Adaptação transcultural e análise da confiabilidade do Southampton Assessment of Mobility para avaliar a mobilidade de idosos brasileiros com demência

Correlation between functionality, mobility and risk of falls in elderly people with Alzheimer’s disease

Abstract To evaluate functional capacity, mobility and balance in elderly patients with Alzheimer's Disease (AD), in its mild, moderate and severe forms, verifying the existence of correlation among these parameters. Eighty-eight elderly patients (81.79 ± 6.54 years) diagnosed with AD treated at an elderly care reference center in Taguatinga-DF were selected, and information was collected between November 2018 and March 2019. Data collection was initially made by filling in the evaluation form. Subsequently, two questionnaires were administered to caregivers (Clinical Dementia Rating-CDR and Disability Assessment for Dementia -DAD) and two tests to demented patients (Southampton Assessment of Mobility-SAM-Br and Timed Up and Go-TUG). Variables were correlated using the SPSS software version 22 using Pearson's correlation, with significance level p?0.05. The following results were obtained: 1. weak correlations between CDR and DAD (p = 0.04; r = -0.31) with significant difference; 2. strong correlation and significant difference between CDR and TUG (p = 0.02; r = 0.87); 3. weak and non-significant correlation between CDR and SAM-Br (p = 0.14; r = -0.24); 4. significant difference and highly strong correlation between SAM-Br and TUG (p = 0.01; r = 0.70). Older adults with Alzheimer's disease present decreased functional capacity, mobility and risk of falls associated with the disease progression. SAM-Br and TUG tools showed strong correlation and, although it is a generic measure, TUG showed strong correlation with AD progression, and may be a predictive test for the risk of falls in this population.

Can clinical and physical-functional factors predict falls in cognitively impaired older adults?

Abstract Objective: to investigate the frequency of falls and clinical and physical-functional factors associated with falls, and the accuracy of such factors to identify the risk of falling in cognitively impaired older adults. Method: a cross-sectional study with cognitively impaired older adults was carried out using the Mini-Mental State Examination. The dependent variable was a history of falls in the previous six months. The independent variables were self-reported mental confusion, hearing and visual impairment, physical fatigue, muscle weakness, dizziness, body imbalance, insecurity when walking, diagnosed depression, hospitalizations, continuous use medications (form from study used), muscle mass (calf circumference) and handgrip strength (dynamometry), functional capacity (Pfeffer) and mobility (SAM-Br). Descriptive statistics were applied. The groups were compared using the Mann Whitney U test, the risk factors were identified by univariate and multivariate logistic regression, and the area under the ROC curve (AUC) was calculated for the associated factors. Results: 216 cognitively impaired older adults were included in the analysis, 41.7% of whom were fallers. Multivariate regression analyzes indicated that complaints of visual impairment (OR=2.8; p=0.015) and body imbalance (OR=2.7; p=0.004), and greater medication use (OR=1.1; p=0.038) were associated with a history of falls. The AUC found poor accuracy for quantity of medications as a screening tool for fallers (AUC=0.6 [0.5; 0.7]; p=0.028). Conclusion: cognitively impaired older adults had a high frequency of falls. Complaints of visual impairment, body imbalance and polypharmacy were predictors of falls. The early assessment of these factors can contribute to the identification of cognitively-impaired older adults at risk of falling in clinical practice and research.

O impacto do declínio cognitivo, da capacidade funcional e da mobilidade de idosos com doença de Alzheimer na sobrecarga dos cuidadores

O objetivo foi avaliar capacidade funcional, mobilidade e função cognitiva de idosos com a doença de Alzheimer (DA), bem como o nível de sobrecarga de seus cuidadores, verificando possíveis associações entre essas variáveis. Foram selecionados 28 idosos (77,8±8,3 anos) diagnosticados com DA por meio do manual diagnóstico e estatístico das doenças mentais e da Classificação Internacional de Doenças; e também os respectivos cuidadores (58,0±13,9 anos), todos participantes da Associação Brasileira de Alzheimer em Goiás. Foram avaliadas função cognitiva, mobilidade e capacidade funcional dos idosos, por meio do miniexame do estado mental, Southampton assessment of mobility e Disability assessment for dementia, respectivamente. O nível de sobrecarga dos cuidadores foi avaliado pela Zarit burden interview. As associações foram calculadas pelo teste de correlação de Spearman e o nível de significância fixado em 0,05. Obtiveram-se correlações fracas significativas entre o nível cognitivo e a escolaridade dos idosos (r=0,389; p=0,041), nível de funcionalidade dos idosos e nível de sobrecarga dos cuidadores (r=-0,398; p=0,036), e mobilidade e tempo de diagnóstico da DA (r=0,401; p=0,042). Os resultados sugerem que o deficit cognitivo não interferiu na capacidade funcional e a perda cognitiva foi proporcionalmente maior que a perda da mobilidade. Foi possível associar a sobrecarga dos cuidadores ao nível de funcionalidade dos idosos com doença de Alzheimer.

[Cross-cultural adaptation of the Exercise Benefits/Barriers Scale (EBBS) for application in elderly Brazilians: preliminary version]

This article describes the cross-cultural adaptation of the Exercise Benefits/Barriers Scale (EBBS) to the Portuguese language and its application in elderly Brazilians. The EBBS was originally developed in the United States to identify perceptions concerning the barriers to (and benefits of) physical exercise, and thus to determine factors affecting this practice. Cross-cultural adaptation involved the following phases: initial translation, summary of the translation, retranslation into the original language (back-translation), review by an expert panel to evaluate semantic, idiomatic, experimental, and conceptual equivalence, and pre-test of the final version with 30 elderly subjects. The EBBS cross-cultural adaptation allowed proposing a preliminary Portuguese-language version. However, to ensure that the cross-cultural equivalence between the original version and the translation has been fully achieved, it is necessary to compare the psychometric properties of the Portuguese version and the original instrument, a crucial task that is now being performed and will soon be published.

Operacionalização de adaptação transcultural de instrumentos de aferição usados em epidemiologia

O objetivo do artigo foi propor uma sistemática operativa para avaliar o processo de adaptação transcultural de instrumentos desenvolvidos em outros contextos lingüístico sócio-culturais. São feitas considerações sobre a necessidade do uso de instrumentos de aferição robustos; a importância de instrumentos "universais" que permitam sintonias transculturais; e a necessidade de partir para adaptação em contraposição ao desenvolvimento de um instrumento novo. Aborda-se a existência de controvérsias e diferentes propostas processuais na literatura e apresenta-se um modelo de adaptação. Essa síntese envolve os passos operativos dos processos de avaliação de equivalência conceitual, de itens, semântica e operacional, e apresenta um roteiro de análise psicométrica que alicerça a avaliação de equivalência de mensuração. Finalmente, reforça-se a necessidade de cuidar da qualidade da informação em estudos epidemiológicos, incluindo meticulosos processos de adaptação transcultural nas agendas de pesquisas.