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To evaluate the cumulative incidence of depression and its associated factors in the older population living in the urban area of the municipality of Bagé, Rio Grande do Sul State, Brazil, a prospective cohort study was conducted from 2008 to 2016/2017. The analysis was restricted to 615 older adults with complete information on the Geriatric Depression Scale (GDS-15), both at baseline and at follow-up, and who did not present depression in 2008. To calculate crude and adjusted incidence ratios and 95% confidence interval, Poisson regression with robust variance adjustment was used, including the baseline variables. A hierarchical model of four levels of determination was used. The variables were controlled for those of the same or of higher levels, and the p-value ≤ 0.20 was established to remain in the analysis model. In 2008, 523 older people did not have depression and 92 had been screened with the disease. In 2016/2017, of the 523 individuals without depression in the baseline measure, 10.3% tested positive at screening (incident cases), whereas 89.7% of the older adults remained free of the condition. Of the 92 older adults with depression in 2008, 32.6% continued to present depressive symptoms at follow-up and 67.3% had remission of symptoms. Leaving home once or never and being incapable of doing functional and instrumental activities of daily living were associated with a higher risk of positive screening for depression. The results reinforce the multidimensional and dynamic character of depression, which alternates short and long episodes, and may become recurrent and chronic.

The scope of this study was to measure the prevalence of negative self-perceived health and depressive symptoms in elderly adults according to the presence of urinary incontinence, after a follow-up of nine years. This is a prospective population-based cohort study entitled Bagé Cohort Study of Aging, from Rio Grande do Sul. A total of 1,593 elderly adults were interviewed in the baseline study (2008) and 735 between September 2016 and August 2017. The "urinary incontinence (UI)" exposure was assessed in the baseline study and the outcomes "negative self-perceived health" and "depressive symptoms" in 2016/17. The odds ratio and 95% confidence interval were calculated by Logistic Regression and adjusted for demographic, social, behavioral and health conditions. The prevalence of UI was 20.7% in 2008 and 24.5% in 2016/17; the incidence was 19.8%, being 23.8% among women and 14.6% among men (p = 0.009). Elderly adults with UI at the baseline study had a 4.0 (CI95%: 1.8-8.8) and a 3.4 (CI95%: 1.8-6.2) greater chance to develop negative self-perception of health and depressive symptoms, respectively, after nine years of follow-up, compared to those without UI. The results show a greater probability of mental problems among elderly adults with UI.

Objective: to verify the influence of social relations on the survival of older adults living in southern Brazil., Method: a cohort study (2008 and 2016/17), conducted with 1,593 individuals aged 60 years old or over, in individual interviews. The outcomes of social relations and survival were verified by Multiple Correspondence Analysis, which guided the proposal of an explanatory matrix for social relations, the analysis of survival by Kaplan-Meier, and the multivariate analysis by Cox regression to verify the association between the independent variables., Results: follow-up was carried out with 82.5% (n=1,314), with 46.1% being followed up in 2016/17 (n=735) and 579 deaths (36.4%). The older adults who went out of their homes daily had a 39% reduction in mortality, and going to parties kept the protective effect of 17% for survival. The lower risk of death for women is modified when the older adults live in households with two or more people, in this case women have an 89% higher risk of death than men., Conclusion: strengthened social relationships play a mediating role in survival. The findings made it possible to verify the importance of going out of the house as a marker of protection for survival.

Objective: Evaluate the association of multimorbidity, primary health care model and possession of a private health plan with hospitalization., Methods: A population-based cross-sectional study with 1,593 elderly individuals (60 years old or older) living in the urban area of the city of Bagé, State of Rio Grande do Sul, Brazil. The outcome was hospitalization in the year preceding the interview. The multimorbidity was evaluated through two cut-off points (≥ 2 and ≥ 3). The primary health care model was defined by residence in areas covered by traditional care or by Family Health Strategy. The older adults mentioned the possession of a private health plan. We performed a gross and adjusted analysis by Poisson regression using a hierarchical model. The adjustment included demographic, socioeconomic, functional capacity disability and health services variables., Results: The occurrence of overall and non-surgical hospitalization was 17.7% (95%CI 15.8-19.6) and 10.6% (95%CI 9.1-12.1), respectively. Older adults with multimorbidity were admitted to hospitals more often when to older adults without multimorbidity, regardless of the exhibition' form of operation. Having a private health plan increased the hospitalization by 1.71 (95%CI 1.09-2.69) times among residents in the areas of the Family Health Strategy when compared to elderly residents in traditional areas without a private health plan., Conclusions: The multimorbidity increased the occurrence of hospitalizations, especially non-surgical ones. Hospitalization was more frequent in older adults with private health plan and those living in Family Health Strategy areas, regardless of the presence of multiple diseases., Objetivo: Avaliar a associação da multimorbidade, modelo de atenção básica e posse de plano de saúde com hospitalização., Métodos: Estudo transversal de base populacional com 1.593 idosos (60 anos ou mais) residentes na zona urbana do município de Bagé, Rio Grande do Sul. O desfecho foi a hospitalização no ano anterior à entrevista. A multimorbidade foi avaliada por meio de dois pontos de corte (≥ 2 e ≥ 3). O modelo de atenção básica foi definido pela residência em áreas cobertas pela atenção tradicional ou da Estratégia Saúde da Família. A posse de plano de saúde foi referida pelos idosos. Realizou-se análise bruta e ajustada por regressão de Poisson utilizando modelo hierarquizado. O ajuste incluiu variáveis demográficas, socioeconômicas, capacidades funcionais e de serviços de saúde., Resultados: A ocorrência de hospitalização geral e não cirúrgica foi de 17,7% (IC95% 15,8-19,6) e 10,6% (IC95% 9,1-12,1), respectivamente. Idosos com multimorbidade hospitalizaram mais em comparação com os idosos sem multimorbidade, independentemente da forma de operacionalização da exposição. O plano de saúde aumentou em 1,71 (IC95% 1,09-2,69) vezes a internação hospitalar entre residentes nas áreas da Estratégia Saúde da Família em comparação aos idosos residentes nas áreas tradicionais sem plano de saúde., Conclusões: A multimorbidade aumentou a ocorrência de hospitalizações, principalmente aquelas não cirúrgicas. Idosos com plano de saúde e residentes em áreas de Estratégia Saúde da Família internaram mais, independentemente da presença de múltiplas doenças.

The scope of the article is to present the reflections of professionals from the Mais Médicos Program (More Doctors Program) on the significance of the specialization course in Family Health in terms of professional practice and learning the most important concepts. This is an empirically based qualitative study on the statements recorded in the "Critical reflection on their personal learning process" of the final work of the specialization course at the Federal University of Pelotas. For textual analysis, 101 reports were randomly selected from a total of 1,011 reports completed in seven states of the North, Northeast and South of Brazil from June to December 2015. The initial barriers were overcome with tutor support and team integration, with emphasis on teaching tools for the improvement of clinical practice and strategic organization of work and greater understanding of the public health system. Fostering the learning of the Portuguese language and the exchange of experience in the forums were considered valuable positive aspects. Despite the difficulty in Internet access in some municipalities it reaffirmed the central role of ongoing education and the viability of the problem-solving methodology, even from a distance.

The aim of this study was to evaluate the prevalence of home care for the Brazilian elderly population and associated factors, using a cross-sectional design with a sample of individuals 60 years or older living in the urban areas of 100 municipalities located in 23 states. A Poisson regression model was used for crude and adjusted analyses. A total of 6,624 elderly individuals were interviewed, and prevalence of home care was 11.7%. After adjustment, higher home care rates were associated with female gender, older old age, lower schooling and purchasing power, diagnosis of chronic illness, history of falls, previous hospitalization, and medical consultation in the previous three months. The results highlight more extensive use of home care by the most vulnerable elderly. This finding suggests a contribution from home care to the promotion of healthcare equity in Brazil, especially due to the expansion of the Family Health Strategy. The results can support the organization of the work process for primary care professionals and managers.