Redução da capacidade funcional de idosos residentes em comunidade: estudo longitudinal

Association between vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling Brazilian older adults: results from ELSI-Brazil study

Low serum 25(OH)D levels (< 30 nmol/L) have been associated with increased depressive symptom scores over time, and it is believed that functionality may play a mediating role in the relationship between 25(OH)D and depressive symptoms. To comprehend the association between these factors could have significant implications for public health policy. The aim of this study was to verify the association between simultaneous vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling older adults. This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), collected between 2015 and 2016. The outcomes were functional disability assessed through basic activities of daily living (ADL) and instrumental activities of daily living (IADL). The exposures were vitamin D insufficiency (< 30 nmol/L) and depressive symptoms (≥ 4 points in 8-item version of the Center for Epidemiological Studies-Depression). Crude and adjusted Poisson regression was performed to estimate associations. A total of 1781 community-dwelling older adults included in this study, 14.6% had disability in ADL and 47.9% in IADL; 59.7% had vitamin D insufficient levels, and 33.2% depressive symptoms. The concomitant presence of vitamin D insufficient and depressive symptoms increased the prevalence of ADL by 2.20 (95% CI: 1.25; 3.86) and IADL by 1.54 (95% CI: 1.24; 1.91), respectively. Therefore, preventive strategies to keep older adults physically and socially active, with a good level of vitamin D, are essential to avoid depression and functional disability.

Greater Care Program in the face of the challenges of aging: a qualitative analysis

OBJECTIVE

To understand the perception of different actors involved in the older adults care process in the intersectoral strategy of the Programa Maior Cuidado (PMC - Greater Care Program), aiming at the development of actions that contribute to the improvement of the services provided.

METHODS

Eleven qualitative interviews guided by a semi-structured script were conducted in 2020 with key informants directly involved in the PMC: the older adults and their families, caregivers, health professionals and social assistance. In addition, to understand the functioning and proposals of the PMC, a documentary analysis was also carried out with the tracking of existing information on the guidelines, protocols, and management instruments. The content analysis technique was used to classify textual data, and the interpretation process was mediated by the theoretical-methodological framework of hermeneutic anthropology.

RESULTS

Two categories were identified: "Repercussions of the care offered by the PMC: the 'little' that makes a difference" and "Problems beyond the PMC: the limits of family care in the face of violence against the older adults". For all interviewees, the perception the PMC is very necessary is unison, being able to minimize the occurrence of health problems and avoid transfers of the older adults to hospitals and Long Stay Institutions for the Elderly (Instituição de Longa Permanência - ILPI in Portuguese). Chronic comorbidities increase the demands of health care and generate situations that can be managed by the PMC caregiver. Population aging requires the planning of strategies and public policies aimed at providing continuous care for the older adults, including those living in communities. The PMC emerges as an intersectoral alternative to assist in this issue.

CONCLUSIONS

The PMC can be considered a good practice model to be expanded to other locations, however there are gaps that need to be rediscussed so that its processes are improved and its results enhanced.

Health profile of the elderly person accompanied by the family health strategy in a countryside of Ceará - Brazil

Objective: To evaluate the correlation between functional dependence and emotional state, cognitive function, and ambulation of the elderly people accompanied by a family health team. Methods: A cross-sectional, quantitative, and prospective study was conducted in the city of Quixeré/CE between August 2020 and April 2021. Participated in 229 elderly people registered in the Family Health Strategy teams evaluated using the Lawton scale, MMSE, GDS-15, and Tinneti test. The association of variables was verified using the chi-square or Fisher's exact tests. Odds Ratio (95%CI) were calculated, followed by logistic regression using the Hosmer and Lemeshow test. Results: The sample was primarily composed of women with low education, average age of 70 years, and a high demand for primary health services. Women were more vulnerable to depression, with no difference in falls related to sex. Age was a risk factor for all aspects evaluated. There was a correlation between functional dependence and all aspects analyzed. There was a relationship between the level of functional dependence and education (OR: 2.0; 95%CI: 0.05 - 78.32), living in the rural area (OR: 2.83; 95%CI: 1.6 - 5.1), depression (OR: 5.18; 95%CI: 1.2 – 22.8) and risk of falls (OR: 1.67 CI: 0.8 – 3.5), with the last two factors remaining significant in the logistic regression. Conclusion: Functional dependence to more complex daily activities among the elderly was significant, with an essential relationship with emotional and cognitive aspects and risk of falls.

[Longitudinal association between social capital and functional disability in a cohort of community dwelling older adults]

This study aimed to investigate the association between social capital and functional disability, based on a longitudinal perspective, using data from the cohort of older adults from Bambuí, Minas Gerais State, Brazil. The baseline of this study was composed of all surviving and disability-free - up until the seventh year of follow-up (2004) - older adults who were followed up until 2011. The outcome variable was functional disability for basic activities of daily living (ADL) and instrumental activities of daily living (IADL), separately analyzed. Social capital was the exposure of interest, measured through its cognitive (cohesion and social support) and structural (social participation and satisfaction with the neighborhood) components. Sociodemographic variables, health conditions, and lifestyle habits were used for adjustment purposes, and the occurrence of death was considered a competitive event. The hypothesis of association between social capital and functional disability was tested using the competing risk model, which provides hazard ratios (HR) and a 95% confidence interval (95%CI). After multivariate analysis, social capital - in its structural component - was associated with functional disability. Older adults who were dissatisfied with the neighborhood had a higher risk of developing functional disability for IADL (HR = 2.36; 95%CI: 1.31-4.24), in relation to their counterparts. This study results suggest that functional disability is associated with aspects other than health, evidencing the need for the development of policies and interventions that support aspects related to the physical and social environment in which older adults live.

The positive impact of 12 weeks of dance and balance training on the circulating amyloid precursor protein and serotonin concentration as well as physical and cognitive abilities in elderly women

BACKGROUND

The study aimed to compare the effectiveness of 12-weeks dance training with balance training on fall risk, physical and cognitive functions. The study's second aim was to evaluate the association between physical and cognitive functions with circulating markers of neurodegeneration and cognitive impairments in elders.

MATERIALS AND METHODS

30 older women (aged 73.3 ± 4.5) were randomly assigned into three groups: balance training (BG), dance training (DG) and control group (CG). To assess the study aims Time up and go test (TUG), 6 minute walk test (6MWT), determination test (DT), blood amyloid precursor protein (APP) and serotonin concentration were performed.

RESULTS

The results showed an improvement in 6MWT (p = 0.0001 for DG and BD), walking speed (p = 0.0001 for DG and BG) and TUG, only for DG (p = 0.0013). The number of correct responses in DT increased in both groups (p = 0.014 and p = 0.005, for DG and BG, respectively). In DG the increase in the total number of reactions was observed (p = 0.013). The improvement in cognitive and physical functions was associated with an increase in APP (p = 0.036 and p = 0.014) and a decrease in serotonin concentrations (p = 0.042 and p = 0.049), respectively in DG and BG.

CONCLUSION

Dance training intervention could have more benefits on elders' physical and cognitive functions. However, both trainings may be important factors modifying the concentration of circulating proteins associated with neurodegenerative and cognitive disorders.

Factors correlated with the frailty of elderly in outpatient care: difference between age groups

Abstract Objective to correlate socio-demographic and health variables of elderly people of different age groups with frailty. Method this is a quantitative, cross-sectional study conducted with 50 elderly individuals seen at a Gerontology Outpatient Clinic in the interior of São Paulo. Socio-demographic and health data were collected, including: frailty, cognitive performance, dependence on Basic and Instrumental Activities of Daily Living, and depressive symptoms. For data analysis, the Spearman correlation test was used. Results there was a predominance of women, with a mean age of 79.4 (±9.4) years and low education. A total of 58.3% of the elderly aged between 60 and 79 years and 84.6% of those above 80 years were considered frail. In the first group, there was a correlation between frailty and a higher number of medications, worse cognitive performance, and dependence on Basic and Instrumental Activities of Daily Living. In the oldest old, frailty correlated with a greater number of morbidities, worse cognitive performance, and dependence on Basic and Instrumental Activities of Daily Living. Conclusion and implications for practice the correlations found allow the establishment of measures to improve the planning of actions aimed at outpatient care, enabling the organization of prevention and intervention priorities.

Fatores correlacionados à fragilidade de idosos em atenção ambulatorial: diferença entre grupos etários

RESUMO Objetivo correlacionar variáveis sociodemográficas e de saúde de idosos de diferentes grupos etários com a fragilidade. Método estudo quantitativo, transversal, realizado com 50 idosos atendidos em um Ambulatório de Gerontologia no interior de São Paulo. Foram coletados dados sociodemográficos e de saúde, sendo: fragilidade; desempenho cognitivo; dependência em Atividades Básicas e Instrumentais de Vida Diária e sintomas depressivos. Para a análise dos dados, foi utilizado o teste de correlação de Spearman. Resultados houve o predomínio de mulheres, com média de 79,4 (±9,4) anos de idade e baixa escolaridade. Foram considerados frágeis 58,3% dos idosos entre 60 e 79 anos e 84,6% daqueles acima de 80 anos. No primeiro grupo, houve correlação entre a fragilidade e o maior número de medicamentos, pior desempenho cognitivo, dependência em Atividades Básicas e Instrumentais de Vida Diária. Nos mais longevos, a fragilidade correlacionou-se ao maior número de morbidades, pior desempenho cognitivo e dependência em Atividades Básicas e Instrumentais de Vida Diária. Conclusão e implicações para a prática: as correlações encontradas permitem o estabelecimento de medidas para aperfeiçoar o planejamento de ações voltadas à assistência ambulatorial, possibilitando organizar prioridades de prevenção e intervenção.

Self-Reported and Performance-Based Evaluations of Functional Status in Older Women With Breast Cancer

OBJECTIVES

To evaluate self-reported and performance-based functional status (FS) in older women with breast cancer according to stage and time of visit during treatment.

SAMPLE & SETTING

72 women with breast cancer aged 78 years or older and receiving any type of treatment at a midwestern outpatient clinic.

METHODS & VARIABLES

FS was evaluated using grip strength, the Index of Activities of Daily Living (ADLs), the instrumental ADLs (IADLs) scale, and the Timed Up and Go Test (TUGT). Mixed models were fit for grip strength and the TUGT, and generalized estimating equations were used to fit binary logistic regressions for the Index of ADLs and the IADLs scale. Continuous FS outcomes were evaluated using means and standard deviations.

RESULTS

Cancer stage and time of visit did not affect self-reported or performance-based FS scores. Most participants were considered independent on the Index of ADLs, the IADLs scale, and the TUGT, which did not change significantly between visits. Self-reported measures revealed less impairment.

IMPLICATIONS FOR NURSING

Monitoring FS using self-reported and performance-based measures can ensure that older patients receive timely support.

Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis

Disability is negatively associated with the health of older adults, and it can be mediated by healthy lifestyles and behaviors throughout one's life. In this context, understanding the interrelationships between sedentary behavior, physical activity and functionality may assist in the implementation of effective public health actions. Thus, the aim of the present study was to investigate the relationships between both physical activity and sedentary behavior and functionality in older adults and the possible mediators. The variables analyzed were selected according to the content analysis of International Classification of Functioning, Disability and Health model, and included activity, participation, health conditions, body functions and structures, environmental factors and personal factors. 419 individuals participated in the study. Physical activity was directly associated with disability in instrumental activities of daily living (IADL), and the association was mediated by self-esteem, aerobic endurance, and agility/balance. Sedentary behavior was indirectly associated with IADL disability, and the association was mediated by aerobic resistance, nutritional status, and agility/balance. Regarding the basic activities of daily living (BADL), physical activity showed an indirect association mediated by aerobic resistance and IADL. The association of sedentary behavior with BADL was mediated by aerobic resistance and lower limb flexibility. These results reinforce the idea that functionality is multidimensional, and the mediating factors must be considered when strategies for promoting physical activity and reducing sedentary behavior are designed.

Vulnerabilidade e Declínio Funcional em pessoas idosas da Atenção Primária à Saúde: estudo longitudinal

Resumo Objetivo Avaliar a associação da vulnerabilidade e o declínio funcional para Atividades Instrumentais de Vida Diária (AIVD) em pessoas idosas atendidas em unidades da Atenção Primária à Saúde (APS) no município de Várzea Grande (MT), Brasil. Método Estudo longitudinal realizado com 304 pessoas idosas, com acompanhamento de 24 meses. A variável de exposição principal, vulnerabilidade, foi mensurada na linha de base utilizando-se o Vulnerable Elders Survey (VES-13). A variável dependente foi “declínio funcional em AIVD”, definido como a diminuição de pelo menos um ponto no score de capacidade funcional, avaliada pela Escala de Lawton e Brody, entre a coleta da linha de base e o follow-up. As associações entre declínio funcional em AIVD e vulnerabilidade, condições de saúde, fatores sociodemográficos, autoavaliação de saúde, estilo de vida e eventos adversos em saúde foram estimadas por meio do Odds Ratio (OR), utilizando regressão logística binária. Resultados 35,20% das pessoas idosas apresentaram declínio da capacidade funcional em AIVD. O declínio funcional se associou no modelo final com a interação entre vulnerabilidade e inatividade física (OR=3,12, IC95%, 1,42-6,86), insatisfação com a vida (OR=2,23, IC95%, 1,09-4,56) e hospitalização (OR=2,01, IC95%, 1,18-3,41). Conclusão O declínio funcional em AIVD foi maior nas pessoas idosas vulneráveis que estavam inativas fisicamente, naquelas insatisfeitas com a vida e que foram hospitalizadas durante o período de seguimento, sendo importante que essas condições sejam identificadas precocemente, para que ações de prevenção de declínio funcional sejam implementadas, além dos programas de incentivo à prática de atividade física pelas pessoas idosas.

Functional capacity and physical performance of community-dwelling elderly: a longitudinal study

This study aimed to verify the occurrence of changes in the functional capacity and physical performance of community-dwelling elderly and its determining factors over a two-year period. This is a quantitative, observational and longitudinal household survey conducted in 2014 and 2016, with the participation of 380 elderly from Uberaba, Minas Gerais. The following instruments were used: The Mini-Mental State Examination and questionnaires with sociodemographic/economic, clinical and life habits data. The functional capacity was evaluated through the Katz Index and Lawton-Brody's scale. Physical performance was verified through the Short Physical Performance Battery. A descriptive, bivariate and linear multiple regression analysis was conducted, with a significance level of α < 0.05. The results showed reduced functional capacity for the instrumental activities of daily living and physical performance in a two-year period. The determining factors for both outcomes were age group, occupational activity, and physical activity. Schooling was a specific factor only for the instrumental activities of daily living, and gender and the number of medicines used, for physical performance.

The frailty syndrome in older adults with type 2 diabetes mellitus and associated factors

Abstract Objective: To compare clinical-functional factors among groups in relation to the frailty syndrome (pre-frail and frail) phenotype profile in older adults with type 2 diabetes mellitus (DM 2). Methods: A descriptive, analytical, cross-sectional study with a quantitative approach was performed. A total of 113 diabetic older adults of both sexes were evaluated in terms of their personal, socio-demographic, clinical-functional, mental, cognitive and fragility phenotype data. The Chi-square test and a logistic regression model were used. Results: The mean age was 68.66±6.62 years, and the sample was mostly female (61.9%), illiterate or with an incomplete primary education (60.2%), pre-frail (52.2%), sedentary (79.6%), and had been diagnosed with DM2 for more than 5 years (58.3%). There was a significant association between “pre-frail and frail” individuals and schooling (p=0.004), social participation (p=0.004), a subjective perception of vision (p=0.004), glycated hemoglobin (p=0.036), limb pain (p=0.012), depressive symptoms (p=0.002) and mobility (p=0.004). The logistic regression model showed an accuracy of 93.6% and the significant variables were education (p=0.039), pain in the lower limbs (p=0.025) and risk of falls (p=0.033). Conclusion: among all the factors related to the “pre-frail” and “frail” phenotype, schooling, pain in the lower limbs and mobility were most related to the worsening of the syndrome and its progress.

Contribuições da arteterapia para promoção da saúde e qualidade de vida da pessoa idosa

Resumo Objetivo Analisar as contribuições da arteterapia na promoção da saúde e na qualidade de vida dos idosos. Método Trata-se de uma revisão integrativa utilizando os descritores em saúde: “health promotion”, “art therapy”, “quality of life” e “aged”. Foram selecionados artigos originais completos, nos idiomas português, inglês e espanhol. Não foi estabelecido período de publicação dos artigos para obter um maior quantitativo de artigos publicados no decorrer do tempo. A busca e a seleção dos artigos incluídos foram realizadas por dois revisores no período de novembro de 2019 a abril de 2020. Resultados Dos quatros artigos selecionados para compor a amostra, dois artigos estavam escritos em inglês e dois em português. Os artigos incluídos foram publicados no período entre 2007 e 2014. Quanto às bases de dados, dois artigos estavam indexados na Scopus, um nas bases Scopus/Pubmed/BVS e um na base CINAHL. Os recursos expressivos utilizados no processo arteterapêutico foram os mais variados: pintura, desenho, modelagem, expressão corporal entre outros Conclusão A utilização da arteterapia para promoção da saúde em idosos mostrou benefícios na redução dos fatores negativos de ordem afetiva, emocional social. Os artigos analisados sugerem o efeito positivo da arteterapia na qualidade de vida em idosos.

Falls among the elderly: environmental limitations and functional losses

Abstract Objective : To identify the intrinsic and extrinsic factors that predispose the elderly to falls and to discuss the consequences of these events in their lives. Method : A descriptive, exploratory study with a qualitative approach was carried out in a city in the southwest region of Bahia, Brazil. The target audience was composed of elderly people living in the area covered by the Family Health Strategy of this city. Data collection took place from April to June 2018 through a semi-structured, scripted interview. The content analysis technique proposed by Laurence Bardin was used to analyze and organize the information. Results : From the analysis of the interviews the main factors that predisposed the elderly to falls emerged, and these were methodologically divided into intrinsic and extrinsic. There were also post-fall events, such as the fear of falling again and the need to inhabit the same place where the fall occurred, as this is a domestic environment which, for social reasons, cannot be modified as recommended by preventive educational actions. Conclusion : The results show that falls among these elderly people occurred in the domestic environment due to structural (extrinsic) issues, and are less influenced by health problems (intrinsic). It can therefore be concluded that the need to inhabit the same place where the fall occurred, without it being modified, generates a fear of falling again, limiting independence and reducing functional capacity, and making effective intersectoral actions essential.

Factors influencing the condition of vulnerability among the elderly

Abstract Objective: Describe health conditions and life habits using Vulnerable Elders Survey-13 scores, with the aim of understanding the factors associated with the vulnerability of the elderly. Method: A quantitative, cross-sectional study was conducted in the Distrito Federal, Brazil. Data were collected by a questionnaire containing the Vulnerable Elders Survey-13 and other variables. Descriptive statistics, correlation and regression analyses were carried out. Results: 956 people aged 60 years and older living in the Distrito Federal were interviewed. Of these, 32.4% had scores equal to or greater than three, and were therefore classified as vulnerable. Some variables exhibited a positive relation with VES-13 score, with intensity ranging from very weak, in the case of systemic arterial hypertension (p=0.035) and diabetes mellitus (p=0.027), to moderate, as was the case with depression (p<0.001), urinary loss (p<0.001) and falls (p<0.001). It was also observed that a 1% increase in the income of the elderly resulted in a reduction of 0.27 points (p<0,001) in Vulnerable Elders Survey score, reducing vulnerability. Conclusion: Depression most influenced vulnerability score, followed by urinary and hearing loss. Public policies aimed at the promotion of the physical and mental health of the elderly and the creation of a propitious environment to increase income, through reinsertion into the labor market or welfare policies, can help to reduce vulnerability.

Evaluation of the clinical-functional vulnerability index in older adults

Abstract Objective: To evaluate the clinical-functional vulnerability index (CFVI) of older adults and its relationship with socioeconomic, behavioral, clinical and therapeutic indicators. Method: A cross-sectional epidemiological study with a quantitative design was performed with 318 randomly drawn older adults registered with the Family Health Strategy. Data were collected through the CFVI-20 questionnaire and analysis was supported by descriptive, bivariate and multivariate statistics, with results with p-value <0.05 considered significant. Results: most older adults (59.1%) were considered frail or potentially frail. Among the groups studied, there was a statistically significant difference in the CFVI for the variables age group (p<0.001), functional literacy (p=0.001), alcohol consumption (p<0.001), physical exercise (p<0.001), self-reported health problems (p<0.001) and medication use (p<0.001), as well as a positive correlation with stress (r=0.135; p=0.016). In the multiple linear regression model, the set of sociodemographic predictor variables explained the frailty of the elderly by 30.4% (R2=0.304). Conclusions: The advancement of age, as a non-controllable variable, indicates a need to encourage the maintenance of functionality in old age, based on the health care strategies that prolong longevity with safety, autonomy and vitality.