MARCOS DANIEL CABRAL SARAIVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Targeted Geriatric Assessment for Fast-Paced Healthcare Settings: Development, Validity, and Reliability(2018) ALIBERTI, Marlon J. R.; APOLINARIO, Daniel; SUEMOTO, Claudia K.; MELO, Juliana A.; FORTES-FILHO, Sileno Q.; SARAIVA, Marcos D.; TRINDADE, Carolina B.; COVINSKY, Kenneth E.; JACOB-FILHO, WilsonObjectivesTo develop and examine the validity and reliability of a targeted geriatric assessment (TaGA) for busy healthcare settings. DesignThe TaGA was developed through the consensus of experts (Delphi technique), and we investigated its construct validity and reliability in a cross-sectional study. SettingGeriatric day hospital specializing in acute care in Brazil. ParticipantsOlder adults (N = 534) aged 79.5 8.4, 63% female, consecutively admitted to the geriatric day hospital. MeasurementsThe Frailty Index (FI), Physical Frailty Phenotype, and Identification of Seniors at Risk (ISAR) were used to explore the TaGA's validity. External scales were used to investigate the validity of each matched TaGA domain. The interrater reliability and time to complete the instrument were tested in a 53-person subsample. ResultsIn 3 rounds of opinion, experts achieved consensus that the TaGA should include 10 domains (social support, recent hospital admissions, falls, number of medications, basic activities of daily living, cognitive performance, self-rated health, depressive symptoms, nutritional status, gait speed). They arrived at sufficient agreement on specific tools to assess each domain. A single numerical score from 0 to 1 expressed the cumulative deficits across the 10 domains. The TaGA score was highly correlated with the FI (Spearman coefficient = 0.79, 95% confidence interval (CI)=0.76-0.82) and discriminated between frail and nonfrail individuals better than the ISAR (area under the receiver operating characteristic curve 0.84 vs 0.72; P < .001). The TaGA score also had excellent interrater reliability (intraclass correlation coefficient = 0.92, 95% CI=0.87-0.95). Mean TaGA administration time was 9.5 +/- 2.2 minutes. ConclusionThe study presents evidence supporting the TaGA's validity and reliability. This instrument may be a practical and efficient approach to screening geriatric syndromes in fast-paced healthcare settings. Future research should investigate its predictive value and effect on care.
- Nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in a Brazilian elderly cohort(2019) ZANELLA, Rosemeire Cobo; BRANDILEONE, Maria Cristina de Cunto; ALMEIDA, Samanta Cristine Grassi; LEMOS, Ana Paula Silva de; SACCHI, Claudio Tavares; GONCALVES, Claudia R.; GONCALVES, Maria Gisele; FUKASAWA, Lucila Okuyama; SARAIVA, Marcos Daniel; RANGEL, Luis Fernando; CUNHA, Julia Lusis Lassance; ROTTA, Thereza Cristina Ariza; DOURADINHO, Christian; JACOB-FILHO, Wilson; MINAMISAVA, Ruth; ANDRADE, Ana LuciaWe aimed to investigate the nasopharyngeal colonization (NPC) by Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in the elderly population and to assess the demographic factors associated with NPC. This was an observational cohort study in which outpatients aged >= 60 years were enrolled from April to August 2017, with a follow-up visit from September through December 2017. Nasopharyngeal (NP) swabs were collected, bacteria were detected and isolated, and isolates were subjected to phenotypic and molecular characterization using standard microbiological techniques. At enrolment, the rates of S. aureus, methicillin-resistant S. aureus (MRSA), H. influenzae, and S. pneumoniae among 776 elderly outpatients were 15.9%, 2.3%, 2.5%, and 2.2%, respectively. Toxin production was detected in 21.1% of methicillin-susceptible S. aureus, and three SCCmec types were identified: II/IIb, IVa, and VI. At the follow-up visit, all carriage rates were similar (p > 0.05) to the rates at enrolment. Most of S. pneumoniae serotypes were not included in pneumococcal conjugate vaccines (PCVs), except for 7F, 3, and 19A. All strains of H. influenzae were non-typeable. Previous use of antibiotics and 23-valent pneumococcal polysaccharide vaccination (p < 0.05) were risk factors for S. aureus and MRSA carriage; S. aureus colonization was also associated with chronic kidney disease (p = 0.021). S. pneumoniae carriage was associated with male gender (p = 0.032) and an absence of diabetes (p = 0.034), while not receiving an influenza vaccine (p = 0.049) and chronic obstructive pulmonary disease (p = 0.031) were risk factors for H. influenzae colonization. The frailty of study participants was not associated with colonization status. We found a higher S. aureus carriage rate compared with the S. pneumoniae- and H. influenzae-carriage rates in a well attended population in a geriatric outpatient clinic. This is one of the few studies conducted in Brazil that can support future colonization studies among elderly individuals.
- The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults During the COVID-19 Pandemic(2021) SARAIVA, M. D.; APOLINARIO, D.; AVELINO-SILVA, T. J.; TAVARES, C. De Assis Moura; GATTAS-VERNAGLIA, I. F.; FERNANDES, C. Marques; RABELO, L. M.; YAMAGUTI, S. Tavares Fernandes; KARNAKIS, T.; KALIL-FILHO, R.; JACOB-FILHO, W.; ALIBERTI, Marlon Juliano RomeroBackground The COVID-19 pandemic has led to abrupt restrictions of lile-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. Objective To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. Design Multicenter prospective cohort study based on structured telephone interviews. Setting Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. Participants 557 community-dwelling adults aged 60 years and older. Measurements The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of >= 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question << How is the COVID-19 pandemic affecting your QoL?>>, to which participants could respond << not at all >>, << to some extent >>, or << to a great extent >>. We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. Results Participants were on average 80 +/- 8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). Conclusion Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.
- Impact of the COVID-19 pandemic on the life-space mobility of older adults with cancer(2021) GATTAS-VERNAGLIA, Isabella Figaro; RAMOS, Paola Teruya; PERINI, Maria Laura Lazaretti; HIGA, Camila Suemi; APOLINARIO, Daniel; ALIBERTI, Marlon Juliano Romero; KANAJI, Ana Lumi; ADRIAZOLA, Izabela Ono; SARAIVA, Marcos Daniel; AVELINO-SILVA, Thiago Junqueira; TAVARES, Caio de Assis Moura; JACOB-FILHO, Wilson; KARNAKIS, Theodora
- COVID-19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients(2021) ALIBERTI, Marlon Juliano Romero; SZLEJF, Claudia; AVELINO-SILVA, Vivian I.; SUEMOTO, Claudia Kimie; APOLINARIO, Daniel; DIAS, Murilo Bacchini; GARCEZ, Flavia Barreto; TRINDADE, Carolina B.; AMARAL, Jose Renato das Gracas; MELO, Leonardo Rabelo de; AGUIAR, Renata Cunha de; COELHO, Paulo Henrique Lazzaris; HOJAIJ, Naira Hossepian Salles de Lima; SARAIVA, Marcos Daniel; SILVA, Natalia Oliveira Trajano da; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.Background Frailty screening using the Clinical Frailty Scale (CFS) has been proposed to guide resource allocation in acute care settings during the pandemic. However, the association between frailty and coronavirus disease 2019 (COVID-19) prognosis remains unclear. Objectives To investigate the association between frailty and mortality over 6 months in middle-aged and older patients hospitalized with COVID-19 and the association between acute morbidity severity and mortality across frailty strata. Design Observational cohort study. Setting Large academic medical center in Brazil. Participants A total of 1830 patients aged >= 50 years hospitalized with COVID-19 (March-July 2020). Measurements We screened baseline frailty using the CFS (1-9) and classified patients as fit to managing well (1-3), vulnerable (4), mildly (5), moderately (6), or severely frail to terminally ill (7-9). We also computed a frailty index (0-1; frail >0.25), a well-known frailty measure. We used Cox proportional hazards models to estimate the association between frailty and time to death within 30 days and 6 months of admission. We also examined whether frailty identified different mortality risk levels within strata of similar age and acute morbidity as measured by the Sequential Organ Failure Assessment (SOFA) score. Results Median age was 66 years, 58% were male, and 27% were frail to some degree. Compared with fit-to-managing-well patients, the adjusted hazard ratios (95% confidence interval [CI]) for 30-day and 6-month mortality were, respectively, 1.4 (1.1-1.7) and 1.4 (1.1-1.7) for vulnerable patients; 1.5 (1.1-1.9) and 1.5 (1.1-1.8) for mild frailty; 1.8 (1.4-2.3) and 1.9 (1.5-2.4) for moderate frailty; and 2.1 (1.6-2.7) and 2.3 (1.8-2.9) for severe frailty to terminally ill. The CFS achieved outstanding accuracy to identify frailty compared with the Frailty Index (area under the curve = 0.94; 95% CI = 0.93-0.95) and predicted different mortality risks within age and acute morbidity groups. Conclusions Our results encourage the use of frailty, alongside measures of acute morbidity, to guide clinicians in prognostication and resource allocation in hospitalized patients with COVID-19.
- AMPI-AB validity and reliability: a multidimensional tool in resource-limited primary care settings(2020) SARAIVA, Marcos Daniel; VENYS, Amanda Lagreca; ABDALLA, Fabio Luiz Pantaleao; FERNANDES, Mariana Seabra; PISOLI, Priscila Henriques; SOUSA, Danilsa Margareth da Rocha Vilhena; BIANCONI, Barbara Lobo; HENRIQUE, Expedita Angela; GARCIA, Vanessa Silva Suller; MAIA, Lucas Henrique de Mendonca; SUZUKI, Gisele Sayuri; SERRANO, Priscila Goncalves; HIRATSUKA, Marcel; SZLEJF, Claudia; JACOB-FILHO, Wilson; PASCHOAL, Sergio Marcio PachecoBackgroundThe early identification of individuals at high risk for adverse outcomes by a Comprehensive Geriatric Assessment (CGA) in resource-limited primary care settings enables tailored treatments, however, the evidence concerning its benefits are still controversial. The main objective of this study was to examine the validity and reliability of the ""Multidimensional Assessment of Older People in Primary Care (AMPI-AB)"", a CGA for primary care in resource-limited settings.MethodsLongitudinal study, with median follow-up time of 16months. Older adults from a public primary care unit in SAo Paulo, Brazil, were consecutively admitted. Reliability was tested in a sample from a public geriatric outpatient clinic. Participants were classified by the AMPI-AB score as requiring a low, intermediate or high complexity of care. The Physical Frailty Phenotype was used to explore the AMPI-AB's concurrent validity. Predictive validity was assessed with mortality, worsening of the functional status, hospitalizations, emergency room (ER) visits and falls. The area under the ROC curve and logistic regression were calculated for binary outcomes, and a Cox proportional hazards model was used for survival analysis.ResultsOlder adults (n=317) with a median age of 80 (74-86) years, 67% female, were consecutively admitted. At the follow-up, 7.1% of participants had died, and increased dependency on basic and instrumental activities of daily living was detected in 8.9 and 41.1% of the participants, respectively. The AMPI-AB score was accurate in detecting frailty (area under the ROC curve=0.851), predicted mortality (HR=1.25, 95%CI=1.13-1.39) and increased dependency on basic (OR=1.26, 95%CI=1.10-1.46) and instrumental (OR=1.22, 95%CI=1.12-1.34) activities of daily living, hospitalizations (OR=2.05, 95%CI=1.04-1.26), ER visits (OR=1.20, 95%CI=1.10-1.31) and falls (OR=1.10, 95%CI=1.01-1.20), all models adjusted for sex and years of schooling. Reliability was tested in a sample of 52 older adults with a median age of 72 (85-64) years, 63.5% female. The AMPI-AB also had good interrater (ICC=0.87, 95%CI=0.78-0.92), test-retest (ICC=0.86, 95%CI=0.76-0.93) and proxy reliability (ICC=0.84, 95%CI=0.67-0.93). The Cronbach's alpha was 0.69, and the mean AMPI-AB administration time was 05:4402:42min.ConclusionThe AMPI-AB is a valid and reliable tool for managing older adults in resource-limited primary care settings.
- Prospective GERiatric Observational (ProGERO) study: cohort design and preliminary results(2020) SARAIVA, Marcos Daniel; RANGEL, Luis Fernando; CUNHA, Julia Lusis Lassance; ROTTA, Thereza Cristina Ariza; DOURADINHO, Christian; KHAZAAL, Eugenia Jatene Bou; ALIBERTI, Marlon Juliano Romero; AVELINO-SILVA, Thiago Junqueira; APOLINARIO, Daniel; SUEMOTO, Claudia Kimie; JACOB-FILHO, WilsonBackgroundThe demographic changes in Brazil as a result of population aging is one of the fastest in the world. The far-reaching new challenges that come with a large older population are particularly disquieting in low- and middle-income countries (LMICs). Longitudinal studies must be completed in LMICs to investigate the social and biological determinants of aging and the consequences of such demographic changes in their context. Therefore, we designed the Prospective GERiatric Observational (ProGERO) study, a longitudinal study of outpatient older adults in SAo Paulo, Brazil, to collect data both on aging and chronic diseases, and investigate characteristics associated with adverse outcomes in this population.MethodsThe ProGERO study takes place in a geriatric outpatient clinic in the largest academic medical center in Latin America. We performed baseline health examinations in 2017 and will complete subsequent in-person visits every 3 years when new participants will also be recruited. We will use periodic telephone interviews to collect information on the outcomes of interest between in-person visits. The baseline evaluation included data on demographics, medical history, physical examination, and comprehensive geriatric assessment (CGA; including multimorbidity, medications, social support, functional status, cognition, depressive symptoms, nutritional status, pain assessment, frailty, gait speed, handgrip strength, and chair-stands test). We used a previously validated CGA-based model to rank participants according to mortality risk (low, medium, high). Our selected outcomes were falls, disability, health services utilization (emergency room visits and hospital admissions), institutionalization, and death. We will follow participants for at least 10 years.ResultsWe included 1336 participants with a mean age of 828years old. Overall, 70% were women, 31% were frail, and 43% had a Charlson comorbidity index score >= 3. According to our CGA-based model, the incidence of death in 1 year varied significantly across categories (low-risk=0.6%; medium-risk=7.4%; high-risk=17.5%; P<0.001).Conclusion The ProGERO study will provide detailed clinical data and explore the late-life trajectories of outpatient older patients during a follow-up period of at least 10years. Moreover, the study will substantially contribute to new information on the predictors of aging, senescence, and senility, particularly in frail and pre-frail outpatients from an LMIC city.
- The geriatrician's perspective on practical aspects of the multidisciplinary cam of older adults with cancer(2016) KARNAKIS, Theodora; GATTAS-VERNAGLIA, Isabella F.; SARAIVA, Marcos Daniel; GIL-JUNIOR, Luiz Antonio; KANAJI, Ana Lumi; JACOB-FILHO, WilsonMultidisciplinary teams (MDTs) have been incorporated into the practical care of elderly patients with cancer. Several geriatric oncology centres have attempted to determine the best way to implement MDTs by using geriatric assessment (GA). Developing a geriatric oncology service is a feasible work, which requires significant resources. The challenges of MDTs must be known so that better care planning for elderly patients with cancer can be devised. The aim of this paper is to discuss the practical aspects of the multidisciplinary care of older adults with cancer by considering a geriatric point of view and the recent literature. Reviewing data from recent studies helps enumerate the major challenges in establishing collaboration in geriatric oncology: evaluating the resources of your centre, knowing the role of each member of the team, establishing good communication both within the team and with the patients, and determining referral criteria and using screening tests to select which patients can benefit the most from the multidisciplinary evaluation and a more thorough GA.
- Functional Status is a Predictor of Postoperative Complications After Cancer Surgery in the Very Old(2017) SARAIVA, Marcos Daniel; KARNAKIS, Theodora; GIL-JUNIOR, Luiz Antonio; OLIVEIRA, Julio Cesar; SUEMOTO, Claudia Kimie; JACOB-FILHO, WilsonThe association between preoperative functional status and postoperative complications after cancer surgery is very well described in the 'youngest old' population; however, limited information is available for the very old (i.e. those aged 80 years and older). Our aim was to evaluate whether functional status, expressed as metabolic equivalents (METs), is a predictor of adverse postoperative outcomes in very old patients. In a retrospective cohort study, we included all patients aged 80 years or older who underwent elective oncological surgery at a tertiary hospital in Brazil in 2011. The primary outcome was postoperative complications up to 30 days after surgery. Functional status was evaluated using a simple questionnaire, which classified participants into three groups based on METs. We used logistic regression models to investigate the association between functional status and the occurrence of complications, adjusted for possible confounders. We analyzed data from 138 patients aged 80 years or older. The mean age of the sample was 84.2 +/- 4.2 years and 52% were female; 65% of the procedures were classified as low risk and 35% were classified as intermediate risk. Regarding functional status, 72% of the sample had a performance equivalent to fewer than 4 METs, 27% had 4-6 METs, and 1% had more than 6 METs. Postoperative complications were observed in 25%, and the mortality rate was 2%. Better functional status was associated with reduced odds of postoperative complications in multivariate analysis (odds ratio 0.11, 95% confidence interval 0.02-0.85; p = 0.034). Functional status seems to be related to surgical morbidity in the very old.