methods/designMulticentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis.DiscussionThis study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions.Trial registrationClinicalTrials.gov (NCT01698580)

Objective -To analyze in out clinic elderly patients of both sexes for the prevalence of risk factors for atherosclerosis and study their association with the complications of atherosclerosis. Cardiovascular disease as a complication of atherosclerosis is today the most important cause of morbidity and mortality among elderly people especially in the developed countries [1][2][3] . Although in the earlier decades of life women have a lower prevalence of cardiovascular disease, the latter increases with age, reaching a similar level to that of men around the age of 75 4-6 . The same tendency has been observed in Brazil. According to the Sistema Estadual de Análise de Dados (SEADE) and the Instituto Brasileiro de Geografia e Estatística (IBGE), in 1995, in the city of São Paulo coronary artery disease was more prevalent in men up to the age of 75 years, but the prevalence became similar in both sexes after that age 7 . Atherosclerosis is a disease in which multiple factors contribute to the degeneration of the arterial wall. It is evident that intensity and duration of injury define the severity of the alterations. Many risk factors were identified as having influence on the progression of atherosclerosis, mainly age, sex, heredity, diet composition, tobacco smoking, physical activity, obesity, systemic arterial hypertension, dyslipidemia, diabetes mellitus, plasma fibrinogen levels, hyperhomocysteinemia, left ventricular hypertrophy and psycho-social factors. MethodsResearchers in the area agree that an order of risk factors exists and, in addition to age, sex, and heredity, hypertension, dyslipidemia, diabetes mellitus, tobacco smoking, and obesity must also be considered as major risk factors and deserve more attention. Most of the research, however, involves individuals of middle age and, more specifically, white males 8 . More recently, population studies have been aiming at the behavior of risk factors in the elderly, and some of these studies have cast doubt on their importance at this age 1,2,[9][10][11][12] . The goal of the present study was analyze in elderly individuals of both sexes the prevalence of the major risk factors and their correlation with atherosclerotic complications.