Evaluation of the clinical-functional vulnerability index in older adults

Factors Associated With PIM use in the Frail Elderly: A Cross-sectional Study

Background: The use of potentially inappropriate medications (PIM) by the elderly is commonly studied, but studies evaluating the use of PIM by frail elderly covered by prepaid health plans are still lacking. Objective: To identify the prevalence of use and the factors associated with the use of PIM by the elderly patients with high and moderate risk of clinical-functional vulnerability, according to the Beers criteria 2019. Methods: A cross-sectional study was developed with elderly people from a private health plan in Vitória-ES, Brazil. Socioeconomic, demographic and clinical data were collected through a digital platform and a structured questionnaire through an interview, from October 2018 to June 2019. The association between the use of PIM and independent variables was verified by univariate logistic regression with their respective confidence intervals (CI) 95%. The Multiple Model included the variables with P ≤ .20. Results: 332 elderly patients were interviewed (mean age 81.5 years, gender 237 female, 95 male). A 65% prevalence of PIM use was identified. In the multiple logistic regression model, the variables associated with the use of PIM were self-medication (P = .004), high risk of clinical-functional vulnerability (P = .022), use of psychotropic medications (P = .000001), musculoskeletal medications (P = .04) and alimentary tract medications (P = .03). Physical exercises were considered a protection factor (P = .02). Conclusion: The high prevalence of PIM use indicates the need for improvement in elderly private health care, to increase pharmacotherapy safety for this population.

Association between Domains of the Clinical-Functional Vulnerability Index and Falls History in Older Adults: A Cross-Sectional Study

Objectives: The study aimed to determine which domains, sets, and isolated or combined questions of the Clinical-Functional Vulnerability Index (CFVI-20) are associated with falls history in older adults. Methods: Instruments used were the CFVI-20 assessment and reported falls during the last year. The receiver operating characteristics (ROC) curves identified the performance of the CFVI-20 domains and questions in identifying older adults with and without falls history, while logistic regression identified relevant questions to identify fall history. Results: This study included 1725 individuals (71.9 ± 7.3 years). The area under the curve (AUC) between the CFVI-20 and fall history was 0.69. The mobility domain presented the largest AUC (0.71; p < 0.01), and most isolated domains showed low AUCs (0.51 to 0.58). Isolated questions were limited to identifying fallers. The regression analysis identified 7 questions of the CFVI-20 with falls. Conclusions: The CFVI-20 general score identified older adults with a fall history. When considered in isolation, most domains were limited to identifying falls, except for the mobility domain. Combining the CFVI-20 questions enabled identification of fallers.

Use of the activities and participation profile to assess the functioning of physically inactive elderly

Abstract Introduction: Physical inactivity negatively impacts the functional status of the elderly during aging. Objective: To describe the activity and participation profile of physically inactive elderly and to investigate associated factors. Methods: A cross-sectional study with physically inactive elderly, aged ≥ 60 years, both sexes, with good cognitive function and independent gait. Personal factors, clinical history, history of falls in the last year, and identification of activity and participation profiles were investigated. Nonparametric statistical tests (SPSS 20.0) were performed, considering p < 0.05 significant. Results: The elderly (n = 36) had a mean age of 72.5 years (±7.7). Most were women (78%), with one to four years of education (69%), retired (72%), referring episodes of falling (58%) and affected by two to four comorbidities (53%). In the activities and participation profile, most of the physically inactive elderly presented mild problems for: crawling, kneeling, squatting, walking long distances, walking on different surfaces, walking around obstacles, climbing, and using public transportation. However, kneeling, squatting, walking on different surfaces, and climbing represented higher percentages of elderly who presented some problem. The advancement of age (p = 0.045), female sex (p = 0.022), episodes of falls (p = 0.037), and comorbidities (p = 0.031) were identified as factors that can impact functioning. Conclusion: The physically inactive elderly presented a mild problem in activities and participation items that are more related to strength and walking. Elderly aged over 70, female, with episodes of falls and comorbidities were significantly associated with reduced or impaired functioning.

Uso do perfil de atividades e participação para avaliação da funcionalidade de idosos inativos fisicamente

Resumo Introdução: A inatividade física impacta negativamente a funcionalidade dos idosos durante o envelhecimento. Objetivo: Descrever o perfil de atividade e participação de idosos inativos fisicamente e investigar fatores associados. Métodos: Estudo transversal com idosos inativos fisicamente, ≥ 60 anos, ambos os sexos, boa função cognitiva e independentes na marcha. Foram investigados fatores pessoais, história clínica, histórico de quedas no último ano e identificação do perfil de atividade e participação. Foram realizados testes estatísticos não paramétricos (SPSS 20.0), considerando p < 0,05. Resultados: Os idosos (n = 36) apresentaram média de 72,5 anos (± 7,7). A maioria era mulher (78%), com escolaridade de um a quatro anos de estudo (69%), aposentados (72%), referindo episódios de queda (58%) e acometidos por duas a quatro comorbidades (53%). No perfil de atividades e participação, a maioria dos idosos inativos fisicamente apresentaram problema leve para os itens: engatinhar, ajoelhar-se, agachar-se, andar longas distâncias, andar sobre superfícies diferentes, andar desviando-se de obstáculos, subir e utilizar transporte público. Entretanto, ajoelhar-se, agachar-se, andar sobre superfícies diferentes e subir compreendem maiores percentuais de idosos que apresentaram algum problema. Idade avançada (p = 0,045), sexo feminino (p = 0,022), episódios de quedas (p = 0,037) e presença de comorbidades (p = 0,031) foram identificados como fatores que podem impactar na funcionalidade. Conclusão: Idosos inativos fisicamente apresentaram problema leve nos itens das atividades e participação que estão mais relacionados à força e ao andar. Idosos com mais de 70 anos, do sexo feminino, com presença de episódios de quedas e de comorbidades, apresentaram associação significativa com a funcionalidade reduzida ou prejudicada.