ABSTRACT This study describes an outbreak of Streptococcus equi subspecies zooepidemicus infections that caused meningoencephalitis and bacteremia related to unpasteurized milk consumption in northeastern Brazil. Epidemiological investigations and a brief literature review were conducted. Strains with possible neurotropism had not been identified in Brazil before these cases; however, in 2023, another case of meningoencephalitis caused by Streptococcus equi sp. zooepidemicus was described, revealing the need to maintain surveillance and highlighting that these neurotropic strains continue to circulate in the environment. conducted cases however 2023 sp described environment 202 20 2

Objective: To investigate whether having a higher number of depressive symptoms is associated with negative self-rated health (SRH) even in the absence of illness. Methods: This is a secondary analysis of baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, using a national sample of 9,412 people aged 50 or over. SRH was dichotomized into poor or very poor and very good or excellent, good, or average. Depressive symptoms were assessed through the eight-item Center for Epidemiologic Studies Depression Scale (CES-D8). Sociodemographic variables, information about unhealthy behaviors, and the number of chronic conditions were also analyzed. Results: Having depressive symptoms was strongly associated with poor or very poor SRH both in the unadjusted and adjusted analyses. The magnitude of the association was reduced when the number of chronic illnesses was included in the multivariate analysis, along with the other sociodemographic variables and unhealthy behaviors (OR 1.35, 95%CI 1.31-1.39). Conclusion: Having depressive symptoms may contribute towards having a poorer perception of health, even in the absence of health conditions. SRH is a multidimensional construct that can accurately reflect a person’s state of general mental health. Objective selfrated self rated (SRH illness Methods ELSIBrazil, ELSIBrazil ELSI Brazil , (ELSI-Brazil) 20152016, 20152016 2015 2016, 2016 2015-2016 9412 9 412 9,41 5 over excellent average eightitem eight item CESD8. CESD8 CESD CES D8 . D (CES-D8) analyzed Results analyses OR 135 1 35 1.35 95CI CI 95 1.311.39. 131139 1.31 1.39 31 39 1.31-1.39) Conclusion persons person s (ELSI-Brazil 2015201 201 2015-201 941 41 9,4 (CES-D8 13 3 1.3 311 1.311.39 13113 131 139 1.31-1.39 201520 20 2015-20 94 4 9, (CES-D 1. 1.311.3 1311 1.31-1.3 20152 2 2015-2 1.311. 1.31-1. 2015- 1.311 1.31-1 1.31-

Objective: To investigate the association between depressive symptoms and social support among a representative sample of the Brazilian population aged 50 years or older. Methods: Cross-sectional study of 8,074 participants of the second wave of the Brazilian Longitudinal Study on Aging (ELSI-Brasil). Depressive symptoms were screened with the Center for Epidemiologic Studies Depression Scale (CES-D8) instrument, and social support was investigated in its structural and functional dimensions. Sociodemographic variables and health conditions were considered for adjustment in investigating the association between social support and depressive symptoms using the Poisson regression model. Results: The prevalence of depressive symptoms was estimated at 19.1% (95%CI 16.7-21.7). In the analysis adjusted for possible confounding factors, depressive symptoms were independently associated with negative social support in the items “not married” (prevalence ratio [PR] = 1.24; 95%CI 1.07-1.44), “not having someone to trust” (PR = 1.31; 95%CI 1.10-1.56) and “not having someone to borrow money or an object from, in case of need” (PR = 1.46; 95%CI 1.21-1.75). Conclusion: The present findings highlight the importance of social relations in determining the presence of depressive symptoms and reinforce the need to implement public policies aimed at strengthening social networks to minimize this public health problem. Objective 5 older Methods Crosssectional Cross sectional 8074 8 074 8,07 ELSIBrasil. ELSIBrasil ELSI Brasil . (ELSI-Brasil) CESD8 CESD CES D8 D (CES-D8 instrument dimensions model Results 191 19 1 19.1 95CI CI 95 16.721.7. 167217 16.7 21.7 16 7 21 16.7-21.7) factors not married PR [PR 1.24 124 24 1.071.44, 107144 1.07 1.44 , 07 44 1.07-1.44) trust 1.31 131 31 1.101.56 110156 1.10 1.56 10 56 1.10-1.56 from 1.46 146 46 1.211.75. 121175 1.21 1.75 75 1.21-1.75) Conclusion problem 807 8,0 (ELSI-Brasil (CES-D 19. 9 721 16.721.7 16721 167 16. 217 21. 2 16.7-21.7 1.2 12 071 1.071.44 10714 107 1.0 144 1.4 0 4 1.07-1.44 1.3 13 3 101 1.101.5 11015 110 1.1 156 1.5 1.10-1.5 14 211 1.211.75 12117 121 175 1.7 1.21-1.75 80 8, 72 16.721. 1672 16.7-21. 1. 1.071.4 1071 1.07-1.4 1.101. 1101 11 15 1.10-1. 1.211.7 1211 17 1.21-1.7 16.721 16.7-21 1.071. 1.07-1. 1.101 1.10-1 1.211. 1.21-1. 16.72 16.7-2 1.071 1.07-1 1.10- 1.211 1.21-1 16.7- 1.07- 1.21-

ABSTRACT OBJECTIVE To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS This is a cross-sectional study conducted with baseline data from the 2015–2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42–2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21–1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89–4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02–2.57) and 32% (OR = 1.32, 95%CI: 1.10–1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions. racecolor race color (IC domains middleaged middle aged cohort objective regions crosssectional cross sectional 20152016 2015 2016 2015–201 ELSIBrazil. ELSIBrazil ELSI Brazil . (ELSI-Brazil) verbal fluency, fluency , fluency) gait velocity/handgrip, velocityhandgrip velocity/handgrip velocity handgrip velocity/handgrip) Center Depression Moreover selfreported self reported vision andor or impairment criteria 9070 9 070 9,07 5 years. years years) 80 41 controls 180 1 1.80 95%CI 95CI CI 95 142228 42 2 28 1.42–2.28 0001 0 001 0.00 141 1.41 121165 21 65 1.21–1.65 0.001. 291 91 2.91 189447 89 4 47 1.89–4.47 251 51 2.51 209 09 2.0 302 3 02 3.02 62 162 1.62 1.02–2.57 102257 57 32 132 1.32 1.10–1.57 110157 10 South aging 2015201 201 2015–20 (ELSI-Brazil 907 07 9,0 8 18 1.8 14222 1.42–2.2 000 00 0.0 14 1.4 12116 6 1.21–1.6 29 2.9 18944 1.89–4.4 25 2.5 20 2. 30 3.0 16 1.6 1.02–2.5 10225 13 1.3 1.10–1.5 11015 201520 2015–2 90 9, 1. 1422 1.42–2. 0. 1211 1.21–1. 1894 1.89–4. 3. 1.02–2. 1022 1.10–1. 1101 20152 2015– 142 1.42–2 121 1.21–1 189 1.89–4 1.02–2 102 1.10–1 110 1.42– 12 1.21– 1.89– 1.02– 1.10– 11 1.42 1.21 1.89 1.02 1.10 1.2 1.0 1.1

ABSTRACT OBJECTIVE This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction. Additionally (IADL macroregion crosssectional cross sectional ELSIBrazil. ELSIBrazil ELSI . (ELSI-Brazil) populationbased population noninstitutionalized non institutionalized communitydwelling community dwelling 5 7 country stratification addition group gender level North, (North Southeast Midwest, Midwest , Midwest) selfreported self reported health multimorbidity falls 8849 8 849 8,84 94% 94 (94% 28.5% 285 28 (28.5 351 35 1 35.1% respectively. respectively respectively) fluency 4.8% 48 4 (4.8 55 5.5% respectively, 2.3%. 23 2.3% 2 3 (2.3%) 5.8% 58 (5.8% (ELSI-Brazil 884 84 8,8 9 (94 28.5 (28. 35.1 4.8 (4. 5.5 2.3 (2.3% 5.8 (5.8 88 8, (9 28. (28 35. 4. (4 5. 2. (2.3 (5. ( (2 (2. (5

ABSTRACT OBJECTIVE To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS This is a cross-sectional study conducted with baseline data from the 2015–2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42–2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21–1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89–4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02–2.57) and 32% (OR = 1.32, 95%CI: 1.10–1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions.

ABSTRACT OBJECTIVE This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction.

RESUMO: Objetivo: Examinar a prevalência dos sintomas psiquiátricos e seus fatores associados na população adulta de Brumadinho (MG), após o rompimento da barragem. Métodos: Foram incluídos 2.740 participantes com informações coletadas em 2021 sobre os sintomas de estresse pós-traumático (TEPT), depressão, ansiedade, ideias de morte/automutilação e pior qualidade do sono. Estimaram-se as prevalências de todas as condições. Para a comparação das prevalências dos sintomas psiquiátricos e as características sociodemográficas e local de moradia, empregou-se o teste χ2 de Pearson, com correção de Rao-Scott. Regressões logísticas brutas e ajustadas estimaram os odds ratios e intervalos de confiança de 95%, permitindo a avaliação da associação entre os sintomas psiquiátricos e as características dos participantes. Resultados: Os sintomas depressivos foram a condição mais prevalente (29,3%), seguidos pelos sintomas de TEPT (22,9%) e sintomas ansiosos (18,9%). Com relação à investigação da associação entre as características dos participantes na análise ajustada, observou-se que o sexo feminino e os moradores da área de mineração apresentaram relação positiva com os sintomas de TEPT, depressivos, ansiosos, ideia de morte e pior qualidade de sono. Também se encontraram associação positiva entre a escolaridade de nível médio e os sintomas de TEPT e associação negativa entre aqueles com ≥60 anos e os sintomas de TEPT, depressivos e ansiosos. Conclusão: Altas prevalências foram encontradas para todos os sintomas psiquiátricos após a ruptura da barragem em Brumadinho. Sexo feminino, local de moradia na área de mineração, ≥60 anos e escolaridade foram associados aos sintomas psiquiátricos investigados.

ABSTRACT: Objective: To examine the prevalence of psychiatric symptoms and associated factors in the adult population of Brumadinho (MG), after the dam collapse. Methods: We included 2,740 participants with information about symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, thoughts of death/self-harm, and poor sleep quality collected in 2021. Prevalence values of all conditions were estimated to compare the prevalence of psychiatric symptoms with the participants’ sociodemographic characteristics and place of residence. Pearson’s c2 test was used, with Rao Scott’s correction. Crude and adjusted logistic regressions estimated odds ratios and 95% confidence intervals to assess the association between psychiatric symptoms and participants’ characteristics. Results: The most common condition was depressive symptoms (29.3%), followed by post-traumatic stress symptoms (22.9%) and anxious symptoms (18.9%). Regarding the association between participants’ characteristics in the adjusted analysis, being a female and living in a mining area was positively associated with symptoms of PTSD, depression, anxiety, thoughts of death/self-harm, and poor sleep quality. A positive association was also found between high school education and post-traumatic stress symptoms. In contrast a negative association was found between being aged ≥60 years and symptoms of PTSD, depression, and anxiety. Conclusion: High prevalence values were found for all psychiatric symptoms after the dam failure in Brumadinho. Being a female, living in the mining area, being ≥60 years old, and having an educational level were all associated with the psychiatric symptoms investigated.

RESUMO: Objetivo: Examinar a prevalência dos sintomas psiquiátricos e seus fatores associados na população adulta de Brumadinho (MG), após o rompimento da barragem. Métodos: Foram incluídos 2.740 participantes com informações coletadas em 2021 sobre os sintomas de estresse pós-traumático (TEPT), depressão, ansiedade, ideias de morte/automutilação e pior qualidade do sono. Estimaram-se as prevalências de todas as condições. Para a comparação das prevalências dos sintomas psiquiátricos e as características sociodemográficas e local de moradia, empregou-se o teste χ2 de Pearson, com correção de Rao-Scott. Regressões logísticas brutas e ajustadas estimaram os odds ratios e intervalos de confiança de 95%, permitindo a avaliação da associação entre os sintomas psiquiátricos e as características dos participantes. Resultados: Os sintomas depressivos foram a condição mais prevalente (29,3%), seguidos pelos sintomas de TEPT (22,9%) e sintomas ansiosos (18,9%). Com relação à investigação da associação entre as características dos participantes na análise ajustada, observou-se que o sexo feminino e os moradores da área de mineração apresentaram relação positiva com os sintomas de TEPT, depressivos, ansiosos, ideia de morte e pior qualidade de sono. Também se encontraram associação positiva entre a escolaridade de nível médio e os sintomas de TEPT e associação negativa entre aqueles com ≥60 anos e os sintomas de TEPT, depressivos e ansiosos. Conclusão: Altas prevalências foram encontradas para todos os sintomas psiquiátricos após a ruptura da barragem em Brumadinho. Sexo feminino, local de moradia na área de mineração, ≥60 anos e escolaridade foram associados aos sintomas psiquiátricos investigados. RESUMO Objetivo MG, MG , (MG) Métodos 2740 2 740 2.74 202 póstraumático pós traumático (TEPT) depressão ansiedade morteautomutilação automutilação sono Estimaramse Estimaram condições empregouse empregou χ Pearson RaoScott. RaoScott Rao Scott. Scott Rao-Scott 95 95% Resultados 29,3%, 293 29,3% 29 3 (29,3%) 22,9% 229 22 9 (22,9% 18,9%. 189 18,9% . 18 (18,9%) ajustada observouse observou 60 ≥6 Conclusão investigados (MG 274 74 2.7 20 (TEPT 29,3 (29,3% 22,9 (22,9 18,9 1 (18,9% 6 ≥ 27 7 2. 29, (29,3 22, (22, 18, (18,9 (29, (22 (18, (29 (2 (18 ( (1

ABSTRACT: Objective: To examine the prevalence of psychiatric symptoms and associated factors in the adult population of Brumadinho (MG), after the dam collapse. Methods: We included 2,740 participants with information about symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, thoughts of death/self-harm, and poor sleep quality collected in 2021. Prevalence values of all conditions were estimated to compare the prevalence of psychiatric symptoms with the participants’ sociodemographic characteristics and place of residence. Pearson’s c2 test was used, with Rao Scott’s correction. Crude and adjusted logistic regressions estimated odds ratios and 95% confidence intervals to assess the association between psychiatric symptoms and participants’ characteristics. Results: The most common condition was depressive symptoms (29.3%), followed by post-traumatic stress symptoms (22.9%) and anxious symptoms (18.9%). Regarding the association between participants’ characteristics in the adjusted analysis, being a female and living in a mining area was positively associated with symptoms of PTSD, depression, anxiety, thoughts of death/self-harm, and poor sleep quality. A positive association was also found between high school education and post-traumatic stress symptoms. In contrast a negative association was found between being aged ≥60 years and symptoms of PTSD, depression, and anxiety. Conclusion: High prevalence values were found for all psychiatric symptoms after the dam failure in Brumadinho. Being a female, living in the mining area, being ≥60 years old, and having an educational level were all associated with the psychiatric symptoms investigated. ABSTRACT Objective MG, MG , (MG) collapse Methods 2740 2 740 2,74 posttraumatic post traumatic PTSD (PTSD) depression anxiety death/selfharm, deathselfharm death/self harm, death self harm death/self-harm 2021 residence Pearsons Pearson s c used Scotts Scott correction 95 Results 29.3%, 293 29.3% 29 3 (29.3%) 22.9% 229 22 9 (22.9% 18.9%. 189 18.9% . 18 (18.9%) analysis 60 ≥6 Conclusion old investigated (MG 274 74 2,7 (PTSD selfharm death/selfharm deathself 202 29.3 (29.3% 22.9 (22.9 18.9 1 (18.9% 6 ≥ 27 7 2, 20 29. (29.3 22. (22. 18. (18.9 (29. (22 (18. (29 (2 (18 ( (1

Objective: To compare mortality in older adults with and without mild or moderate cognitive impairment over 15 years of follow-up in a middle-income country, where little information on this subject is available. Methods: A total of 1,281 community-dwelling older adults were followed-up for a median of 13.3 years. We evaluated their cognitive impairment using the Mini-Mental State Examination, categorizing it as none (1.0 SD above cutoff means), mild (1.0 SD below cutoff means) or moderate (2.0 SD below cutoff means). The date of death was determined by reviewing death certificates. Cox’s proportional hazards models were used to evaluate the risk of mortality in participants with cognitive impairment. Results: Participants with mild or moderate cognitive impairment had a higher mortality risk than those without it in the unadjusted model, but these associations did not remain in the final model. After sex stratification, only men with moderate cognitive impairment had a higher mortality risk in the final model. Conclusion: The findings suggest an association between moderate cognitive impairment and all-cause mortality in men in a large Brazilian cohort of older adults.

RESUMO: Introdução: Os benzodiazepínicos são os psicofármacos mais utilizados globalmente, apesar dos riscos associados ao seu uso prolongado, especialmente entre os idosos. Objetivo: O estudo teve como objetivo investigar a tendência do uso de benzodiazepínicos entre idosos mais velhos (75 anos ou mais) residentes em comunidade. Métodos: Trata-se de um estudo realizado com idosos com idades entre 75 e 89 anos, integrantes da linha base (em 1997) e sobreviventes (em 2012) da coorte idosa do Projeto Bambuí. A prevalência do uso de benzodiazepínicos foi estimada separadamente para cada ano, e a comparação entre elas foi realizada por meio de regressão de Poisson com variância robusta. Resultados: A prevalência do uso de benzodiazepínicos foi maior em 2012 (33,9%) em comparação a 1997 (24,9%). Após o ajuste múltiplo, a diferença de prevalências não permaneceu significativa na população total de estudo (razão de prevalência (RP) = 1,25; intervalo de confiança de 95% (IC95%) 0,99 - 1,60), diferentemente do observado no estrato feminino (RP = 1,38; IC95% 1,04 - 1,84). O clonazepam foi o medicamento que apresentou o mais forte crescimento (RP = 4,94; IC95% 2,54 - 9,62) entre os dois anos. Conclusão: O presente estudo evidenciou um importante aumento no uso de benzodiazepínicos em uma população idosa mais velha. Esses resultados preocupam, pois são medicamentos contraindicados para idosos, especialmente se utilizados cronicamente, e estão disponíveis na relação nacional de medicamentos essenciais. Os profissionais de saúde devem estar atentos para os riscos envolvidos no seu uso por essa população.

ABSTRACT: Background: Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. Objective: To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. Methods: The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. Results: The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). Conclusion: This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.

RESUMO: Introdução: Os benzodiazepínicos são os psicofármacos mais utilizados globalmente, apesar dos riscos associados ao seu uso prolongado, especialmente entre os idosos. Objetivo: O estudo teve como objetivo investigar a tendência do uso de benzodiazepínicos entre idosos mais velhos (75 anos ou mais) residentes em comunidade. Métodos: Trata-se de um estudo realizado com idosos com idades entre 75 e 89 anos, integrantes da linha base (em 1997) e sobreviventes (em 2012) da coorte idosa do Projeto Bambuí. A prevalência do uso de benzodiazepínicos foi estimada separadamente para cada ano, e a comparação entre elas foi realizada por meio de regressão de Poisson com variância robusta. Resultados: A prevalência do uso de benzodiazepínicos foi maior em 2012 (33,9%) em comparação a 1997 (24,9%). Após o ajuste múltiplo, a diferença de prevalências não permaneceu significativa na população total de estudo (razão de prevalência (RP) = 1,25; intervalo de confiança de 95% (IC95%) 0,99 - 1,60), diferentemente do observado no estrato feminino (RP = 1,38; IC95% 1,04 - 1,84). O clonazepam foi o medicamento que apresentou o mais forte crescimento (RP = 4,94; IC95% 2,54 - 9,62) entre os dois anos. Conclusão: O presente estudo evidenciou um importante aumento no uso de benzodiazepínicos em uma população idosa mais velha. Esses resultados preocupam, pois são medicamentos contraindicados para idosos, especialmente se utilizados cronicamente, e estão disponíveis na relação nacional de medicamentos essenciais. Os profissionais de saúde devem estar atentos para os riscos envolvidos no seu uso por essa população.

ABSTRACT: Background: Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults. Objective: To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years. Methods: The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance. Results: The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62). Conclusion: This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.

RESUMO OBJETIVO: Investigar se o uso de psicofármacos seria um preditor da incidência de incapacidade funcional entre idosos residentes em comunidade. MÉTODOS: Trata-se de um estudo longitudinal de base populacional, desenvolvido entre primeiro de janeiro de 1997 e 31 de dezembro de 2011, junto a idosos residentes em comunidade. A associação entre o uso de psicofármacos e o desenvolvimento de incapacidade funcional para atividades instrumentais (AIVD) e básicas (ABVD) de vida diária foi testada por meio do modelo de riscos proporcionais de Cox estendido, que considera a medida da exposição de interesse ao longo de todo o tempo de seguimento. As análises foram estratificadas por sexo e ajustadas por características sociodemográficas, comportamento em saúde e condições de saúde. RESULTADOS: Após ajuste multivariado, no estrato feminino o uso de dois ou mais psicofármacos foi associado à incapacidade tanto para AIVD (HR = 1,58; IC95% 1,17–2,13) quanto para ABVD (HR = 1,43; IC95% 1,05–1,94), o uso de benzodiazepínicos se manteve associado à incapacidade para AIVD (HR = 1,32; IC95% 1,07–1,62) e o uso de antidepressivos se manteve associado à incapacidade, tanto para AIVD (HR = 1,51; IC95% 1,16–1,98) quanto para ABVD (HR = 1,44; IC95% 1,10–1,90). No estrato masculino, o uso de antipsicóticos foi associado à incapacidade para AIVD (HR = 3,14; IC95% 1,49–6,59). CONCLUSÕES: O estudo evidenciou uma associação prospectiva entre o uso de psicofármacos e a incapacidade funcional. Esses resultados indicam a necessidade de avaliar cuidadosamente a prescrição de psicofármacos para idosos e monitorar o seu uso, buscando detectar prejuízos à saúde dos seus usuários.

ABSTRACT OBJECTIVE: Investigate whether the use of psychoactive drugs would be a predictor of incidence of functional disability among seniors living in community. METHODS: It is a population-based longitudinal study, developed between January 1, 1997 and December 31, 2011, with older adults living in community. The association between the use of psychoactive drugs and the development of functional disability for instrumental (IADLs) and basic (BADLs) activities of daily living was tested using the extended Cox proportional hazards model, which considers the measure of exposure of interest throughout the follow-up period. The analyses were stratified by sex and adjusted by sociodemographic characteristics, health behavior and health conditions. RESULTS: After multivariate adjustment, the use of two or more psychoactive drugs in the female stratum was associated with disability for both IADLs (HR = 1.58; 95%CI 1.17–2.13) and BADLs (HR = 1.43; 95%CI 1.05–1.94), the use of benzodiazepines was associated with disability for IADLs (HR = 1.32; 95%CI 1.07–1.62), and the use of antidepressants was associated with disability for both IADLs (HR = 1.51; 95%CI 1.16–1.98) and BADLs (HR = 1.44; 95%CI 1.10–1.90). In the male stratum, the use of antipsychotics was associated with disability for IADLs (HR = 3.14; 95%CI 1.49–6.59). CONCLUSIONS: The study showed a prospective association between the use of psychoactive drugs and functional disability. These results indicate the need to carefully assess the prescription of psychoactive drugs for older adults and monitor their usage in order to detect damages to the health of users.

RESUMO OBJETIVO: Investigar se o uso de psicofármacos seria um preditor da incidência de incapacidade funcional entre idosos residentes em comunidade. MÉTODOS: Trata-se de um estudo longitudinal de base populacional, desenvolvido entre primeiro de janeiro de 1997 e 31 de dezembro de 2011, junto a idosos residentes em comunidade. A associação entre o uso de psicofármacos e o desenvolvimento de incapacidade funcional para atividades instrumentais (AIVD) e básicas (ABVD) de vida diária foi testada por meio do modelo de riscos proporcionais de Cox estendido, que considera a medida da exposição de interesse ao longo de todo o tempo de seguimento. As análises foram estratificadas por sexo e ajustadas por características sociodemográficas, comportamento em saúde e condições de saúde. RESULTADOS: Após ajuste multivariado, no estrato feminino o uso de dois ou mais psicofármacos foi associado à incapacidade tanto para AIVD (HR = 1,58; IC95% 1,17–2,13) quanto para ABVD (HR = 1,43; IC95% 1,05–1,94), o uso de benzodiazepínicos se manteve associado à incapacidade para AIVD (HR = 1,32; IC95% 1,07–1,62) e o uso de antidepressivos se manteve associado à incapacidade, tanto para AIVD (HR = 1,51; IC95% 1,16–1,98) quanto para ABVD (HR = 1,44; IC95% 1,10–1,90). No estrato masculino, o uso de antipsicóticos foi associado à incapacidade para AIVD (HR = 3,14; IC95% 1,49–6,59). CONCLUSÕES: O estudo evidenciou uma associação prospectiva entre o uso de psicofármacos e a incapacidade funcional. Esses resultados indicam a necessidade de avaliar cuidadosamente a prescrição de psicofármacos para idosos e monitorar o seu uso, buscando detectar prejuízos à saúde dos seus usuários.

ABSTRACT OBJECTIVE: Investigate whether the use of psychoactive drugs would be a predictor of incidence of functional disability among seniors living in community. METHODS: It is a population-based longitudinal study, developed between January 1, 1997 and December 31, 2011, with older adults living in community. The association between the use of psychoactive drugs and the development of functional disability for instrumental (IADLs) and basic (BADLs) activities of daily living was tested using the extended Cox proportional hazards model, which considers the measure of exposure of interest throughout the follow-up period. The analyses were stratified by sex and adjusted by sociodemographic characteristics, health behavior and health conditions. RESULTS: After multivariate adjustment, the use of two or more psychoactive drugs in the female stratum was associated with disability for both IADLs (HR = 1.58; 95%CI 1.17–2.13) and BADLs (HR = 1.43; 95%CI 1.05–1.94), the use of benzodiazepines was associated with disability for IADLs (HR = 1.32; 95%CI 1.07–1.62), and the use of antidepressants was associated with disability for both IADLs (HR = 1.51; 95%CI 1.16–1.98) and BADLs (HR = 1.44; 95%CI 1.10–1.90). In the male stratum, the use of antipsychotics was associated with disability for IADLs (HR = 3.14; 95%CI 1.49–6.59). CONCLUSIONS: The study showed a prospective association between the use of psychoactive drugs and functional disability. These results indicate the need to carefully assess the prescription of psychoactive drugs for older adults and monitor their usage in order to detect damages to the health of users.

Resumo O propósito do estudo foi investigar se a religiosidade e o suporte social estariam associados ao uso de antidepressivos entre idosos residentes em comunidade. A investigação envolveu 1.606 integrantes da coorte idosa do Projeto Bambuí, um estudo longitudinal sobre envelhecimento e saúde. A variável dependente foi o uso de antidepressivos nos últimos 90 dias, e as exposições de interesse foram suporte social e religiosidade. As hipóteses de associação foram testadas por meio de regressão logística multivariada, que incluiu características sociodemográficas, condições de saúde e uso de serviços de saúde como potenciais fatores de confusão. As chances de utilização de antidepressivos foram significativamente menores entre os idosos com nível mais elevado de religiosidade (OR = 0,45; IC95%: 0,29-0,7), mas nenhum dos descritores de suporte social mostrou-se associado ao evento. É possível que, nessa população, a religiosidade ocupe um lugar de destaque no arsenal de estratégias de enfrentamento de problemas de saúde, especialmente os mentais. Profissionais de saúde que atendem este segmento específico da população (idosos com transtornos depressivos) devem considerar a religiosidade dos pacientes quando das orientações e tratamento propostos no enfrentamento do seu sofrimento mental.

Abstract The purpose of the study was to investigate whether religiousness and social support were associated with the use of antidepressants among community-dwelling elders. The research involved 1,606 older adults who make up the cohort of Bambuí Project, a study on ageing and health. The dependent variable was the use of antidepressants in the last 90 days, and the exposures of interest were social support and religiousness. Logistic regression was used to test the associations and to estimate crude and adjusted Odds Ratio and their 95% confidence intervals. The chances of use of antidepressants were significantly lower among older people with higher level of religiosity (OR = 0.45; 95% CI: 0.29 to 0.70), but none of the descriptors social support was associated with the event. In this population, it is possible that religion occupies a prominent role in the arsenal of health problems coping strategies, especially mental. Health professionals attending this particular segment of the population (elderly people with depressive disorders) should consider religiousness of patients when the proposed guidelines and treatment in coping with their mental suffering.