Prevalence of self-reported morbidities and associated factors among community-dwelling elderly in Uberaba, Minas Gerais, Brazil

Cross-Sectional Study on the Association Between Respiratory Muscle Strength and Dynapenic Abdominal Obesity in Community-Dwelling Older Adults

Purpose

Impaired respiratory muscle strength has been associated with some geriatric syndromes. However, no studies have previously evaluated the relationship between respiratory muscle strength and dynapenic abdominal obesity. This study aimed to analyze whether there is an association between respiratory muscle strength and abdominal obesity, dynapenia and dynapenic abdominal obesity (DAO) in community-dwelling older adults.

Patients and Methods

Cross-sectional study conducted with community-dwelling older adults (n=382 / 70.03 ± 7.3 years) from Macapá, Amapá, Brazil. Respiratory muscle strength was assessed by measuring maximal inspiratory and expiratory pressures (MIP and MEP, respectively), using an analog manovacuometry. DAO was defined as the combination of dynapenia (grip strength < 26 kgf for men and < 16 kgf for women) and abdominal obesity (abdominal circumference > 102 cm for men and > 88 cm for women). We performed descriptive and inferential statistical analyses using the student's t-test for independent and related samples and linear regression model.

Results

Older adults with abdominal obesity, dynapenia, and DAO presented lower mean values (obtained and obtained versus predicted; except abdominal obesity versus MIP) for maximal respiratory pressures compared to individuals without these conditions. However, the adjusted analysis only indicated an association between MIP and the following conditions: dynapenia (MIP - β =-0.171; p<0.001), abdominal obesity (MIP - β=0.102; p=0.042), and DAO (MIP - β=-0.101; p=0.028).

Conclusion

Older adults with abdominal obesity, dynapenia, and DAO showed impaired maximal respiratory pressures. The results of the adjusted analysis indicate that inspiratory muscle strength may require greater attention by health professionals aiming at preventing respiratory complications and improving respiratory health care in older people with these conditions.

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.

Health self-care practices among community older adults with morbidity

OBJECTIVES

to describe sociodemographic and health characteristics of older adults with morbidity, identify self-care practices and verify the association of sociodemographic variables with those related to health and self-care practices.

METHODS

a quantitative, analytical and cross-sectional household survey, developed in the urban area in the countryside of Minas Gerais, from 2017 to 2018. A total of 796 older adults were assessed using validated instruments, such as Geriatric Depression Scale: short form, Brazilian Questionnaire for Functional and Multidimensional Assessment, International Physical Activity Questionnaire, Instrument for Assessing Attitude Towards Taking Medications. Multiple logistic regression (p<0.05) was used.

RESULTS

negative self-perceived health was associated with low income and education. As for self-care in health, being physically active associated with the age group 60 |-| 79 years and higher education.

CONCLUSIONS

sociodemographic variables such as sex, age group, income, education, marital status, housing arrangement were related to health status and self-care practice.

Práticas de autocuidado em saúde entre pessoas idosas com morbidade da comunidade

RESUMO Objetivos: descrever as características sociodemográficas e de saúde dos idosos com morbidade, identificar as práticas de autocuidado e verificar a associação das variáveis sociodemográficas com as relacionadas à saúde e às práticas de autocuidado. Métodos: inquérito domiciliar quantitativo, analítico e transversal, desenvolvido na zona urbana no interior de Minas Gerais, de 2017 a 2018. Avaliados 796 idosos por instrumentos validados, como Escala de Depressão Geriátrica abreviada, Questionário Brasileiro de Avaliação Funcional e Multidimensional, Questionário Internacional de Atividade Física, Instrumento de Avaliação da Atitude Frente à Tomada de Remédios. Utilizou-se regressão logística múltipla (p<0,05). Resultados: a autopercepção de saúde negativa associou-se às baixas renda e escolaridade. Quanto ao autocuidado em saúde, ser ativo fisicamente associou-se à faixa etária 60 |-| 79 anos e à maior escolaridade. Conclusões: as variáveis sociodemográficas, como sexo, faixa etária, renda, escolaridade, estado conjugal, arranjo de moradia, relacionaram-se à condição de saúde e à prática de autocuidado.

Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis

OBJECTIVE

To estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC).

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, Global Health, Scopus and LILACS up to 1 July 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

The outcome was the prevalence of multimorbidity. Reports were selected whether they enrolled adult individuals (age ≥18 years) from the general population.

DATA EXTRACTION AND SYNTHESIS

Reviewers extracted relevant data and assessed risk of bias independently. A random-effects meta-analysis was conducted to report pooled prevalence estimates of multimorbidity; pooled estimates by pre-specified subgroups (eg, national studies) were also pursued.

RESULTS

From 5830 results, we selected 28 reports, mostly from Brazil and 16 were based on a nationally representative sample. From the 28 selected reports, 26 were further included in the meta-analysis revealing a pooled multimorbidity prevalence of 43% (95% CI: 35% to 51%; I²: 99.9%). When only reports with a nationally representative sample were combined, the pooled prevalence was 37% (95% CI: 27% to 47%; I²: 99.9%). When the ascertainment of multimorbidity was based on self-reports alone, the pooled prevalence was 40% (95% CI: 31% to 48%; I²: 99.9%); this raised to 52% (95% CI: 33% to 70%; I²: 99.9%) for reports including self-reported and objective diagnosis.

CONCLUSIONS

Our results complement and advance those from global efforts by incorporating much more reports from LAC. We revealed a larger presence of multimorbidity in LAC than previously reported.

PROSPERO REGISTRATION NUMBER

CRD42020196177.

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors. Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables. Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28). Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08-1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31-3.47) and with scores 24-29 (OR 1.92; 95% CI 1.07-3.43) or 11-23 (OR 2.09; 95% CI 1.15-3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24-9 (OR 2.38; 95% CI 1.31-4.33) or low 11-23 (OR 5.31; 95% CI 2.69-10.45) scores in neuroticism were more likely to evaluate their health as very good/good. Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

Prevalência de sintomas depressivos e fatores associados em idosos de Unidades de Atenção Primária à Saúde em Rio Branco, Acre

Resumo Objetivo Estimar a prevalência de sintomas depressivos e fatores associados em idosos assistidos por Unidades de Atenção Primária à Saúde em Rio Branco, Acre, Brasil. Método Estudo transversal realizado com idosos cadastrados em duas unidades de Atenção Primária à Saúde de Rio Branco, Acre, entre 2016 e 2017. A prevalência de sintomas depressivos foi medida por meio da Geriatric Depression Scale (GDS-15) e as associações foram testadas com variáveis selecionadas. Foram calculadas as razões de prevalências brutas e ajustadas com intervalo de confiança de 95%, por regressão de Poisson, com variância robusta. Resultados A prevalência de sintomas depressivos foi de 74,5%. Os fatores mais fortemente associados foram: percepção de insegurança no local de moradia (RP=1,46; IC 95% 1,23-1,74), renda familiar menor que um salário mínimo (RP=1,10; IC 95% 1,01-1,20) e autopercepção da saúde insatisfatória (RP=1,25; IC 95% 1,14-1,37), ajustados por sexo, faixa etária, escolaridade, atividade laboral e fragilidade. Conclusão Evidenciou-se uma elevada prevalência de sintomas depressivos na população estudada. A identificação dos fatores associados apontou a vulnerabilidade socioeconômica e de saúde nas quais os idosos estão imersos, relacionando-se com as condições associadas à sintomatologia depressiva.

Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study

BACKGROUND

The scientific literature has shown that an association between polypharmacy and frailty exists. However, few studies have also considered drug interactions and the use of potentially inappropriate medications.

OBJECTIVE

To evaluate the association between the use of drugs and frailty among community-dwelling older people.

DESIGN AND SETTING

Cross-sectional study carried out among 580 older people in Uberaba (MG).

METHODS

Data were collected at these older people's homes using instruments validated in Brazil. Descriptive, bivariate and binary logistic regression analyses were performed (P < 0.05).

RESULTS

Most of these individuals were classified as pre-frail (55.7%), while 13.1% were frail. It was found that 31.7% of them presented polypharmacy, 41.7% had drug interactions and 43.8% were using potentially inappropriate medications. In the initial model, polypharmacy (odds ratio, OR = 1.91; confidence interval, CI = 1.27-2.86) and use of potentially inappropriate medications (OR = 2.45; CI = 1.68-3.57) increased the chance that these older people would be pre-frail or frail. In the final adjusted model, use of potentially inappropriate drugs remained associated with the outcome (OR = 2.26; CI = 1.43-3.57).

CONCLUSION

Use of potentially inappropriate medications was the independent variable that explained the occurrence of frailty in a representative sample of community-dwelling older adults.

Respiratory muscle strength for discriminating frailty in community-dwelling elderly: a cross-sectional study

OBJECTIVES

To compare obtained and predicted inspiratory and expiratory muscle strength between frail, pre-frail, and non-frail older people; to examine the association between inspiratory and expiratory muscle strength and frailty in older people; and to determine cut-off points for inspiratory and expiratory muscle strength for discriminating frailty in older people.

METHODS

A cross-sectional study was conducted with 379 community-dwelling older adults. Frailty was assessed using Fried's phenotype, while inspiratory and expiratory muscle strength were measured with maximum inspiratory and maximum expiratory pressures. Inferential analyses were performed using paired Student t-tests, one-way analysis of variance (ANOVA) tests, and a multinomial logistic regression model. ROC curves were constructed to establish cut-off points of maximum inspiratory and expiratory pressures for discriminating frailty and pre-frailty.

RESULTS

Frail and pre-frail participants presented significantly lower mean inspiratory and expiratory pressures compared to non-frail participants; values were significantly lower than predicted. Inspiratory and expiratory muscle strength were inversely associated with frailty and pre-frailty. Cut-off points ≥-50cmH₂O and ≤60cmH₂O for maximum inspiratory and expiratory pressures, respectively, were established as optimal discriminators of frailty. The cut-off point ≤65cmH₂O for maximum expiratory pressure was established as a discriminant for the presence of pre-frailty.

CONCLUSIONS

Inspiratory and expiratory muscle strength were lower in frail than in pre-frail older adults, and lower in pre-frail than in non-frail peers. Frailty and pre-frailty were inversely associated with inspiratory and expiratory muscle strength. Cut-off points for inspiratory and expiratory muscle strength may be useful in clinical practice for discriminating frailty and pre-frailty in older adults.