{"id":2188,"date":"2026-06-09T06:00:00","date_gmt":"2026-06-09T09:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2188"},"modified":"2026-06-09T06:00:00","modified_gmt":"2026-06-09T09:00:00","slug":"rss-clinica-medicina-geriatria-delirium-demencia-sarcopenia-fragilidade-polifarmacia-cga","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/rss-clinica-medicina-geriatria-delirium-demencia-sarcopenia-fragilidade-polifarmacia-cga\/","title":{"rendered":"RSS geriatria: delirium, sarcopenia, polifarm"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente subaproveitada por gestores de cl\u00ednicas de geriatria que reduzem RSS a descarte de fralda geri\u00e1trica e gaze<\/strong>. Em 2026, h\u00e1 um cen\u00e1rio desafiador \u2014 cl\u00ednicas de geriatria<\/strong> + delirium hipoativo+hiperativo+misto CAM-ICU<\/strong> + dem\u00eancia Alzheimer + vascular + corpos Lewy + frontotemporal<\/strong> + sarcopenia EWGSOP2 baixa massa+for\u00e7a+performance<\/strong> + fragilidade Fried+Rockwood CFS<\/strong> + polifarm\u00e1cia \u22655 f\u00e1rmacos+Beers Criteria+STOPP\/START<\/strong> geram fluxos heterog\u00eaneos de RSS Grupo A1 (sangue venoso geri\u00e1trico + capilar HbA1c) + Grupo A2 (secre\u00e7\u00e3o respirat\u00f3ria + urin\u00e1ria + escara \u00falcera press\u00e3o) + Grupo B (f\u00e1rmacos vencidos + retorno paciente domiciliar polifarm\u00e1cia + Beers Criteria + Lecanemab Leqembi + donepezil + memantina) + Grupo E (perfuro + agulha + cateter venoso + sonda enteral). A consequ\u00eancia \u00e9 a pr\u00e1tica de cl\u00ednicas que otimizam apenas para fralda + gaze<\/strong> + ignoram especificidades geri\u00e1tricas + fragilidade<\/strong> + subdimensionam polifarm\u00e1cia retorno paciente<\/strong> + perdem rastreabilidade Beers\/STOPP<\/strong>. A realidade \u00e9 exatamente o oposto. RSS geriatria opera em 5 fluxos geri\u00e1tricos<\/strong> \u2014 delirium (CAM-ICU + DRS-R-98 + RASS + 4AT + medica\u00e7\u00e3o trigger), dem\u00eancia (CDR + MMSE + MoCA + GDS + Lecanemab Leqembi + donepezil + memantina + rivastigmina), sarcopenia (EWGSOP2 + DXA + BIA + handgrip + gait speed + SARC-F), fragilidade (Fried 5 crit\u00e9rios + Rockwood CFS 1-9 + VES-13 + G8), polifarm\u00e1cia (Beers Criteria 2023 + STOPP\/START 2023 + medication review).<\/p>\n

Para o gestor que opera ou planeja cl\u00ednica de geriatria, \u00e9 fundamental dimensionar RSS espec\u00edfico desde o in\u00edcio.<\/p>\n

Os 5 fluxos geri\u00e1tricos<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, o RSS geriatria tem 5 fluxos.<\/p>\n\n\n\n\n\n\n\n\n\n
Fluxo<\/th>\nVolume<\/th>\nFrequ\u00eancia<\/th>\nParticularidade<\/th>\n<\/tr>\n<\/thead>\n
Delirium<\/td>\n2-6 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nCAM-ICU+RASS<\/td>\n<\/tr>\n
Dem\u00eancia+Lecanemab<\/td>\n1,5-4 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nLeqembi+anti-A\u03b2<\/td>\n<\/tr>\n
Sarcopenia+nutri\u00e7\u00e3o<\/td>\n1-3 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nDXA+BIA+suplem<\/td>\n<\/tr>\n
Fragilidade Fried<\/td>\n0,8-2,5 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nCFS+G8<\/td>\n<\/tr>\n
Polifarm\u00e1cia Beers<\/td>\n3-9 kg\/dia<\/td>\nDi\u00e1ria<\/td>\n\u22655 f\u00e1rmacos+RDC 222<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 8,3-24,5 kg\/dia<\/strong> em cl\u00ednica geriatria m\u00e9dia porte.<\/p>\n

Delirium + dem\u00eancia + Lecanemab: o est\u00e1gio cognitivo<\/h2>\n

A primeira camada \u00e9 cognitivo. Padr\u00e3o setorial inclui (a) delirium<\/strong> com hipoativo + hiperativo + misto + CAM-ICU Confusion Assessment Method + 4AT 4 ‘A’s Test + DRS-R-98 + RASS Richmond Agitation Sedation Scale + medica\u00e7\u00e3o trigger benzodiazep\u00ednico + opioide + anticolin\u00e9rgico + corticoide; (b) dem\u00eancia Alzheimer<\/strong> com CDR Clinical Dementia Rating + MMSE Mini-Mental + MoCA Montreal Cognitive + GDS Global Deterioration Scale + biomarcador LCR A\u03b242\/tau + PET amyloid Florbetapir + tau Flortaucipir; (c) Lecanemab Leqembi Eisai\/Biogen anti-amyloid-\u03b2 monoclonal<\/strong> Lista C5 R$ 25-45k\u00d726 doses bisemanais + ARIA-E edema cerebral + ARIA-H micro-hemorragia + biomarker confirmation; (d) donanemab Kisunla<\/strong> Eli Lilly + aducanumab Aduhelm Biogen retirado FDA 2024 + tofersen Qalsody ALS SOD1; (e) descarte cognitivo<\/strong> com Lista C5 anti-amyloid + Lista B donepezil Aricept + memantina Namenda + rivastigmina Exelon + galantamina Razadyne + saco amarelo + identifica\u00e7\u00e3o Lista B\/C5.<\/p>\n

Cl\u00ednica com cognitivo madura escala diagn\u00f3stico precoce<\/strong> + prescreve anti-amyloid Lecanemab<\/strong> + gerencia ARIA monitor RM<\/strong>. Como discutimos no post sobre Lecanemab onco geri\u00e1trica<\/a>, Lecanemab \u00e9 integrado.<\/p>\n

Sarcopenia + fragilidade + Fried Phenotype: o est\u00e1gio funcional<\/h2>\n

A segunda camada \u00e9 funcional. Padr\u00e3o setorial inclui (a) sarcopenia EWGSOP2 European Working Group on Sarcopenia in Older People 2<\/strong> com baixa for\u00e7a handgrip <27kg \u2642\/<16kg \u2640 + baixa massa muscular DXA Dual X-ray Absorptiometry SMI <7,0 kg\/m\u00b2 \u2642\/<5,5 \u2640 + BIA Bioimped\u00e2ncia + baixa performance gait speed <0,8 m\/s + SARC-F screening; (b) fragilidade Fried Phenotype<\/strong> 5 crit\u00e9rios perda peso + exaust\u00e3o + baixa atividade + lentid\u00e3o + fraqueza + 0=robusto\/1-2=pr\u00e9-fr\u00e1gil\/3-5=fr\u00e1gil; (c) Rockwood CFS Clinical Frailty Scale<\/strong> 1-9 muito-em-forma \u2192 terminalmente-doente + VES-13 Vulnerable Elders Survey + G8 Geriatric 8 onco-geriatria; (d) interven\u00e7\u00e3o nutricional<\/strong> suplementa\u00e7\u00e3o proteica 1,2-1,5 g\/kg\/dia + leucina HMB \u03b2-hidroxi-\u03b2-metilbutirato + Vitamina D3 800-2.000 UI + creatina monohidrato 3-5 g\/dia + \u00f3leo peixe \u00f4mega-3; (e) descarte sarcopenia+fragilidade<\/strong> com seringa BIA + agulha bi\u00f3psia muscular + RSS Grupo E perfuro + Grupo B suplementa\u00e7\u00e3o Lista B.<\/p>\n

Cl\u00ednica com sarcopenia+fragilidade madura escala diagn\u00f3stico EWGSOP2<\/strong> + previne sarcopenia avan\u00e7ada<\/strong> + escala interven\u00e7\u00e3o nutricional<\/strong>. Conex\u00e3o com pediatria<\/a> (espelho ciclo vida).<\/p>\n

Polifarm\u00e1cia Beers + STOPP\/START: o est\u00e1gio prescri\u00e7\u00e3o<\/h2>\n

A terceira camada \u00e9 polifarm\u00e1cia. Padr\u00e3o setorial inclui (a) polifarm\u00e1cia \u22655 f\u00e1rmacos<\/strong> + hiperpolifarm\u00e1cia \u226510 f\u00e1rmacos + cascata prescri\u00e7\u00e3o + intera\u00e7\u00e3o Drug-Drug Interaction DDI + Stockley’s Drug Interactions Pharmaceutical Press; (b) Beers Criteria 2023<\/strong> AGS American Geriatrics Society 30+ f\u00e1rmacos potencialmente inadequados PIM + benzo + anticolin\u00e9rgico + sulfonilur\u00e9ia + AINE + cyclobenzaprina + meperidina; (c) STOPP\/START 2023<\/strong> Screening Tool of Older People’s Prescriptions Screening Tool to Alert doctors to Right Treatment 80+ crit\u00e9rios STOPP-stop + 34 crit\u00e9rios START-start; (d) deprescribing<\/strong> com BeMedWise Coalition + STOPPFrail palliative + Med-Safety adverse drug event + medication review CGA-driven; (e) descarte polifarm\u00e1cia<\/strong> com retorno paciente domiciliar + lote vencido + Lista B controlado Portaria 344 + Lista C5 oncol\u00f3gico + saco amarelo + identifica\u00e7\u00e3o granular + RDC 222.<\/p>\n

Cl\u00ednica com Beers+STOPP\/START madura escala medication review CGA<\/strong> + reduz PIM 30-50%<\/strong> + previne queda+delirium iatrog\u00eanico<\/strong>. Conex\u00e3o com Lista B<\/a>.<\/p>\n

Tr\u00eas perfis de RSS por capacidade geriatria<\/h2>\n

Cl\u00ednica geriatria b\u00e1sica.<\/strong> 2 fluxos. Custo mensal R$ 7.000-22.000<\/strong> mas perda de Lecanemab+Beers+STOPP.<\/p>\n

Cl\u00ednica geriatria m\u00e9dia.<\/strong> 3 fluxos. Custo mensal R$ 14.000-38.000<\/strong>, captura cognitivo+funcional.<\/p>\n

Cl\u00ednica geriatria completa 5 fluxos.<\/strong> Delirium+dem\u00eancia+sarcopenia+fragilidade+polifarm\u00e1cia + integra\u00e7\u00e3o com servi\u00e7os hospitalares<\/a>. Custo mensal R$ 28.000-72.000<\/strong>, efic\u00e1cia 95%, ROI 800-2.500% via captura geri\u00e1trica + Lecanemab Lista C5 + medication review.<\/p>\n

Os tr\u00eas erros que aparecem em geriatria<\/h2>\n

O primeiro \u00e9 a subdimensionamento Lecanemab Lista C5<\/strong>. Sem Lista C5 anti-amyloid + R$ 25-45k\u00d726 doses = n\u00e3o-conformidade ANVISA + risco contamina\u00e7\u00e3o cruzada + impacto financeiro.<\/p>\n

O segundo \u00e9 a mistura polifarm\u00e1cia Beers + B-controlado<\/strong>. Confunde rastreabilidade Portaria 344 + impossibilita medication review CGA-driven + zero deprescribing.<\/p>\n

O terceiro \u00e9 a falta de protocolo CAM-ICU + 4AT delirium<\/strong>. Sem screening sistem\u00e1tico = subdiagn\u00f3stico 60-80% + risco institucionaliza\u00e7\u00e3o + mortalidade 20-40%.<\/p>\n

A regula\u00e7\u00e3o de RSS geriatria no Brasil est\u00e1 em fase de moderniza\u00e7\u00e3o t\u00e9cnica acelerada com geriatria especializada como prioridade. As institui\u00e7\u00f5es que estruturam fluxos completos desde o in\u00edcio \u2014 alinhadas com calend\u00e1rio 2026 de compliance<\/a> \u2014 atravessam o crescimento sem solavanco. Para gestores que precisam alinhar com gest\u00e3o paralela industrial, o portal Seven Res\u00edduos sobre servi\u00e7os completos<\/a> traz a perspectiva integrada. A SBGG Sociedade Brasileira Geriatria<\/a> \u00e9 refer\u00eancia t\u00e9cnica nacional.<\/p>\n

Solicite cota\u00e7\u00e3o RSS geriatria 5 fluxos completos<\/a><\/strong> \u2014 cap\u00edtulo dedicado a delirium CAM-ICU+4AT+RASS+DRS-R-98, dem\u00eancia CDR+MMSE+MoCA+GDS+Lecanemab Leqembi+donanemab Kisunla+donepezil+memantina+rivastigmina, sarcopenia EWGSOP2+DXA+BIA+handgrip+gait speed+SARC-F+HMB+leucina, fragilidade Fried 5 crit\u00e9rios+Rockwood CFS 1-9+VES-13+G8, polifarm\u00e1cia Beers Criteria 2023+STOPP\/START 2023+deprescribing+Portaria 344.<\/p>\n","protected":false},"excerpt":{"rendered":"

RSS geriatria: delirium + dem\u00eancia + sarcopenia + polifarm\u00e1cia. Veja.<\/p>\n","protected":false},"author":3,"featured_media":2187,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2521,1947,1389,2522],"class_list":["post-2188","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-delirium","tag-demencia","tag-geriatria","tag-polifarmacia"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2188","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/comments?post=2188"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2188\/revisions"}],"predecessor-version":[{"id":4318,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2188\/revisions\/4318"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2187"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2188"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2188"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2188"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}