Translation, Adaptation and Validation of Rapid Geriatric Assessment to the Brazilian context

[Feasibility, Reliability, and Validity of the VIG-Express Questionnaire as an Instrument for Rapid Multidimensional Geriatric Assessment: A Multicenter Study]

OBJECTIVE

To evaluate the feasibility, reliability and validity of the VIG-express questionnaire.

DESIGN

Descriptive, observational, cross-sectional and multicenter study.

SETTING

Catalonia.

PARTICIPANTS

24 professionals from 18 centers: 10 from Primary Care, 5 from hospitals acute, 2 intermediate care and 3 residential.

MAIN MEASUREMENTS

For the feasibility analysis, the administration time -mean and standard deviation (SD)-. The questionnaire was administered twice to the same patient by the same professional (intraobserver agreement), or by two different professionals (interobserver agreement), evaluating the intraclass correlation coefficient (ICC). Discriminant validity was calculated by comparing the responses of subgroup with higher fragility (percentile >75) and subgroup with lower fragility (percentile <25), for each item of the questionnaire.

RESULTS

195 questionnaires were administered, 59 repeatedly, in a group of elderly (mean age of 79 years) and fragile (mean score of 0.33 in the Fragile Index-VIG). The average administration time was 6.52minutes (DE: 6.02). The concordance in the degree of fragility score obtained a ICC of 0.95 (intraobserver) and 0.72 (interobserver). In discriminant validity, the differences in response frequencies between the two subgroups ranged from 1.7 (oncological disease) to 67.1 (medication management), all of which were statistically significant (p<0.05), with the sole exceptions of the presence of oncological and neurological diseases.

CONCLUSIONS

The VIG-express questionnaire appears to be a feasible, reliable and valid tool for rapid multidimensional/geriatric assessment.

Cultural adaptation and validation of the Sinhala version of the Frail Non-disabled tool (FiND)

BACKGROUND

Frailty, a common geriatric syndrome of vulnerability, is associated with a decline in health and function. The most problematic expression of population ageing is associated with weakness, slowing, decreased energy, lower activity and when severe, unintended weight loss. Frailty is not consciously identified in clinical practice and is not widely studied in Sri Lanka. A validated tool for screening frailty in a busy clinical setting is therefore much needed. This study was done as a part of validating the Sinhala version of the Frail Non-Disabled (S-FiND) tool.

METHODS

The FiND tool was translated from English to Sinhala by two translators, blinded to each other. They were combined and translated back to the original language by two separate translators. After verifying the content validity, unambiguity and clarity of items in a focused group discussion, the pre-final version was piloted among 30 volunteers. After assessing the psychometric properties of the pre-final version, the final version was tested among 100 adults older than 65 years from the Colombo South Teaching Hospital. The tool was compared with Fried's frailty phenotype taken as the gold standard.

RESULTS

Data were analysed for the agreement with the reference standard, the Fried Phenotype. The mean (SD) age of subjects was 73.9 (7.8) years. The overall time taken to fill out the questionnaire was 2 min. The agreement (Kappa) between the S-FiND questionnaire and the Fried phenotype was 0.7 (P < 001). The sensitivity and specificity of FiND in detecting frailty were 92% and 74%, respectively. The agreements (Kappa) between the individual items of S-Find: involuntary loss of weight/ more than 4.5 kg over one year, the feeling of effort/ not getting going and level of physical activity, with the Fried phenotype, were 0.28 (p = 0.001), 0.06 (p = 0.045) and 0.339 (p < 0.001). respectively. When subjects were categorized frail and robust based on FiND, frail subjects reported a higher incidence of falls (50%) during the previous 12 months, compared to those robust (13%) (p < 0.001 for Chi stat).

CONCLUSION

The S-FiND is a reliable, valid and well-received tool that can be used in detecting the frailty of non-disabled Sinhala-speaking older adults.

Sarcopenia and health-related quality of life: A systematic review and meta-analysis

The decrease of physical abilities and functional decline that can be caused by musculoskeletal conditions such as sarcopenia, can lead to higher levels of dependency and disability. Therefore, it may influence patient reported outcome measures (PROM), such as the health-related quality of life (HRQoL). The purpose of this systematic review and meta-analysis is to provide a comprehensive overview of the relationship between sarcopenia and HRQoL. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed throughout the whole process of this work. A protocol was previously published on PROSPERO. The electronic databases MEDLINE, Scopus, Allied and Complementary Medicine (AMED), EMB Review - ACP Journal Club, EBM Review - Cochrane Central of Register of Controlled Trials and APA PsychInfo were searched until October 2022 for observational studies reporting a HRQoL assessment in both sarcopenic and non-sarcopenic individuals. Study selection and data extraction were carried out by two independent researchers. Meta-analysis was performed using a random effect model, reporting an overall standardized mean difference (SMD) and its 95% confidence interval (CI) between sarcopenic and non-sarcopenic individuals. Study quality was measured using the Newcastle-Ottawa Scale and the strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The search strategy identified 3725 references from which 43 observational studies were eligible and included in this meta-synthesis study. A significantly lower HRQoL was observed for sarcopenic individuals compared with non-sarcopenic ones (SMD -0.76; 95% CI -0.95; -0.57). Significant heterogeneity was associated with the model (I²  = 93%, Q test P-value <0.01). Subgroup analysis showed a higher effect size when using the specific questionnaire SarQoL compared with generic questionnaires (SMD -1.09; 95% CI -1.44; -0.74 with the SarQoL versus -0.49; 95% CI -0.63; -0.36 with generic tools; P-value for interaction <0.01). A greater difference of HRQoL between sarcopenic and non-sarcopenic was found for individuals residing in care homes compared with community-dwelling individuals (P-value for interaction <0.001). No differences were found between age groups, diagnostic techniques, and continents/regions. The level of evidence was rated as moderate using the GRADE assessment. This systematic review and meta-analysis combining 43 observational studies shows that HRQoL is significantly reduced in sarcopenic patients. The use of disease-specific HRQoL instruments may better discriminate sarcopenic patients with respect to their quality of life.

Improving Detection of Client Complexity in the Community (Impact): A Study Protocol of a Pragmatic Randomized Controlled Trial

Background: Community-dwelling older clients are becoming increasingly complex. Detecting this complexity in clinical practice is limited, with greater reliance on community nurses’ clinical judgment and skills. The lack of a consistent approach to complexity impacts the level of care and support for older clients to remain in their homes for longer. Objective: To examine the effectiveness of the Patient Complexity Instrument (PCI) in addition to nurses’ clinical judgment to enhance detection of complexity, and subsequent older clients’ resource allocation compared to usual nursing assessment. Design: A pragmatic randomized controlled trial will be conducted within a community nursing service in regional Victoria, Australia. Clients 65 years and over referred to the service who are eligible for Commonwealth Home Support Programme (CHSP) funding will be randomized into Control group: usual nursing assessment or Intervention group: usual nursing assessment plus the PCI. Nurse participants are Registered Nurses currently employed in the community nursing service. Results: This study will explore whether introducing the PCI in a community nursing service enhances detection of complexity and client care resource allocation compared to nurses’ clinical judgment based on usual nursing assessment. Conclusion: This protocol outlines the study to enhance the detection of complexity by nurses delivering care for community-dwelling older people in the regional Australian context. The findings will inform the use of a standardized tool to detect complexity among community-dwelling older Australians.

Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review

Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.

Tradução, adaptação cultural e validação do Frail Non-Disabled Questionnaire para o contexto brasileiro

Resumo Objetivo Traduzir, adaptar e validar o Frail Non-Disabled Questionnaire (FiND) para o contexto brasileiro. Método Foram seguidas as etapas preconizadas para instrumentos da área da saúde: tradução inicial, síntese das traduções, retrotradução, revisão por um comitê de especialistas, pré-teste e avaliação das propriedades psicométricas da escala. Todos os preceitos éticos foram seguidos. Resultados A tradução e a retrotradução foram realizadas por dois tradutores independentes e qualificados. A revisão por especialistas demonstrou sua validade de conteúdo. No pré-teste, o FiND foi de fácil compreensão e aplicação. Na avaliação das propriedades psicométricas, o instrumento demonstrou valores satisfatórios de confiabilidade e reprodutibilidade. A validade de critério concorrente foi verificada, encontrando correlação positiva com significância estatística entre o escore do FiND e do Fenótipo de Fragilidade de Fried, e valores satisfatórios de sensibilidade, especificidade, valores preditivos positivo e negativo, e acurácia. A validade de construto convergente foi analisada, indicando correlação positiva estatisticamente significante entre o escore do FiND e os sintomas depressivos, e correlações negativas com o estado nutricional, cognitivo, e com os domínios do componente físico da qualidade de vida. A validade discriminante foi analisada por meio da comparação das médias do FiND entre os grupos: robusto, não frágil e frágil, com e sem sintomas depressivos, com melhor e com pior percepção de qualidade de vida, e com estado nutricional adequado, sob risco de desnutrição e com estado de desnutrição, as quais mostraram-se estatisticamente significantes. Conclusão O FiND encontra-se traduzido, adaptado e validado para o contexto brasileiro.

Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review

Spinal sarcopenia is a complex and multifactorial disorder associated with a loss of strength, increased frailty, and increased risks of fractures and falls. In addition, spinal sarcopenia has been associated with lumbar spine disorders and osteoporosis, which renders making decisions on treatment modalities difficult. Patients with spinal sarcopenia typically exhibit lower cumulative survival, a higher risk of in-hospital complications, prolonged hospital stays, higher postoperative costs, and higher rates of blood transfusion after thoracolumbar spine surgery. Several studies have focused on the relationships between spinal sarcopenia, appendicular muscle mass, and bone-related problems-such as osteoporotic fractures and low bone mineral density-and malnutrition and vitamin D deficiency. Although several techniques are available for measuring sarcopenia, each of them has its advantages and shortcomings. For treating spinal sarcopenia, nutrition, physical therapy, and medication have been proven to be effective; regenerative therapeutic options seem to be promising owing to their repair and regeneration potential. Therefore, in this narrative review, we summarize the characteristics, detection methodologies, and treatment options for spinal sarcopenia, as well as its role in spinal disorders.

Anorexia of Aging Associated with Nutrients Intake in Brazilian Elderly

This study evaluated the association between anorexia of aging and nutrients intake. It was a cross-sectional study with 130 individuals aged 60 years or older, undergoing outpatient care in the city of Campinas, São Paulo. Anorexia of Aging (AA) was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ), and food consumption was evaluated using the 24-hour recall (24HR). The prevalence of AA was 27.7%, in which 66.7% were women and 38.9% were older than 80 years. Elderly with AA presented lower intake of calories (1172.6 kcal vs 1477.9 kcal; p = 0.003), carbohydrates (158.5 g vs 194.1 g; p = 0.015), proteins (49.9 g vs 68.5 g; p = 0.004) and lipids (34.6 g vs 46.1 g; p = 0.006). They also had lower intake of fibers (12.6 g vs 19.4 g; p < 0.001), iron (6.4 mg vs 8.9 mg; p < 0.001) and zinc (6.0 mg vs 8.5 mg; p = 0.004). Our results show that intake of most nutrients is significantly lower in AA elderly, except carbohydrates, which may point to worse-quality diets. The diagnosis of AA, as well as the evaluation of elderly food intake, are essential to prevent undernutrition, vulnerabilities, and increased morbidity and mortality.