Advanced activities of daily living and incidence of cognitive decline in the elderly: the SABE Study

Immediate fall prevention: the missing key to a comprehensive solution for falling hazard in older adults

The world is witnessing an unprecedented demographic shift due to increased life expectancy and declining birth rates. By 2050, 20% of the global population will be over 60, presenting significant challenges like a shortage of caregivers, maintaining health and independence, and funding extended retirement. The technology that caters to the needs of older adults and their caregivers is the most promising candidate to tackle these issues. Although multiple companies and startups offer various aging solutions, preventive technology, which could prevent trauma, is not a big part of it. Trauma is the leading cause of morbidity, disability, and mortality in older adults, and statistics constitute traumatic fall accidents as its leading cause. Therefore, an immediate preventive technology that anticipates an accident on time and prevents it must be the first response to this hazard category to decrease the gap between life expectancy and the health/wellness expectancy of older adults. The article outlines the challenges of the upcoming aging crisis and introduces falls as one major challenge. After that, falls and their mechanisms are investigated, highlighting the cognitive functions and their relation to falls. Moreover, since understanding predictive cognitive mechanisms is critical to an effective prediction-interception design, they are discussed in more detail, signifying the role of cognitive decline in balance maintenance. Furthermore, the landscape of available solutions for falling and its shortcomings is inspected. Finally, immediate fall prevention, the missing part of a wholesome solution, and its barriers are introduced, and some promising methodologies are proposed.

A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions

Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.

Taking precautions in advance: a lower level of activities of daily living may be associated with a higher likelihood of memory-related diseases

Introduction

Memory-related diseases (MDs) pose a significant healthcare challenge globally, and early detection is essential for effective intervention. This study investigates the potential of Activities of Daily Living (ADL) as a clinical diagnostic indicator for MDs. Utilizing data from the 2018 national baseline survey of the China Health and Retirement Longitudinal Study (CHARLS), encompassing 10,062 Chinese individuals aged 45 or older, we assessed ADL using the Barthel Index (BI) and correlated it with the presence of MDs. Statistical analysis, supplemented by machine learning algorithms (Support Vector Machine, Decision Tree, and Logistic Regression), was employed to elucidate the relationship between ADL and MDs.

Background

MDs represent a significant public health concern, necessitating early detection and intervention to mitigate their impact on individuals and society. Identifying reliable clinical diagnostic signs for MDs is imperative. ADL have garnered attention as a potential marker. This study aims to rigorously analyze clinical data and validate machine learning algorithms to ascertain if ADL can serve as an indicator of MDs.

Methods

Data from the 2018 national baseline survey of the China Health and Retirement Longitudinal Study (CHARLS) were employed, encompassing responses from 10,062 Chinese individuals aged 45 or older. ADL was assessed using the BI, while the presence of MDs was determined through health report questions. Statistical analysis was executed using SPSS 25.0, and machine learning algorithms, including Support Vector Machine (SVM), Decision Tree Learning (DT), and Logistic Regression (LR), were implemented using Python 3.10.2.

Results

Population characteristics analysis revealed that the average BI score for individuals with MDs was 70.88, significantly lower than the average score of 87.77 in the control group. Pearson's correlation analysis demonstrated a robust negative association (r = -0.188, p < 0.001) between ADL and MDs. After adjusting for covariates such as gender, age, smoking status, drinking status, hypertension, diabetes, and dyslipidemia, the negative relationship between ADL and MDs remained statistically significant (B = -0.002, β = -0.142, t = -14.393, 95% CI = -0.002, -0.001, p = 0.000). The application of machine learning models further confirmed the predictive accuracy of ADL for MDs, with area under the curve (AUC) values as follows: SVM-AUC = 0.69, DT-AUC = 0.715, LR-AUC = 0.7. Comparative analysis of machine learning outcomes with and without the BI underscored the BI's role in enhancing predictive abilities, with the DT model demonstrating superior performance.

Conclusion

This study establishes a robust negative correlation between ADL and MDs through comprehensive statistical analysis and machine learning algorithms. The results validate ADL as a promising diagnostic indicator for MDs, with enhanced predictive accuracy when coupled with the Barthel Index. Lower levels of ADL are associated with an increased likelihood of developing memory-related diseases, underscoring the clinical relevance of ADL assessment in early disease detection.

Examining the factors associated with functional capacity of community-dwelling older adults using the ICF framework: a cross-sectional study from the Frailty in Brazilian Older Adults Study (FIBRA)

BACKGROUND

There are many factors associated with functioning and disability in older adults and these relationships are not clear.

OBJECTIVE

To explore the factors associated with functional capacity of older adults using the framework of the International Classification of Functioning, Disability, and Health (ICF).

METHODS

This is a cross-sectional study with a dataset from a survey of 1 377 community-dwelling older adults (≥ 65 years) in a middle-income country. Three functional outcomes were selected to represent the functioning domains: 1) muscle strength for body function; 2) walking speed for activity; and 3) advanced activities of daily living (ADL) for participation. Demographic, clinical, and social information was selected to represent the domains of health conditions and contextual factors (i.e. personal and environmental factors). Multivariate models tested the impact of these factors on each outcome.

RESULTS

Depressive symptoms, age, and physical activity were associated with the three outcomes. Muscle strength was also associated with urinary incontinence, visual deficits, female sex, and employment. Walking speed was also associated with urinary incontinence, obesity, fractures due to falls, female sex, health professionals' visits, and walking aid devices. Advanced ADL were also associated with stroke, visual deficits, education, employment, health perception, social support, and walking aid devices.

CONCLUSION

Functional capacity of older adults is associated with some non-modifiable factors, such as age and sex. The modifiable factors must be addressed by health professionals and policymakers in the geriatric area, especially depression, obesity, physical inactivity, and social support.

Social determinants of health associated with attitudes towards hearing loss and hearing aids in older adults fitted in a Latin American country: validation of the ALHQ questionnaire into Spanish

OBJECTIVE

This study aimed to evaluate the association between certain social determinants of health (i.e. educational level, income, and social support) and attitudes towards hearing loss and hearing aids among older adults with hearing loss fitted in a Latin American country.

DESIGN

Older adults were asked about their attitudes towards hearing loss and hearing aids, years of formal education, income, social support, perception of having a hearing disability, and social pressure when using the hearing aid. To do so, we adapted the Attitudes towards Loss of Hearing Questionnaire (S-ALHQ) into Spanish. All the questionnaires were conducted as structured interview.

STUDY SAMPLE

Two hundred fifty-two older hearing aids users were recruited from a public hospital in Chile.

RESULTS

The S-ALHQ showed adequate validity, along with good reliability. The multivariate models showed that educational level and social support were the social determinants of health negatively associated with the attitudes. Aided hearing disability and social pressure to use hearing aids were the co-variables associated with S-ALHQ scores.

CONCLUSIONS

The study showed a significant relationship between specific social determinants of health and attitudes towards hearing loss and hearing aids. These attitudes should be considered when implementing rehabilitation programs for older adults with hearing loss.

Association between lower serum vitamin D (25-hydroxy-cholecalciferol) concentrations and cognitive impairment in older adults: data from a populational-based cohort study in a middle-income country

OBJECTIVE

To investigate the association between serum vitamin D (25-hydroxy-cholecalciferol) (25(OH)D) concentrations and cognitive impairment in older adults living in Southern Brazil.

DESIGN

Cross-sectional analysis using data from the second follow-up wave of the populational-based EpiFloripa Aging Cohort Study was collected in 2013-2014.

SETTING

Cognitive impairment was evaluated using the Mini-Mental State Examination (MMSE). Blood samples were collected to measure serum vitamin D concentrations using a chemiluminescent microparticle immunoassay. Vitamin D concentrations were distributed in quartiles (Q1: 4·0-20·7 ng/ml; Q2: 20·8-26·6 ng/ml; Q3: 26·7-32·0 ng/ml and Q4: 32·1-60·1 ng/ml), and its association with cognitive impairment was tested by crude and adjusted logistic regression (sociodemographic, behavioural and health aspects) using Q4 as a reference group.

PARTICIPANTS

200 men and 371 women aged 60 years or older participated in this study.

RESULTS

The prevalence of probable cognitive impairment was 21·7 %. Those without cognitive impairment had a higher mean of vitamin D serum concentrations (26·8 v. 24·6, P = 0·014). In the crude analysis, only individuals in Q2 of vitamin D presented an increased risk for probable cognitive impairment compared with Q4 (highest quartile) (OR 2·65, 95 % CI 1·46, 4·81), remaining significant in the adjusted analysis (OR 6·04, 95 % CI 2·78, 13·13). While Q1 (lowest quartile) was not associated in the crude analysis, but when adjusted, an increased risk of cognitive impairment was observed.

CONCLUSION

The lowest quartile of vitamin D was directly associated with probable cognitive impairment in older adults in Southern Brazil. More studies are needed to investigate whether maintaining adequate serum levels may represent a significant factor in preventing age-related neurological disorders as well as to verify the need for new cutoff points for this age group.

Validating intrinsic capacity to measure healthy aging in an upper middle-income country: Findings from the ELSI-Brazil

Background

While efforts have been made to validate intrinsic capacity (IC) as a multidimensional indicator of healthy aging in high-income countries, we still need evidence from lower-income countries. We examined associations of IC with wide ranges of activities of daily living in a nationally representative sample of Brazilians aged≥50 years.

Methods

This cross-sectional analysis included 7175 participants from the Brazilian Longitudinal Study of Aging. IC domains (cognitive, psychological, sensory, locomotor, and vitality) were determined using self-reported and physical performance measures. IC was operationalized through factorial analysis. We investigated associations of IC and its domains with functional ability in basic, instrumental, and advanced activities of daily living (ADL, IADL, and AADL) using logistic regressions adjusted for sociodemographic, clinical, and modifiable risk factors.

Findings

The IC bi-factorial model revealed satisfactory goodness-of-fit. Preserved ability in ADL and IADL, respectively, ranged from 69% and 29% to 89% and 74% across IC quartiles. In adjusted analyses, every standard deviation increment in IC composite score was associated with almost twice the odds of preserved ADL (OR=1·72; 95%CI=1·54-1·93), preserved IADL (OR=1·95; 95%CI=1·77-2·16), and high performance in AADL (OR=1·79; 95%CI=1·59-2·00). Similar results were reported using the IC domains as predictors. Although age, race/ethnicity, and education did not modify associations of IC with functional ability, we found sex differences with stronger relationships of IC with preserved ADL or IADL in females.

Interpretation

Our results support IC validity and reliability to measure healthy aging in diverse socioeconomic and cultural settings. Incorporating IC in routine practices can promote holistic and person-centered care approaches in aging societies.

Funding

The Brazilian Ministry of Health and Ministry of Science, Technology, Innovation, and Communication.

Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges

Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.

Watching TV and Cognition: The SPAH 2-Year Cohort Study of Older Adults Living in Low-Income Communities

Watching TV is a highly prevalent leisure activity among older adults and, in many cases, the only leisure option of those living in low-income communities. While engaging in leisure activities have proven to protect older adults from cognitive decline, the effects of watching TV on cognition of this population is controversial in the literature. This study investigated the impact of watching TV on global cognitive function, immediate memory, verbal fluency, risk of dementia of amnestic mild cognitive impairment (aMCI) in a cohort of older adults residents of socioeconomically deprived areas of São Paulo, Brazil. We used data from the São Paulo Aging & Health Study (SPAH). Participants aged 65 years or over, with no dementia diagnosis at baseline and who completed the 2-year follow-up assessment were included in this study (n = 1,243). Multivariable linear regression models were performed to assess the effect of watching TV on global cognitive function, immediate memory and verbal fluency. Multivariable logistic regression models were used to evaluate the risk of developing dementia and aMCI. Models were controlled by cognitive performance at baseline, sociodemographic characteristics and functional status. Cognitive performance at baseline and follow-up were similar. Thirty-one participants were diagnosed with dementia, and 23 with aMCI 24 months after inclusion in the study. Watching TV did not show any positive or negative effect on global cognitive function, immediate memory, verbal fluency, risk of dementia and risk of aMCI. It is good news that watching TV did not predict the decline in cognition in elders. However, it is essential to increase opportunities for other leisure activities for low-income and low-educated older adults if we do consider that leisure activities protect cognition decline in older adults. In the coming decades, developing countries will experience the highest burden of dementia and more than fun, public policies to promote leisure activities might be a strategy to alleviate this burden shortly.

Associação entre limitação funcional e deficit cognitivo em pacientes idosos hospitalizados

Resumo Introdução A hospitalização é reconhecida como um fator de risco para o declínio funcional do idoso, bem como para o declínio cognitivo. Entretanto, a associação entre essas variáveis ainda não é bem estabelecida, sobretudo no contexto hospitalar. Objetivo Verificar a associação entre deficit cognitivo e limitação funcional em atividades básicas da vida diária entre idosos hospitalizados. Método Estudo seccional, com idosos internados em dois hospitais públicos. Foi verificada a presença de deficit cognitivo por meio do teste de rastreio Mini Exame do Estado Mental e a presença de limitação funcional pelo Índice Katz para Atividades Básicas de Vida Diária. Foi realizada análise descritiva da amostra e regressão logística, estimando-se os valores de odds ratio e respectivos intervalos de confiança (95%). Resultados A prevalência de deficit cognitivo foi de 51,5% (IC95%, 41,6-61,4) e 37,6% dos idosos apresentaram dependência em uma ou mais atividades básicas de vida diária. Os resultados mostraram que tanto o número de atividades comprometidas (p=0,002) quanto a classificação final do índice Katz (p=0,001) foram diferentes estatisticamente entre os grupos de idosos com e sem deficit cognitivo. Entre os idosos que eram dependentes parciais para as atividades, 14,9% apresentaram deficit cognitivo; já entre aqueles que eram dependentes totais, o valor foi de 13,9%. Os idosos dependentes nas atividades apresentaram 5,08 vezes (IC95%, 1,84-14,01) maior chance de deficit cognitivo. Conclusão: O deficit cognitivo foi associado à limitação funcional e os resultados colaboraram no direcionamento da sistematização da assistência precoce direcionada, a fim de minimizar perdas cognitivas e funcionais na hospitalização.

Awareness of Functional Status: People with Alzheimer's Disease Abilities to Self-Report Impairment in Activities of Daily Living

BACKGROUND

Awareness of functional status may underlie specific profiles and differences related to stage severity in individuals with Alzheimer's disease (AD).

OBJECTIVE

This study aimed to assess self-reported experiences of awareness of functional activity in people with mild and moderate AD.

METHODS

This is a mixed methods approach. The qualitative part was conducted through semi-structured interviews concerning the experiences and awareness of deficits in 38 older adults with mild or moderate AD. The quantitative approach included a comparison between groups with regard to concerns of awareness and clinic and demographic data.

RESULTS

Impairment on awareness of disease and awareness of functional deficits was observed even in the mild stages of AD. There was also a noticeable progression of impairments of both kinds of awareness from mild to moderate stage of disease. The majority of participants with mild and moderate AD were partially aware of their functional deficits. Both groups of participants reported some negative impact; however, they were not able to entirely describe their functional status. Also, deficits to recognize the need for help with hygiene and general tasks were observed. Significant differences were found in awareness of need for help with general tasks and awareness of need for help with hygiene tasks.

CONCLUSION

People with mild and moderate AD may describe their aware of the disease better than specific functional deficits, and most of them can provide some reports concerning to the impact of the disease.

The association between nutritional status, advanced activities of daily living, and cognitive function among Brazilian older adults living in care homes

Institutionalized older adults are at greater risk of malnutrition, which is associated with cognitive impairment. This study investigated the association between nutritional status, advanced activities of daily living (AADL), and cognitive function among Brazilian older adults living in care homes. This cross-sectional study was conducted on 95 older adults (73.3 ± 12.5 years). Socio-demographic variables, cognitive function (measured by Mini Mental State Examination - MMSE), AADL, Mini Nutritional Assessment (MNA), and anthropometric variables were assessed. Regarding MNA, 37.8% were malnourished, 47.3% were at risk of malnutrition, and 14.9% were well-nourished. Malnourished participants (37.8%) and those with fewer number of AADL (82.3%) showed cognitive decline (MMSE < 24) (p = 0.000 and 0.030, respectively). Inadequate waist-hip ratio was associated with cognitive decline (OR 9.3; 95% IC, 9.06 - 9.85; p = 0.03). Nutritional status and AADL were associated with cognitive function. Nutritional assessment helps to early identify malnutrition and possibly to prevent cognitive impairment.

Influence of instrumental activities of daily living on the cognitive impairment: EpiFloripa study

Objective: To investigate the influence of instrumental activities of daily living (IADL) on cognitive impairment of the older adults' population in southern Brazil.Methods: A longitudinal, population-based and home-based study that evaluates the older adults population (60 years or older) living in the city of Florianópolis, Southern Brazil. The sample at the baseline (2009/2010) was composed by 1,702 older adults. Cognitive impairment and IADL disability were investigated. A multilevel logistic model was used, in which the analyzed variables were included as the first level and time (baseline and follow-up interviews) as the second level variable.Results: The prevalence of cognitive impairment increased from baseline to follow-up. There was an increase in the chance of the older adults presenting cognitive impairment among those with low (OR: 1.5, 95% CI: 1.0-2.3) and moderate/severe disability (OR: 3.2, 95% CI: 2.1-4.9). Adjusted probability of presenting the outcome almost doubled among those with mild disability, and were nearly four times higher among the older adults with moderate/severe disability when compared to those without disability.Conclusions: IADL disability can be considered an indicator of risk for clinical diagnosis of cognitive impairment. Its evaluation and follow-up are of paramount importance, especially in the older adults with mild disability, in order to avoid the progression of functional and cognitive impairment over time.

Cognition and Daily Functioning: Results from the Hispanic Community Health Study/Study of Latinos (SOL) and Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA)

BACKGROUND

Among older adults, poorer cognitive functioning has been associated with impairments in instrumental activities of daily living (IADLs). However, IADL impairments among older Hispanics/Latinos is poorly understood.

OBJECTIVE

To characterize the relationships between cognition and risk for IADL impairment among diverse Hispanics/Latinos.

METHODS

Participants included 6,292 community-dwelling adults from the Study of Latinos - Investigation of Neurocognitive Aging, an ancillary study of 45+ year-olds in the Hispanic Community Health Study/Study of Latinos. Cognitive data (learning, memory, executive functioning, processing speed, and a Global cognitive composite) were collected at Visit 1. IADL functioning was self-reported 7 years later, and treated as a categorical (i.e., risk) and continuous (i.e., degree) measures of impairment. Survey two-part models (mixture of logit and generalized linear model with Gaussian distribution) and ordered logistic regression tested the associations of cognitive performance (individual tests and composite z-score) with IADL impairment. Additionally, we investigated the moderating role of age, sex, and Hispanic/Latino background on the association between cognition and IADL impairment.

RESULTS

Across all cognitive measures, poorer performance was associated with higher odds of IADL impairment 7 years later. Associations were generally stronger for the oldest group (70+ years) relative to the youngest group (50-59 years). Sex and Hispanic/Latino background did not modify the associations. Across the full sample, lower scores on learning, memory, and the Global cognitive composite were also associated with higher degree of IADL impairment.

CONCLUSION

Across diverse Hispanics/Latinos, cognitive health is an important predictor of everyday functioning 7 years later, especially in older adulthood.

Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: A four-year follow-up study with older adults

OBJECTIVE

Evaluate the cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization in older adults over a four-year period.

METHOD

Four hundred five older adults (60-95 years; mean age: 70.62 ± 7.12 years), 57 % female. The frailty evaluation was performed using the clinical criteria of the Cardiovascular Health Study (CHS): weight loss, fatigue, weakness, slowness and low physical activity. Cognitive impairment was defined by cutoff scores of the Mini Mental State Examination (MMSE) based on schooling. Follow-up - functional decline was assessed using the Lawton&Brody scale of instrumental activities of daily living (IADL). An investigation was also performed of the occurrence of falls and admissions to the hospital in the previous twelve months.

RESULTS

Cognitive impairment was associated with admissions to the hospital and declines in the IADL category of using a telephone. Frailty was associated with admissions to hospital. Cumulative effects were observed for hospitalization and the decline in using the telephone and shopping. Frailty and cognitive impairment increased the risk of being admitted to hospital by 557 % and increased the risk of a decline in using the phone by 262% and shopping by 208%. No conditions were associated with the risk of falls.

CONCLUSION

The combination of the MMSE and the CHS criteria was adequate for measuring the cumulative effects of cognitive impairment and frailty. Shared physiological mechanisms may explain the relation between cognitive impairment and frailty, but further investigations are needed in Brazil and other low/middle-income countries.

Does educational level predict hearing aid self-efficacy in experienced older adult hearing aid users from Latin America? Validation process of the Spanish version of the MARS-HA questionnaire

Hearing aids are the most common rehabilitation strategy for age-related hearing loss. However, 25% to 50% of older adults fitted with hearing aids do not wear them post-fitting. Hearing aid self-efficacy has been suggested as one of the key factors that may explain adherence to hearing aids in older adults. The primary aim of this study was to determine a possible association between educational level and hearing aid self-efficacy in older adult hearing aid users from a Latin American country (i.e., Chile). The secondary aim was to determine if in this sample of older adults, hearing aid self-efficacy predicted hearing aid adherence as previously suggested by other studies. The MARS-HA (Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids) questionnaire was used to measure hearing aid self-efficacy. This questionnaire was initially adapted into Spanish (S-MARS-HA) using forward and backward translations by bilingual English-Spanish speakers. A sample of 252 older adults fitted with hearing aids at a public hospital in Santiago, Chile, was investigated. Educational level was measured as the number of years of formal education. Participants responded to the S-MARS-HA along with questions exploring social support, attitudes in using hearing aids, participation in social events, and vision and joint problems. Hearing aid adherence was investigated with the use of a question from the International Outcome Inventory for Hearing Aids. All these procedures were conducted at the participants' homes. Pure-tone average (PTA; 500-4000 Hz) in the fitted ear was obtained from the participants' medical records. Univariate and multivariate regression models were constructed to investigate the association between educational level and hearing aid self-efficacy controlling for the covariates of interest (e.g., social support, attitudes in using hearing aids, PTA). The S-MARS-HA showed an adequate construct validity along with a good reliability. Results of the multivariate regression analyses showed that educational level significantly predicted hearing aid self-efficacy. Covariates significantly associated with this outcome included attitudes in using hearing aids and PTA in the fitted ear. Finally, a significant association between hearing aid self-efficacy and adherence to hearing aid use was observed. In conclusion, this study showed a significant association between educational level and hearing aid self-efficacy in older adults from a developing Latin American country. Thus, this variable should be considered when designing and delivering aural rehabilitation programs such as hearing aids to older adults, especially those from developing countries.

Functional and self-care capacity of people with multiple sclerosis

Objective:

describe the self-care and functionality levels of patients with multiple sclerosis and determine whether sociodemographic, clinical and functional variables interfere with self-care and/or functionality.

Method:

correlational, cross-sectional study with a quantitative approach performed with individuals in outpatient follow-up. We collected sociodemographic and clinical data and applied the Appraisal of Self-care Agency Scale, the Barthel index, the Lawtton and Brody Scale, and the instrument to investigate the performance in Advanced Activities of Daily Living. We performed descriptive and inferential analysis.

Results:

most patients were classified as “having self-care” (82.14%); with moderate dependence (51.19%) for the basic activities of daily living, partial dependence for the instrumental activities of daily living (55.95%), and more active for the advanced activities of daily living (85.71%). Patients with longer disease duration had a higher number of disabilities and, in those with better socioeconomic and educational profile, the functionality was better.

Conclusion:

disease duration was strongly correlated with a higher number of disabilities and better socioeconomic and educational profiles showed to be protective factors for functionality. Care planning should consider the needs observed by the multidisciplinary team, stimulating the development of self-care, functionality and sociability.

Effects of auditory and socio-demographic variables on discontinuation of hearing aid use among older adults with hearing loss fitted in the Chilean public health sector

Background

The percentage of older adults with hearing loss who stop using their hearing aids and the variables associated with this phenomenon have not been systematically investigated in South America. This problem is relevant to the region since countries such as Colombia, Brazil and Chile have public programmes that provide hearing aids to older adults. The aims of this study were to determine the percentage of older adults fitted with a hearing aid at a public hospital in Chile who subsequently stop using it and the auditory and socio-demographic variables associated with the hazard of discontinuing hearing aid use.

Methods

A group that included 355 older adults who had been fitted with a hearing aid was studied retrospectively. In a structured interview, participants were asked about socio-demographic variables and answered part of the Chilean National Survey on Health, evaluating self-perceived hearing loss and responding to questions about discontinuation of hearing aid use and their satisfaction with the device. Survival models were applied to determine the hazard of stopping hearing aid use in relation to the variables of interest.

Results

The rate of discontinuation of hearing aid use reached 21.7%. Older adults stopped using their hearing aids mainly during the first 5–6 months post-fitting, and then this number steadily increased. The income fifth quintile was 2.56 times less likely to stop using the hearing aid compared to the first. Those who self-reported that they could not hear correctly without the hearing aid were 2.62 times less likely to stop using it compared to those who reported normal hearing. The group that was very dissatisfied with the hearing aid was 20.86 times more likely to discontinue use than those who reported satisfaction with the device.

Conclusions

Socio-demographic variables such as economic income and auditory factors such as self-perceived hearing loss and satisfaction with the device were significantly associated with the hazard of stopping hearing aid use. Self-perceived hearing loss should be considered part of the candidacy criteria for hearing aids in older adults in Chile and other (developing) countries.

Relationship between cognitive processing, language and verbal fluency among elderly individuals

Some cognitive dimensions, such as attention, memory and executive functions, may decline with age, while other functions remain intact or even improve due to greater life experience.

Objective

to analyze the relationship between cognitive processing, language and verbal fluency among elderly individuals seen by primary healthcare services located in a city in the interior of São Paulo, Brazil.

Methods

a cross-sectional study with a quantitative method was conducted. A total of 149 elderly individuals were assessed through previously scheduled interviews. Data collection included a questionnaire on sociodemographic data and the Addenbrooke's Cognitive Examination - Revised (ACE-R). Cognitive processing (P300) was assessed using a device that captures potentials elicited in auditory tasks. Descriptive analysis and Spearman's correlation were performed with the level of significance established at 5%.

Results

a negative correlation was found between language and P300 latency, while a positive correlation was found between verbal fluency and P300 amplitude. Comprehension and naming tasks showed a negative correlation with latency. The repetition task revealed a positive correlation with P300 amplitude.

Conclusion

although more extensive testing is needed, these findings suggest that language correlates with P300 latency, whereas verbal fluency correlates with P300 amplitude.

Frailty-associated factors among Brazilian community-dwelling elderly people: longitudinal study

BACKGROUND

Frailty among elderly people is associated with negative health outcomes. Through gaining better understanding of this syndrome over different time periods, healthcare actions that take predictive factors into consideration may be facilitated.

OBJECTIVE

To identify factors associated with frailty syndrome among community-dwelling elderly people over a two-year follow-up.

DESIGN AND SETTING

Longitudinal study on elderly people living in Uberaba (MG), Brazil.Methods: Elderly individuals were selected through multiple-stage conglomerate sampling from a national database. Participants were interviewed and evaluated in 2014 and again in 2016. Predictors were considered at the baseline, and frailty categories (frail, pre-frail or non-frail) at the follow-up. Frailty was identified based on the Fried criteria. Associations with socioeconomic factors, health status and physical performance were investigated using multinomial logistic regression.

RESULTS

353 individuals participated in both assessments. The final model showed that age over 80 years was predictive of both pre-frailty and frailty (odds ratio, OR 4.92; 95% confidence interval, CI: 1.57-15.38; OR 8.64; 95% CI: 2.05-36.35, respectively), while dependency regarding basic activities of daily living (OR 3.66; 95% CI: 1.22-11.02) and poor lower-limb physical performance (OR 7.87; 95% CI: 1.97-31.39) predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15% (OR 0.85; 95% CI: 0.74-0.99).

CONCLUSION

Age over 80 years was predictive of pre-frailty and frailty, while dependency in basic activities of daily living and poor physical performance predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15%.

Associated factors with physical activity and social activity in a sample of Brazilian older adults: data from the FIBRA Study

OBJECTIVE

This study investigates associated factors to participation in four domains of physical activity and social activities among 2344 community-dwelling older adults (72.3 ± 5.5 years; 65.6% female) without cognitive impairment, residents in six Brazilian cities.

METHOD

An adapted version of Minnesota Leisure Time Activity Questionnaire was used to measure physical activity in four different domains. An inventory of social activities was developed for research. Age, gender and family income were assessed by self-report. Comparisons of frequencies and logistic regression analyzes were performed.

RESULTS

All sociodemographic variables were affecting the activity engagement profile of the sample. Have higher family income showed association with high level of leisure time, occupational and transportation physical activity, result supported by the literature. The gender associated with high level of activity varied according to the specific domain of the analyzed activity indicator. Have less age proved to be associated with higher level of activity in all indicators associated with age, highlighting the increasing age as the major barrier to performance physical and social activities in old age.

CONCLUSIONS

Allow the active involvement of older people is the great challenge of public policies that promote active aging.

Social support and cognitive processing among elderly caregivers and non-caregivers of other elderly persons

Abstract Objective : to analyze measures of social support and cognitive processing among elderly caregivers and non-caregivers. Method : a comparative, cross-sectional and quantitative study was performed. Participants were divided into two groups: 41 elderly caregivers of other elderly persons (G1) and 41 elderly non-caregivers (G2). Sociodemographic, health and care variables, social support, cognition and cognitive processing (verified by long-latency auditory evoked potential acquisition with the Neuron-Spectrun-4 / EPM device) were assessed. Results : in G1, the majority were female (n=33, 80.5%), married (n=34, 82.9%), with a mean age of 68.5 (± 5.8) years, a mean 4.5 (± 3.7) years of schooling and had provided care on average for 18.0 (± 18.4) years for 6.5 (± 5.1) hours per day. In G2, the majority were female (n=31, 75.6%), widowed (n=23, 56.1%), had a mean age of 69.8 (± 7.2) years and a mean 3.7 (± 2) years of schooling. There were no statistically significant differences between the groups in social support, cognition and cognitive processing. Conclusion : the task of caring did not have a negative influence on social support and cognitive processing. This research may contribute to the planning of actions among primary health care providers and to future research investigating other factors that permeate this relationship.

Descriptive data in different paper-based cognitive assessments in elderly from the community Stratification by age and education

Cognitive aging is dynamic and heterogeneous in elderly, thus adequate tools such as paper-based tests are relevant to describe the cognitive profile of this population.

[The aging process and work: a case study in the maintenance engineering division of a public hospital in the city of São Paulo, Brazil]

This study aimed to identify and analyze the relations between aging and work. This was a case study in the maintenance engineering division of a high-complexity hospital in the city of São Paulo, Brazil. In September and October 2015, 16 semi-structured interviews were held with the division heads and other workers with a minimum age of 50 years. The data were analyzed with thematic content analysis. Although the workers experienced difficulties resulting from the aging process, these did not prevent them from performing their work activities, since they developed strategies through their knowhow to compensate for their functional losses and/or declines. Still, they felt limited and demotivated due to the poor working conditions, outsourcing of the division, and the prevailing workload organization. Thus, in this division, the working conditions and organization had more impact than the aging process on the individuals' daily work routine.

Early Signs of Pathological Cognitive Aging in Mice Lacking High-Affinity Nicotinic Receptors

In order to address pathological cognitive decline effectively, it is critical to adopt early preventive measures in individuals considered at risk. It is therefore essential to develop approaches that identify such individuals before the onset of irreversible dementia. A deficient cholinergic system has been consistently implicated as one of the main factors associated with a heightened vulnerability to the aging process. In the present study we used mice lacking high affinity nicotinic receptors (β2-/-), which have been proposed as an animal model of accelerated/premature cognitive aging. Our aim was to identify behavioral signs that could serve as indicators or predictors of impending cognitive decline. We used test batteries in order to assess cognitive functions and additional tasks to investigate spontaneous behaviors, such as species-specific activities and exploration/locomotion in a novel environment. Our data confirm the hypothesis that β2-/- animals exhibit age-related cognitive impairments in spatial learning. In addition, they document age-related deficits in other areas, such as recognition memory, burrowing and nesting building, thereby extending the validity of this animal model for the study of pathological aging. Finally, our data reveal deficits in spontaneous behavior and habituation processes that precede the onset of cognitive decline and could therefore be useful as a non-invasive behavioral screen for identifying animals at risk. To our knowledge, this is the first study to perform an extensive behavioral assessment of an animal model of premature cognitive aging, and our results suggest that β2-nAChR dependent cognitive deterioration progressively evolves from initial subtle behavioral changes to global dementia due to the combined effect of the neuropathology and aging.

Relations of morale and physical function to advanced activities of daily living in health promotion class participants

[Purpose] The aim of this study was to clarify the relations of morale and physical function to the presence/absence of advanced activities of daily living. [Subjects] The subjects were 86 elderly community residents participating in health promotion classes. [Methods] A questionnaire survey on age, gender, presence/absence of advanced activities of daily living, and Philadelphia Geriatric Center Morale Scale score was conducted, in addition to assessment of fitness, consisting of measurement of height, body weight, grip and knee extensor muscle strength, functional reach, one-leg standing time, and Timed Up and Go test. Furthermore, multiple logistic regression analysis was performed with the presence/absence of advanced activities of daily living as a dependent variable. [Results] Grip strength and Timed Up and Go time were identified as variables influencing the presence/absence of advanced activities of daily living. [Conclusion] Physical function represented by grip strength and Timed Up and Go time was higher among subjects performing advanced activities of daily living.

Advanced Activities of Daily Living (AADLs) and cognitive performance in community-dwelling elderly persons: Data from the FIBRA Study - UNICAMP

Objective The aim of this study was to investigate the relationship between participation in advanced activities of daily living (AADLs) and cognitive performance in community-dwelling elderly persons. Method The data presented is drawn from the population-based study entitled Frailty Profile of Elderly Brazilians (FIBRA-Unicamp). The sample comprised 2,549 older adults without cognitive impairments suggestive of dementia. Data was collected relating to socio-demographic characteristics (sex, age, years of education and family income), health status (number of diseases and depressive symptoms), cognitive performance (Mini-Mental State Examination - MMSE) and self-reported social, physical and intellectual AADLs. Results Mean MMSE scores were significantly higher among men, younger individuals and those with more years of education, higher income, fewer diseases and fewer depressive symptoms. Multivariate linear regression analysis and hierarchical regression analysis showed that years of education, family income and participation in intellectual AADLs were positively associated with cognitive performance. Conclusion The findings suggest that these factors may have a protective role in cognitive aging and that participation in intellectual AADLs can represent a feasible strategy for the promotion of mental health among older adults.