ABSTRACT Objective: To investigate differences in the prevalence of frailty between LGBT+ and non-LGBT+ older adults. Methods: A cross-sectional study involving Brazilians aged 50 and over was performed. The participants were invited to participate in an anonymous online survey between August 2019 and January 2020. The survey was widely distributed in neighborhood associations, day centers, non-governmental organizations, and social media. Those who identified as homosexual, bisexual, pansexual, non-heterosexual, transgender, travesti, or non-binary were grouped as LGBT+. Participants who were both cisgender and heterosexual were categorized as non-LGBT+. Frailty was measured using the FRAIL scale, and the participants were categorized as robust, prefrail, or frail. Generalized ordered logistic models were used to examine the adjusted association between LGBT+ status and frailty according to age and sex. Results: The study sample included 6,693 participants with a median age of 60 years. Overall, 1,332 patients were LGBT+ (19.9%), and 5,361 were non-LGBT+ (80.1%). Pre-frailty or frailty was observed in 656 (49%) LGBT+ participants and 2,460 (46%) non-LGBT+ participants (p=0.03). Multivariate analyses showed that being LGBT+ was independently associated with frailty in female participants aged ≥50 years (OR=1.52, 95%CI=1.08-2.13, p=0.02) and male participants aged ≥60 years (OR=2.83, 95%CI=1.41-5.69, p=0.004). Non-cisgender participants were also more likely to be frail than cisgender participants (OR=2.21, 95%CI=1.42-3.42, p<0.001). Conclusion: LGBT+ status was independently associated with frailty in female adults aged >50 years and males aged > 60 years. More research in this area and inclusive government policies are needed to promote the healthy aging of the LGBT+ population. Objective LGBT nonLGBT+ nonLGBT non non-LGBT Methods crosssectional cross sectional 5 performed 201 2020 associations centers nongovernmental governmental organizations media homosexual bisexual pansexual nonheterosexual, nonheterosexual heterosexual, non-heterosexual transgender travesti nonbinary binary nonLGBT+. scale robust prefrail sex Results 6693 6 693 6,69 Overall 1332 1 332 1,33 19.9%, 199 19.9% , 19 9 (19.9%) 5361 361 5,36 80.1%. 801 80.1% . 80 (80.1%) Prefrailty Pre 65 49% 49 (49% 2460 2 460 2,46 46% 46 (46% p=0.03. p003 p p=0.03 0 03 (p=0.03) ≥5 OR=1.52, OR152 OR 52 (OR=1.52 95%CI=1.082.13, 95CI108213 CI 95%CI=1.08 2.13, 95 08 13 95%CI=1.08-2.13 p=0.02 p002 02 ≥6 OR=2.83, OR283 83 (OR=2.83 95%CI=1.415.69, 95CI141569 95%CI=1.41 5.69, 41 69 95%CI=1.41-5.69 p=0.004. p0004 p=0.004 004 p=0.004) Noncisgender Non OR=2.21, OR221 21 (OR=2.21 95%CI=1.423.42, 95CI142342 95%CI=1.42 3.42, 42 3 95%CI=1.42-3.42 p<0.001. p0001 p<0.001 001 p<0.001) Conclusion >5 population 20 202 669 6,6 133 33 1,3 19.9 (19.9% 536 36 5,3 80.1 8 (80.1% 4 (49 246 2,4 (46 p00 p=0.0 (p=0.03 ≥ OR=1.52 OR15 (OR=1.5 082 95%CI=1.082.13 95CI10821 95CI108 95%CI=1.0 213 2.13 95%CI=1.08-2.1 OR=2.83 OR28 (OR=2.8 415 95%CI=1.415.69 95CI14156 95CI141 95%CI=1.4 569 5.69 95%CI=1.41-5.6 p000 p=0.00 00 OR=2.21 OR22 (OR=2.2 423 95%CI=1.423.42 95CI14234 95CI142 342 3.42 95%CI=1.42-3.4 p<0.00 66 6, 1, 19. (19.9 53 5, 80. (80.1 (4 24 2, p0 p=0. (p=0.0 OR=1.5 OR1 (OR=1. 95%CI=1.082.1 95CI1082 95CI10 95%CI=1. 2.1 95%CI=1.08-2. OR=2.8 OR2 (OR=2. 95%CI=1.415.6 95CI1415 95CI14 56 5.6 95%CI=1.41-5. OR=2.2 95%CI=1.423.4 95CI1423 34 3.4 95%CI=1.42-3. p<0.0 (19. (80. ( p=0 (p=0. OR=1. (OR=1 95%CI=1.082. 95CI1 95%CI=1 2. 95%CI=1.08-2 OR=2. (OR=2 95%CI=1.415. 5. 95%CI=1.41-5 95%CI=1.423. 3. 95%CI=1.42-3 p<0. (19 (80 p= (p=0 OR=1 (OR= 95%CI=1.082 95CI 95%CI= 95%CI=1.08- OR=2 95%CI=1.415 95%CI=1.41- 95%CI=1.423 95%CI=1.42- p<0 (1 (8 (p= OR= (OR 95%CI p< (p

Abstract Objectives: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. Methods: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. Results: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. Conclusion: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all. Objectives LGBT 5 nonLGBT+. nonLGBT non LGBT+. non-LGBT+ Methods crosssectional cross sectional questionnaire PCAToolBrasil Brasil 10point point 10 healthcare. . healthcare) models Results 669 1332 (133 536 nonLGBT+ 6 included analysis 5.13 513 13 (5.1 582 82 5.82 0.001, 0001 0.001 , 0 001 0.001) ( points, points points) 31 18 0.001. PR 25 2 2.5 95 2.04‒3.06. 204306 2.04‒3.06 04 3 06 2.04‒3.06) breast colon Conclusion peers all 1 66 133 (13 53 5.1 51 (5. 58 8 5.8 000 0.00 00 2. 9 20430 2.04‒3.0 (1 5. (5 0.0 2043 2.04‒3. 0. 204 2.04‒3 20 2.04‒ 2.04 2.0

Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group. COVID19 COVID 19 COVID-1 infection (202 2021. . 2021) records unit death sex comorbidities up 41. 41 4 1 4:1) ChiSquare Chi Square Fishers Fisher s study 17101 17 101 17,10 hospitalized 13 0.76% 076 0 76 (0.76% 5 IQR (IQR 43.064.0 430640 43.0 64.0 43 64 43.0;64.0 202 46.063.5 460635 46.0 63.5 46 63 46.0;63.5 (PLHIV differences inhospital 27.9% 279 27 9 (27.9 vs 17.7% 177 7 0.049, 0049 0.049 , 049 0.049) 25.0% 250 25 (25.0 25.1% 251 0.999. 0999 0.999 999 0.999) pandemic however group COVID1 COVID- (20 4:1 1710 10 17,1 0.76 07 (0.76 064 43.064. 43064 430 43. 640 64. 6 43.0;64. 20 063 46.063. 46063 460 46. 635 63. 46.0;63. 27.9 2 (27. 17.7 004 0.04 04 25.0 (25. 25.1 099 0.99 99 (2 4: 171 17, 0.7 (0.7 06 43.064 4306 43.0;64 46.063 4606 46.0;63 27. (27 17. 00 0.0 25. (25 09 0.9 ( 0. (0. 43.06 43.0;6 46.06 46.0;6 (0 43.0; 46.0;

ABSTRACT BACKGROUND: Older adults frequently experience nonspecific clinical features. However, there is limited evidence on how often admission diagnoses for hospitalized older patients are incorrect, potentially leading to treatment delays. OBJECTIVES: To determine the consistency between hospital admission and discharge diagnoses, and identify factors associated with diagnostic discrepancies in older adults. DESIGN AND SETTING: Population-based cohort study in the United States. We included adults aged ≥ 18 years who were admitted from emergency departments (EDs) to hospitals, identified using the 2005-2010 National Hospital Ambulatory Medical Survey, a nationally representative survey. METHODS: Three admission diagnoses and the principal discharge diagnosis were captured and classified as discrepant if they involved considerably different conditions within the same organ system, or different organ systems altogether. RESULTS: Each year, 12 million adults were hospitalized following ED visits in the United States; 45% were aged ≥ 65 years. These patients' mean age was 79 years and 58% were women. Diagnostic discrepancies between admission and discharge were more common among adults ≥ 65 years (12.5 versus 8.3%; P < 0.001). Certain admission diagnoses had particularly high rates of diagnostic discrepancies: 26-27% of patients presenting with mental disorders or with endocrine and metabolic diseases had substantial diagnostic discrepancies between admission and discharge. Substantial diagnostic discrepancy was independently associated with longer hospitalization and higher in-hospital mortality. CONCLUSION: One out of eight older adults hospitalized from EDs was discharged with a principal diagnosis differing considerably from the admission diagnosis. Given that missed or delayed diagnoses are a critical safety problem, clinicians should be vigilant and frequently cogitate alternative diagnostic possibilities.

RESUMO Objetivo Investigar as características clínicas e laboratoriais associadas à indicação de cuidados paliativos exclusivos em idosos gravemente enfermos. Métodos Neste estudo retrospectivo de coorte, foram incluídas 572 admissões de pacientes gravemente enfermos com idade igual ou superior a 60 anos, em um hospital universitário, em São Paulo, no período de 2009 a 2013. O desfecho primário foi a indicação clínica de cuidados exclusivamente paliativos. Empregamos avaliações geriátricas amplas padronizadas para mensurar preditores de interesse, incluindo informações sociodemográficas, clínicas, cognitivas, funcionais e laboratoriais. Utilizamos modelos de regressão logística stepwise para identificar preditores independentes de cuidados paliativos. Resultados Foram indicados cuidados exclusivamente paliativos em 152 (27%) casos. No grupo de cuidados paliativos, a mortalidade hospitalar foi de 50%, sendo que a mortalidade acumulada em 12 meses atingiu 66%. Os diagnósticos mais frequentemente apontados como motivadores de cuidados paliativos foram demência avançada (45%), câncer (38%), insuficiência cardíaca congestiva (25%), insuficiência renal estágios 4 e 5 (24%), doença pulmonar obstrutiva crônica (8%) e cirrose (4%). As complicações mais comuns no grupo de cuidados paliativos foram delírio (p<0,001), infecções (p<0,001) e úlceras por pressão (p<0,001). Após análise multivariada, sexo masculino (OR=2,12; IC95%: 1,32-3,40), câncer (OR=7,36; IC95%: 4,26-13,03), demência avançada (OR=12,6; IC95%: 7,5-21,2) e níveis de albumina (OR=0,25; IC95%: 0,17-0,38) foram identificados como preditores independentes da indicação de cuidados exclusivamente paliativos. Conclusão Demência avançada e câncer foram as condições clínicas mais frequentemente associadas à indicação de cuidados paliativos exclusivos em idosos hospitalizados. A elevada mortalidade a curto prazo sugere que o prognóstico deva ser melhor avaliado e discutido com os pacientes e suas famílias no ambiente de Atenção Primária.

ABSTRACT Objective To investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care. Methods A retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in São Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care. Results Exclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95%CI: 1.32-3.40), cancer (OR=7.36; 95%CI: 4.26-13.03), advanced dementia (OR=12.6; 95%CI: 7.5-21.2), and albumin levels (OR=0.25; 95%CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care. Conclusion Advanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.

Resumo A prevalência mundial de demencia entre idosos foi de 3,9% em 2005. Cerca de 90% dos dementados apresentarão sintomas como delirium, alucinações, agressividade e agitação. O tratamento dos sintomas não cognitivos envolve estratégias não farmacológicas - com sucesso variável de acordo com a literatura - e tratamento medicamentoso. A presente revisão de literatura discute o atual papel dos antipsicóticos nos sintomas neurocomportamentais de demência. Métodos: Conduzimos uma revisão temática nas principais bases de dados da literatura. Resultados: 313 artigos sobre o tema foram encontrados e 39 selecionaos para compor uma análise crítica. Até 2005, as melhores evidências para tratamento medicamentoso indicavam o uso de inibidores da acetilcolinesterase memantina e antipsicóticos. Em 2005 o FDA desautorizou o uso de antipsicóticos atípicos em dementados (em 2008 fez o mesmo com os típicos). Após isto, 2 ensaios clínicos randomizados placebo-controlados foram concluídos avaliando a eficácia dos antipsicóticos atípicos em portadores de doença de Alzheimer (CATIE-AD) e os efeitos da interrupção destes (DART-AD). Conclusões: Considerando as evidências atuais, os antipsicóticos ainda têm importância no manejo dos sintomas psicóticos mais sérios, após falha de tratamento não farmacológico e de uma abordagem inicial com inibidores de receptação de serotonina, anticolinesterásicos e memantina.

Abstract The estimated worldwide prevalence of dementia among adults older than 60 years of age was 3.9% in 2005. About 90% of demented patients will develop neuropsychiatric symptoms (NS) such as delirium, delusion, aggressiveness and agitation. The treatment of NS involves non-pharmacologic strategies (with varying degrees of success according to the scientific literature) and pharmacologic treatment (PT). The present review of literature examined the current role of AP in the management of NS in dementia. Methods: A thematic review of medical literature was carried out. Results: 313 articles were found, 39 of which were selected for critical analysis. Until 2005, the best evidence for PT had supported the use of selective serotonin re-uptake inhibitors (SSRIs), anticholinesterases, memantine and antipsychotics (AP). In 2005, the U.S. Food and Drug Administration (FDA) disapproved the use of atypical APs to treat neuropsychiatric symptoms in individuals with dementia (the same occurred with the typical APs in 2008). After this, at least two important randomized placebo-controlled multicenter trials were published examining the effectiveness of atypical APs in Alzheimer's disease (CATIE-AD) and the effects of interrupting AP treatment (DART-AD). Conclusions: Based on the current evidence available, APs still have a place in treatment of the more serious psychotic symptoms, after the failure of non-pharmacological treatment and of an initial approach with selective inhibitors of serotonin uptake, anticholinesterases and memantine.

OBJECTIVES: Population aging raises concerns regarding the increases in the rates of morbidity and mortality that result from influenza and its complications. Although vaccination is the most important tool for preventing influenza, vaccination program among high-risk groups has not reached its predetermined aims in several settings. This study aimed to evaluate the impacts of clinical and demographic factors on vaccine compliance among the elderly in a setting that includes a well-established annual national influenza vaccination campaign. METHODS: This cross-sectional study included 134 elderly patients who were regularly followed in an academic medical institution and who were evaluated for their influenza vaccination uptake within the last five years; in addition, the demographic and clinical characteristics and the reasons for compliance or noncompliance with the vaccination program were investigated. RESULTS: In total, 67.1% of the participants received the seasonal influenza vaccine in 2009. Within this vaccinationcompliant group, the most common reason for vaccine uptake was the annual nationwide campaign (52.2%; 95% CI: 41.4-62.9%); compared to the noncompliant group, a higher percentage of compliant patients had been advised by their physician to take the vaccine (58.9% vs. 34.1%; p,0.01). CONCLUSION: The education of patients and health care professionals along with the implementation of immunization campaigns should be evaluated and considered by health authorities as essential for increasing the success rate of influenza vaccination compliance among the elderly.