ABSTRACT BACKGROUND: Studies have shown an association between the clinical severity of coronavirus disease (COVID-19) and sociodemographic and clinical variables in older adults. However, few studies have described the explanatory factors of the relationship between these variables and the clinical severity of COVID-19 using structural equation modeling. OBJECTIVE: To analyze the factors directly and indirectly associated with the clinical severity of coronavirus disease (COVID-19) among older adults in Minas Gerais, Brazil. DESIGN AND SETTING: Retrospective epidemiological study. METHODS: This study included 51,141 elderly adults with COVID-19 living in Minas Gerais, Brazil. Data were collected through the Individual Registration Form – Hospitalized Cases of Severe Acute Respiratory Syndrome from January 28, 2020, to January 27, 2022. RESULTS: Older age (P < 0.001), male sex (P < 0.001), dyspnea (P < 0.001), change in chest X-ray examination findings (P < 0.001), greater number of risk factors/comorbidities (P < 0.001), and longer hospitalization time (P < 0.001) were directly associated with the clinical severity of COVID-19. Female sex, mediated by the greater number of risk/comorbidity factors (β = -0.02, P < 0.001), and younger age, mediated by longer hospitalization time (β = -0.01; P < 0.001), were indirectly associated with the clinical severity of COVID-19. CONCLUSION: Demographic and clinical variables were directly associated with increased disease severity. In addition to the direct effect, a greater number of risk/comorbidity factors and longer hospitalization time mediated the association between demographic variables and outcomes. BACKGROUND COVID19 COVID 19 (COVID-19 However COVID-1 modeling OBJECTIVE Gerais Brazil SETTING METHODS 51141 51 141 51,14 28 2020 27 2022 RESULTS 0.001, 0001 0.001 , 0 001 Xray X ray factorscomorbidities comorbidities COVID19. 19. riskcomorbidity comorbidity β 0.02, 002 02 -0.02 0.01 01 -0.01 CONCLUSION effect outcomes COVID1 1 (COVID-1 COVID- 5114 5 14 51,1 2 202 000 0.00 00 0.02 -0.0 0.0 (COVID- 511 51, 20 -0. 0. (COVID -0 -

Resumo Objetivo Analisar a capacidade intrínseca e sua capacidade preditiva sobre a mortalidade por todas as causas em pessoas idosas residentes em uma microrregião de saúde de Minas Gerais, Brasil. Método Estudo tipo inquérito domiciliar, de abordagem quantitativa. Os dados foram coletados no domicílio com instrumentos validados no país. Resultados A média do escore de capacidade intrínseca foi de 5,8 (±1,63) pontos. No período de acompanhamento, com média de tempo de seguimento de 58,0 (±13,1) meses, ocorreram 142 óbitos (16,4%). Observou-se que para cada acréscimo no escore de capacidade intrínseca, ocorreu diminuição do risco de mortalidade em 21% (p<0,001). Conclusão A capacidade intrínseca exerceu papel preditivo sobre a mortalidade das pessoas idosas. Gerais Brasil domiciliar quantitativa país 58 5 8 5, ±1,63 163 1 63 (±1,63 pontos acompanhamento 580 0 58, ±13,1 131 13 (±13,1 meses 14 16,4%. 164 16,4% . 16 4 (16,4%) Observouse Observou se 21 p<0,001. p0001 p p<0,001 001 (p<0,001) ±1,6 6 (±1,6 ±13, (±13, 16,4 (16,4% 2 p000 p<0,00 00 (p<0,001 ±1, (±1, ±13 (±13 16, (16,4 p00 p<0,0 (p<0,00 ±1 (±1 (16, p0 p<0, (p<0,0 ± (± (16 p<0 (p<0, ( (1 p< (p<0 (p< (p

Abstract Objective To analyze intrinsic capacity and its ability to predict all-cause mortality in older adults living in a health microregion of Minas Gerais state, Brazil. Method A household survey study with a quantitative approach was conducted. Data were collected at homes using instruments validated for use in Brazil. Results Mean intrinsic capacity score was 5.8 (±1.63) points. During the follow-up period, with a mean follow-up time of 58.0 (±13.1) months, 142 deaths (16.4%) occurred. For each 1 point increase in intrinsic capacity score, there was a 21% reduction in the risk of mortality (p<0.001). Conclusion Intrinsic capacity served as a predictor of mortality in older adults. allcause all cause state Brazil conducted 58 5 8 5. ±1.63 163 63 (±1.63 points followup follow up period 580 0 58. ±13.1 131 13 (±13.1 months 14 16.4% 164 16 4 (16.4% occurred 21 p<0.001. p0001 p p<0.001 . 001 (p<0.001) ±1.6 6 (±1.6 ±13. (±13. 16.4 (16.4 2 p000 p<0.00 00 (p<0.001 ±1. (±1. ±13 (±13 16. (16. p00 p<0.0 (p<0.00 ±1 (±1 (16 p0 p<0. (p<0.0 ± (± (1 p<0 (p<0. ( p< (p<0 (p< (p

Resumo Objetivo caracterizar as internações por covid-19, no período de março de 2020 a março de 2022, entre pessoas idosas residentes em Minas Gerais, Brasil, segundo distribuição geográfica, dados sociodemográficos, clínicos e epidemiológicos e de atendimento. Método estudo quantitativo e descritivo realizado com dados sociodemográficos, clínicos, epidemiológicos e de atendimento, do Banco de Dados de Síndrome Respiratória Aguda Grave - incluindo dados da covid-19. Foram consideradas 102.029 internações por covid-19 em pessoas idosas Resultados em 196 dos 853 municípios de Minas Gerais, a incidência foi elevada (3.098 a 8.916 casos por 100.000 habitantes). Houve predomínio de internações em pessoas idosas do sexo masculino (50,7%), entre 60├70 anos (39,0%), pardas (41,6%), com 1ª a 5ª série (17,6%) e que apresentavam fatores de risco/comorbidade (54,0%), dispneia e saturação de oxigênio <95% (72,8%, cada). Referente aos dados de atendimento, uma parcela necessitou de internação em UTI (34,0%), suporte ventilatório não invasivo (54,1%) e apresentou Raio-X com infiltrado intersticial (20,4%). Embora a cura tenha sido o desfecho mais frequente (55,6%), destaca-se que 41,8% das pessoas idosas foram a óbito. Conclusão o estudo mostrou que existem áreas de Minas Gerais com maior número de casos, que precisam ser monitoradas, fornecendo ênfase na atenção aos subgrupos de pessoas idosas do sexo masculino, mais jovens, pardas, com menor escolaridade e fatores de risco/comorbidades, além daqueles com sinais e sintomas indicativos de gravidade clínica. covid19, covid19 covid 19, 19 202 2022 Brasil geográfica sociodemográficos atendimento covid19. 19. 102029 102 029 102.02 covid-1 85 3.098 3098 3 098 (3.09 8916 8 916 8.91 100000 100 000 100.00 habitantes. habitantes . habitantes) 50,7%, 507 50,7% , 50 7 (50,7%) 6070 60 70 60├7 39,0%, 390 39,0% 39 0 (39,0%) 41,6%, 416 41,6% 41 6 (41,6%) ª 17,6% 176 17 (17,6% riscocomorbidade risco comorbidade 54,0%, 540 54,0% 54 (54,0%) 95 <95 72,8%, 728 72 (72,8% cada. cada cada) 34,0%, 340 34,0% 34 (34,0%) 54,1% 541 1 (54,1% RaioX Raio X 20,4%. 204 20,4% 20 4 (20,4%) 55,6%, 556 55,6% 55 (55,6%) destacase destaca se 418 41,8 óbito monitoradas jovens riscocomorbidades comorbidades risco/comorbidades clínica covid1 10202 10 02 102.0 covid- 3.09 309 09 (3.0 891 91 8.9 10000 00 100.0 50,7 5 (50,7% 607 60├ 39,0 (39,0% 41,6 (41,6% 17,6 (17,6 54,0 (54,0% 9 <9 72,8% (72,8 34,0 (34,0% 54,1 (54,1 20,4 2 (20,4% 55,6 (55,6% 41, 1020 102. 3.0 30 (3. 89 8. 1000 100. 50, (50,7 39, (39,0 (41,6 17, (17, 54, (54,0 < 72,8 (72, 34, (34,0 (54, 20, (20,4 55, (55,6 3. (3 (50, (39, (41, (17 72, (72 (34, (54 (20, (55, ( (50 (39 (41 (1 (7 (34 (5 (20 (55 (4 (2

Abstract Objective To characterize hospitalizations for covid-19 among aged individuals residing in Minas Gerais, Brazil, from March 2020 to March 2022, with a focus on geographical distribution, sociodemographic, clinical, epidemiological, and care data. Method This quantitative and descriptive study used sociodemographic, clinical, epidemiological, and care data from the Severe Acute Respiratory Syndrome Database, including covid-19-related data. A total of 102,029 hospitalizations of aged individuals for covid-19 were analyzed for descriptive purposes and mapping the incidence by municipality and macro-region. Results High incidence was observed in 196 of the 853 municipalities in Minas Gerais, ranging from 3,098 to 8,916 cases per 100,000 inhabitants. Hospitalizations were predominantly male (50.7%), aged 60-70 years (39.0%), of mixed race (41.6%), with 1st to 5th grade education (17.6%), and presenting risk factors or comorbidities (54.0%). Common symptoms included dyspnea and oxygen saturation below 95% (72.8% each). Regarding care data, a portion of patients required intensive care unit admission (34.0%), non-invasive ventilatory support (54.1%), and presented interstitial infiltrates in chest X-rays (20.4%). Although most cases resulted in recovery (55.6%), it is noteworthy that 41.8% of hospitalized aged individuals died. Conclusion This study highlights the existence of areas in Minas Gerais with a higher incidence of covid-19 cases that require ongoing monitoring, with a focus on the care of subgroups of aged individuals who are male, younger, of mixed race, have lower educational attainment, and have risk factors or comorbidities. Additionally, special attention is needed for aged individuals with signs and symptoms indicative of clinical severity. covid19 covid 19 covid-1 Brazil 202 2022 distribution sociodemographic epidemiological Database covid19related covidrelated related 102029 102 029 102,02 macroregion. macroregion macro region. region macro-region 85 3098 3 098 3,09 8916 8 916 8,91 100000 100 000 100,00 inhabitants 50.7%, 507 50.7% , 50 7 (50.7%) 6070 60 70 60-7 39.0%, 390 39.0% 39 0 (39.0%) 41.6%, 416 41.6% 41 6 (41.6%) st th 17.6%, 176 17.6% 17 (17.6%) 54.0%. 540 54.0% . 54 (54.0%) 95 72.8% 728 72 (72.8 each. each each) 34.0%, 340 34.0% 34 (34.0%) noninvasive non invasive 54.1%, 541 54.1% 1 (54.1%) Xrays X rays 20.4%. 204 20.4% 20 4 (20.4%) 55.6%, 556 55.6% 55 (55.6%) 418 41.8 died monitoring younger attainment Additionally severity covid1 covid- 10202 10 02 102,0 309 09 3,0 891 91 8,9 10000 00 100,0 50.7 5 (50.7% 607 60- 39.0 (39.0% 41.6 (41.6% 17.6 (17.6% 54.0 (54.0% 9 72.8 (72. 34.0 (34.0% 54.1 (54.1% 20.4 2 (20.4% 55.6 (55.6% 41. 1020 102, 30 3, 89 8, 1000 100, 50. (50.7 39. (39.0 (41.6 17. (17.6 54. (54.0 72. (72 34. (34.0 (54.1 20. (20.4 55. (55.6 (50. (39. (41. (17. (54. (7 (34. (20. (55. (50 (39 (41 (17 (54 ( (34 (20 (55 (5 (3 (4 (1 (2

RESUMO Objetivos: analisar os fatores associados, direta e indiretamente, ao menor apoio social de idosos, segundo o sexo. Métodos: estudo transversal, com 941 idosos de uma microrregião de saúde de Minas Gerais. Realizaram-se análises descritiva e de trajetórias (p<0,05). Resultados: observaram-se, nos grupos de mulheres e homens, associações diretas e significativas entre menor rede social (p<0,001;p<0,001), moradia unipessoal (p=0,046;p<0,001), maior número de sintomas depressivos (p<0,001;p=0,010) e menor participação nas atividades avançadas (p<0,001;p=0,005) com menor apoio social, respectivamente. Nas mulheres, a menor idade se associou direta e significativamente ao desfecho (p<0,001). Nos homens, a maior idade, mediada pela menor participação nas atividades avançadas, associou-se indiretamente ao desfecho. Conclusões: os homens e mulheres apresentaram menor apoio social associado à rede social, arranjo de moradia, sintomatologia depressiva e participação nas atividades avançadas. A compreensão do contexto do apoio social entre idosos possibilita o estabelecimento de medidas mais eficazes na melhoria do cuidado.

ABSTRACT Objectives: to analyze factors associated, directly and indirectly, with lower social support of older adults, according to sex. Methods: a cross-sectional study, with 941 older adults from a health micro-region in Minas Gerais. Descriptive and trajectory analyzes were carried out (p<0.05). Results: in groups of women and men, direct and significant associations were observed between a smaller social network (p<0.001;p<0.001), single-person housing (p=0.046;p<0.001), greater number of depressive symptoms (p<0.001;p=0.010) and lower participation in advanced activities (p<0.001;p=0.005) with lower social support. In women, younger age was directly and significantly associated with outcome (p<0.001). In men, older age, mediated by lower participation in advanced activities, was indirectly associated with outcome. Conclusions: men and women showed less social support associated with social network, housing arrangement, depressive symptoms and participation in advanced activities. Understanding the context of social support among older adults makes it possible to establish more effective measures to improve care.

RESUMEN Objetivos: analizar los factores asociados, directa e indirectamente, al menor apoyo social de los ancianos, según sexo. Métodos: estudio transversal con 941 ancianos de una microrregión de salud de Minas Gerais. Se realizaron análisis descriptivos y de trayectoria (p<0,05). Resultados: en los grupos de mujeres y hombres se observaron asociaciones directas y significativas entre menor red social (p<0,001;p<0,001), vivienda unipersonal (p=0,046;p<0,001), mayor número de síntomas depresivos (p<0,001;p=0,010) y menor participación en actividades avanzadas (p<0,001;p=0,005) con menor apoyo social, respectivamente. En las mujeres, la menor edad se asoció directa y significativamente con el resultado (p<0,001). En los hombres, la mayor edad, mediada por una menor participación en actividades avanzadas, se asoció indirectamente con el resultado. Conclusiones: hombres y mujeres mostraron menor apoyo social asociado a la red social, arreglo de vivienda, síntomas depresivos y participación en actividades avanzadas. Comprender el contexto de apoyo social entre los ancianos permite establecer medidas más eficaces para mejorar la atención.

Resumo Objetivo identificar as evidências científicas disponíveis na literatura sobre os fatores associados à incapacidade funcional de idosos com catarata. Métodos revisão integrativa da literatura realizada nas bases de dados PubMed, Web of Science, LILACS e CINAHL. Incluíram-se os artigos originais que responderam à questão norteadora: quais as evidências científicas sobre os fatores associados à incapacidade funcional de idosos com catarata? Resultados foram incluídos seis artigos, a maioria foi publicada a partir do ano 2000 (n=4) e realizada na América (n=3). Predominaram os estudos do tipo longitudinal (n=3) com nível de evidência IV, e transversal (n=3) com nível de evidência VI, e que realizaram análise de caminhos (n=3). Com base nos achados, emergiram três categorias temáticas: características demográficas; relacionadas à saúde ocular, física e mental, e comportamentais. Conclusão a incapacidade funcional de idosos com catarata pode ser resultante de características demográficas, relacionadas à saúde ocular, física e mental, e comportamentais.

Abstract Objective to identify the scientific evidence available in the literature on factors associated with functional disability in older people with cataract. Methods integrative literature review carried out in PubMed, Web of Science, LILACS and CINAHL databases. Original articles that answered the guiding question were included: what is the scientific evidence on the factors associated with the functional disability of older people with cataract? Results six articles were included, most were published from the year 2000 (n=4) and carried out in America (n=3). Longitudinal (n=3) with level of evidence IV, and cross-sectional (n=3) with level of evidence VI predominated, and that performed path analysis (n=3). Based on the findings, three thematic categories emerged: demographic characteristics; related to eye, physical and mental health, and behavioral. Conclusion the functional disability of older people with cataract may be the result of demographic, related to eye, physical and mental health, and behavioral characteristics.

RESUMO Paciente do sexo feminino, portadora de glaucoma juvenil sem controle clínico adequado, foi submetida à trabeculectomia com mitomicina C, após a qual, desenvolveu hipotensão ocular refratária às medidas conservadoras, evoluindo com um quadro de maculopatia hipotônica. Foi realizado um implante de enxerto de retalho escleral de doador sobre a fístula, com resolução do quadro e ganho de acuidade visual. A enxertia de retalho escleral de doador mostrou-se uma terapia adequada para correção da hipotensão ocular por bolha hiperfiltrante pós trabeculectomia. O cirurgião deve considerar o emprego dessa técnica ao programar a revisão destes casos.

ABSTRACT A female patient with juvenile glaucoma without clinical control underwent a trabeculectomy with mitomycin C, and developed eye hypotension which did not respond to conservative treatment, with subsequent hypotonic maculopathy. The patient was treated using a scleral patch provided by a donor above the fistula, which improved intraocular pressure and visual acuity. The use of the scleral patch above the fistula seems an adequate therapy to treat ocular hypotension due to the over-filtering trabeculectomy bubble. The surgeon should consider this technique when planning surgical solutions for such cases.