Erectile Dysfunction: Evaluation of the sexual function in the elderly male.

Trabalho de Projeto do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntroduction: Age related changes in endocrine functions and increased prevalence of cardiovascular, metabolic and psychological diseases are important risk factors for Erectile Dysfunction in the elderly man. This multifactorial condition, growing worldwide, is a significant problem in the elderly, not because of the immediate risk to their health, but because of its repercussions on the quality of the aging process. Objective: To characterize sexual function in the geriatric population while simultaneously check if the sexual dysfunction of the elderly accompanies the performance status of the geriatric patient, regarding its co-morbidities, autonomy, cognitive and behavioral function. Materials and methods: 80 male patients from the Internal Medicine and Urology departments at Centro Hospitalar e Universitário de Coimbra (CHUC) with ages between 60 and 80 years old were included in this study and then distributed in 4 uniform age groups: [60-65 [; [65-70 [; [70-75 [; [75-80]). Each patient was assessed regarding his sexual function, functional status, and depressive status through a survey that included the International Erectile Function Index-15 (IIEF-15), Katz Index of Independence in Activities of Daily Living and Yesavage’s Geriatric Depression Scale (short version) respectively. Sexual function was classified as no dysfunction, mild dysfunction, mild to moderate dysfunction, moderate dysfunction and severe dysfunction, according to IIEF-15; functional status was classified as independent, mildly dependent, moderately dependent, severely dependent, and totally dependent, according to Katz Index; and depressive status was classified as no depression, mild depression, and severe depression according to the Geriatric Depression Scale. For data treatment, descriptive statistics and inferential statistics methods were used to analyze variables with a non-normal distribution, using non-parametric tests (Mann-Whitney U, chi-square test, Kruskal-Wallis test and Pearson correlation). P<0.05 was accepted as the level of statistical significance. Results: The median age of patients included in the study was 69,50 years. High blood pressure was present in 66,30%, diabetes mellitus in 30,00% and hyperlipidemia in 51,30%. A total of 68,8% individuals presented with some form of ED, 50% presenting with severe ED. 22,5% of patients were slightly dependent and 8,8% presented with mild depression. Regarding geriatric patients, no statistically significant difference was found in the medians of the biometric data for the groups of selected comorbidities. Those who take at least one medication are older than those who do not take any (p=0,007). Elderly patients who suffer from diabetes presented statistically significant lower scores in the IIEF-15 in regarding intercourse satisfaction (p=0,022). Patients with high blood pressure showed worse performance regarding sexual desire (p=0,041). Dyslipidemia, smoking and thyroid dysfunction showed no impact in different domains assessed. Patients taking at least one medication have worse outcomes regarding erectile function (p=0,021), orgasmic function (p=0,010), sexual desire (p=0,034) and intercourse satisfaction (p=0,004). The use of psychiatric medication is associated with less sexual desire (p=0,027). Slightly dependent geriatric patients presented with worse performance regarding erectile function (p=0,005), orgasmic function (p=0,006), sexual desire (p=0,017) and intercourse satisfaction (p=0,005). Regarding depression, there were no significant differences among the elderly people without depression or with mild depression (p≥0,050). Concerning the previous variables for the elderly and the control groups, a significant statistical difference was found regarding the median of the abdominal perimeter (p=0,044). A correlation was found between the use of medication and the geriatric status (p=0,040). For the various comorbidities and various pharmacological classes included in the usual medication category, no other correlation with statistical significance was found. Geriatric patients have a positive correlation regarding slight dependence (p=0,030); A negative correlation for degrees of mild depression was found (p=0,040). Finally, the geriatric patients presented with worse results regarding erectile function (p=0,001), orgasmic function (p=0,005), sexual desire (p=0,001) and intercourse satisfaction (p=0,006). Conclusion: The increasing prevalence of ED around the world is strongly related to the aging population worldwide. Older men are more likely to develop ED due to chronic illness, comorbidities and systemic changes related to the aging process. Realizing the cause of sexual dysfunction thus becomes extremely important to a proper approach. With this, it is intended to draw attention to the fact that ED should be considered a systemic problem and not the dysfunction of a single organ or system.Introdução: Modificações nas funções endócrinas relacionadas com a idade, mas também a maior prevalência de doenças cardiovasculares (DCV), doenças metabólicas e doenças do foro psicológico são determinantes importantes da disfunção erétil (DE) no idoso. Esta condição, multifatorial, crescente a nível mundial, constitui um problema significativo no homem idoso, não propriamente pelo risco para a sua saúde, mas pelas repercussões na qualidade do processo de envelhecimento. Objetivo: Caracterizar a função sexual na população geriátrica e, simultaneamente perceber se a disfunção sexual do idoso acompanha o decair do desempenho geral do doente geriátrico, em relação às suas co-morbilidades, autonomia e função cognitivo-comportamental. Materiais e Métodos: 80 doentes do sexo masculino dos serviços de Medicina Interna e Urologia do Centro Hospitalar e Universitário de Coimbra (CHUC), entre os 60 e 80 anos de idade foram incluídos neste estudo, tendo sido distribuídos por 4 grupos etários uniformes ([60-65[; [65-70[; [70-75[; [75-80]). Cada doente foi avaliado em relação à sua função sexual, estado funcional e status depressivo através de um inquérito que contemplava o Índice Internacional de Função Erétil-15 (IIEF-15), Escala de Katz e Escala de Depressão Geriátrica de Yesavage (versão curta), respetivamente. A função sexual foi classificada em: sem disfunção, disfunção ligeira, disfunção ligeira a moderada, disfunção moderada e disfunção severa, de acordo com o IIEF-15; o estado funcional foi classificado em independência total, dependência ligeira, dependência moderada, dependência grave e dependência total de acordo com a Escala de Katz; e o status depressivo foi classificado em ausência de depressão, depressão ligeira e depressão grave de acordo com a Escala de Depressão Geriátrica. Para o tratamento de dados foram usados métodos de estatística descritiva e de estatística inferencial para a análise de variáveis com uma distribuição não normal, através de testes não paramétricos (U de Mann-Whitney, qui-quadrado, teste de Kruskal-Wallis e correlação de Pearson). Um p