The sensitivity and specificity of the WHO's ICOPE screening tool, and the prevalence of loss of intrinsic capacity in older adults: A scoping review

BACKGROUND

The World Health Organization has developed the Integrated Care for Older People (ICOPE) program, a public health strategy to maintain older adults' functional abilities and promote healthier aging. The approach comprises a 5-step pathway. Step 1 is the screening for impairment in functions, and Step 2 is an in-depth evaluation to confirm the presence and severity of functional impairment. These initial two steps are crucial to determine the subsequent plan of care (Step 3) and follow-up (Step 4). The fifth step encompasses actions to support families and caregivers and to engage communities. This review gathers data from the literature on the prevalence of positive screenings regarding intrinsic capacity detected by the program's first-step screening tool, and on currently available results regarding the instrument's sensitivity and specificity.

METHODS AND FINDINGS

Electronic searches were conducted in the PubMed, Cochrane, Embase, and SciElo databases, the medRxiv platform, and recent human aging scientific events, looking for research analyzing the ICOPE screening instrument. Studies reporting data on the prevalence of positive screenings for loss of intrinsic capacity using the proposed screening tool and/or findings on the instrument's sensitivity and specificity were included. A total of 7 publications with participants aged 50 years or more were selected. The prevalence of at least one impairment in intrinsic capacity detected by the instrument varied among the studies from 17.1 % to 94.3 %. Sensitivity ranged from 26.4 % to 100 % and specificity from 22 % to 96 %, depending on the setting and the assessed domain.

CONCLUSION

Currently available data are heterogeneous, and different results were found among the studies due to diverse settings and methodologies. The evidence on the ICOPE screening tool's performance in different populations is still scarce and reinforces the need for further research worldwide.

Low phase angle in critically ill older patients is associated with late mortality: A prospective study

OBJECTIVES

The aim of this study was to ascertain the accuracy of phase angle (PhA) as a predictor of mortality during intensive care unit (ICU) stay (M_ICU) and at 28 (M₂₈) and 60 d (M₆₀) after ICU admission among patients aged >60 y.

METHODS

Patients aged >60 y who were under mechanical ventilation (MV) ≥48 h were included once they were hemodynamically stable. PhA was measured by single-frequency bioelectrical impedance analysis up to 48 h after admission. ICU prognostic scores, functional scale, and nutritional assessments were performed in the first 24 h. Patients were followed for 60 d after ICU admission.

RESULTS

We enrolled 102 patients into the present study. PhA was significantly higher (P < 0.001) in survivors at M_ICU, M₂₈, and M₆₀. Areas under the receiving operator characteristic curves for M_ICU, M_28, and M₆₀ were 0.77 (95% confidence interval [CI], 0.67-0.86), 0.71 (95% CI, 0.60-0.82), and 0.71 (95% CI, 0.60-0.81), respectively. The PhA cutoff to predict mortality was 3.29° for males at M_ICU, M₂₈, and M₆₀ and lower for females at M₂₈ (2.63°) and M₆₀ (3.01°). PhA better discriminated M₆₀ than conventional prognostic scores. Logistic regression showed that even after controlling for other factors, PhA was a protective factor against late mortality. Survival analysis at 60 d revealed that low PhA was associated with lower median survival (18 versus 58 d; log-rank P < 0.001).

CONCLUSIONS

Low PhA values are associated with higher late mortality and a short survival time at 60 d in critically ill older adults. Low PhA values can be considered a useful ICU prognostic score in similar populations.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = -.074 (95% CI=-.101; -.046) and β = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

Predictors of functional impairment and awareness in people with dementia, mild cognitive impairment and healthy older adults from a middle-income country

OBJECTIVE

To investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.

METHODS

Dementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben's advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.

RESULTS

PwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.

CONCLUSION

Results reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

Mortality, sarcopenic obesity, and sarcopenia: Frailty in Brazilian Older People Study - FIBRA - RJ

OBJECTIVE

To investigate the risk of mortality associated with sarcopenic obesity (SO), obesity (OB), and sarcopenia in elderlies.

METHODS

We analyzed longitudinal data from 270 participants > 65 years of age of Phase III of the Study on Frailty in Brazilian Older People (FIBRA–RJ–2012). Socioeconomic, demographic, lifestyle, morbidity, and functional data were collected by home based interviews. DXA and body composition assessment was conducted in a laboratory. In women, OB was diagnosed when body fat percentage ≥ 38% and sarcopenia by an Appendicular Lean Mass Index (ALMI) < 6.00 kg/m² and muscle strength < 16 Kgf. In men, OB was diagnosed when body fat percentage ≥ 27%, and sarcopenia was diagnosed with ALMI < 7.00 kg/m² and muscle strength < 27 Kgf. SO was assessed by combining variables used to diagnose obesity and sarcopenia. The probabilistic linkage method was used to obtain deaths in the 2012-January 2017 period from the Brazilian Mortality Registry. Cox regression models were tested, and crude and adjusted hazard ratio calculations were conducted.

RESULTS

After adjusting for sex, age, race/skin color, walking as an exercise, and hypertension, individuals with sarcopenia were 5.7 times more likely to die (95%CI: 1.17–27.99) than others without sarcopenia and obesity.

CONCLUSION

A high risk of death was observed in individuals with sarcopenia. These results show the need for preventive strategies of early detection and treatment in order to increase survival employing multimodal interventions.

Difficulty in taking medication and stroke among older adults with systemic arterial hypertension: the Fibra Study

This article aims to investigate whether difficulty in taking medication is associated with stroke among older adults with Systemic Arterial Hypertension (SAH) and to explore their association with living arrangements. Cross-sectional study was based on 3,502 older adults with SAH from the four universities pole of Frailty in Brazilian Older People (Fibra) Study, Brazil, including 14 municipalities of the five Brazilian regions. We used the medical diagnosis of stroke and difficulty in taking medications (self-reported difficulty and financial difficulty affording prescribed medications). Multivariate analysis was performed using logistic regression. Differently from women, older men with SAH, which report difficulty in taking medication (unintentional non-adherence), have higher odds of stroke. When stratified by living arrangements, those living with a partner have even higher odds of stroke compared to those without difficulty in taking medication and living alone. None association was found for difficulty affording prescribed medication for both men and women. Unintentional difficulty in taking medication plays a role in SAH treatment among men. Primary care strategies for controlling blood pressure should not be focus only on patients but targeting spouses as well.

Sarcopenia in the elderly versus microcirculation, inflammation status, and oxidative stress: A cross-sectional study

BACKGROUND

Age-related mechanisms of sarcopenia associated with vascular function have been recently suggested. This study compared and tested associations between muscle mass and strength, microcirculation, inflammatory biomarkers, and oxidative stress in older adults classified as sarcopenic and non-sarcopenic.

METHODS

Thirty-three physically inactive individuals (72±7 yrs) were assigned to age-matched sarcopenic (SG) and non-sarcopenic (NSG) groups. Between-group comparisons were performed for appendicular skeletal mass (ASM), handgrip and isokinetic strength, microvascular function and morphology, C-reactive protein, insulin-like growth factor-1, tumor necrosis factor-alpha, interleukin-6 (IL-6), soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1, endothelin-1, and oxidized low-density lipoprotein.

RESULTS

ASM and knee isokinetic strength were lower in SG than NSG (P <  0.05). No difference between groups was found for outcomes of microvascular function and morphology, but log-transformed IL-6 concentration was twice greater in SG vs. NSG (P = 0.02). Correlations between ASM index, handgrip and knee isokinetic strength vs. markers of microcirculatory function, capillary diameters, vascular reactivity, and endothelial injury were found only in SG.

CONCLUSION

Decreased ASM index and strength have been associated with microcirculatory profile, indicating that microcirculation impairment may be involved somehow in Sarcopenia development. The inflammation status, particularly elevated IL-6, seems to play an important role in this process.

A multidimensional approach to frailty compared with physical phenotype in older Brazilian adults: data from the FIBRA-BR study

BACKGROUND

Frailty is a predictor of negative health outcomes in older adults. The physical frailty phenotype is an often used form for its operationalization. Some authors have pointed out limitations regarding the unidimensionality of the physical phenotype, introducing other dimensions in the approach to frailty. This study aimed to create a multidimensional model to evaluate frailty in older Brazilian adults and to compare the dimensions of the model created among the categories of the physical frailty phenotype.

METHODS

A cross-sectional study was conducted using data from 3569 participants (73.7 ± 6.6 years) from a multicenter and multidisciplinary survey (FIBRA-BR). A three-dimensional model was developed: physical dimension (poor self-rated health, vision impairment, hearing impairment, urinary incontinence, fecal incontinence, and sleeping disorder), social dimension (living alone, not having someone who could help when needed, not visiting others, and not receiving visitors), and psychological dimension (depressive symptoms, concern about falls, feelings of sadness, and memory problems). The five criteria of the phenotype created by Fried and colleagues were used to evaluate the physical frailty phenotype. The proposed multidimensional frailty model was analyzed using factorial analysis. Pearson's chi-square test was used to analyze the associations between each variable of the multidimensional frailty model and the physical phenotype categories. Analysis of variance compared the multidimensional dimensions scores among the three categories of the physical frailty phenotype.

RESULTS

The factorial analysis confirmed a model with three factors, composed of 12 variables, which explained 38.6% of the variability of the model data. The self-rated health variable was transferred to the psychological dimension and living alone variable to the physical dimension. The vision impairment and hearing impairment variables were dropped from the physical dimension. The variables significantly associated with the physical phenotype were self-rated health, urinary incontinence, visiting others, receiving visitors, depressive symptoms, concern about falls, feelings of sadness, and memory problems. A statistically significant difference in mean scores for physical, social, and psychological dimensions among three physical phenotype categories was observed (p < 0.001).

CONCLUSIONS

These results confirm the applicability of our frailty model and suggest the need for a multidimensional approach to providing appropriate and comprehensive care for older adults.

Does Resistance Training with Blood Flow Restriction Affect Blood Pressure and Cardiac Autonomic Modulation in Older Adults?

Resistance training (RT) with blood flow restriction (BFR) appears to accelerate muscle hypertrophy and strength gains in older populations. However, the training-related effects of RT with BFR upon blood pressure (BP) and cardiac autonomic modulation in the elderly remains unclear. The objective of this study is to compare the chronic effects of low-intensity RT performed with soft BFR (BFR) vs. high-intensity (HI) and low-intensity RT (CON) without BFR on BP and heart rate variability (HRV) indices in older adults. Thirty-two physically inactive participants (72 ± 7 yrs) performed RT for upper and lower limbs (50-min sessions, 3 times/week) for 12 weeks, being assigned into three groups: a) BFR; 30% of 1 repetition maximum (RM) with BFR corresponding to 50% of arterial occlusion pressure; b) HI; 70% of 1RM without BFR; c) CON; 30% of 1 RM without BFR. Resting BP and HRV were assessed at rest in the supine position, before and after exercise interventions. Systolic BP (Δ = -7.9 ± 8.0 mmHg; p = 0.002; effect size = 0.62), diastolic BP (Δ = trace length by the duration of the test 5.0 ± 6.0 mmHg; p = 0.007; effect size = 0.67) and mean arterial pressure (Δ = -6.3 ± 6.5 mmHg; p = 0.003/effect size = 0.77) reduced after BFR, remaining unaltered in HI and CON. HRV indices of sympathetic and vagal modulation did not change in all groups (p ≥ 0.07 for all comparisons). 12-wk RT with low intensity and relatively soft BFR substantially reduced BP at rest in older adults vs. traditional RT performed with either low or high intensity. Those reductions were not parallel to changes in autonomic modulation.

Presence of Senescent and Memory CD8+ Leukocytes as Immunocenescence Markers in Skin Lesions of Elderly Leprosy Patients

Leprosy is an infectious disease that remains endemic in approximately 100 developing countries, where about 200,000 new cases are diagnosed each year. Moreover, multibacillary leprosy, the most contagious form of the disease, has been detected at continuously higher rates among Brazilian elderly people. Due to the so-called immunosenescence, characterized by several alterations in the quality of the immune response during aging, this group is more susceptible to infectious diseases. In view of such data, the purpose of our work was to investigate if age-related alterations in the immune response could influence the pathogenesis of leprosy. As such, we studied 87 individuals, 62 newly diagnosed and untreated leprosy patients distributed according to the age range and to the clinical forms of the disease and 25 healthy volunteers, who were studied as controls. The frequency of senescent and memory CD8⁺ leukocytes was assessed by immunofluorescence of biopsies from cutaneous lesions, while the serum levels of IgG anti-CMV antibodies were analyzed by chemiluminescence and the gene expression of T cell receptors' inhibitors by RT-qPCR. We noted an accumulation of memory CD8⁺ T lymphocytes, as well as reduced CD8⁺CD28⁺ cell expression in skin lesions from elderly patients, when compared to younger people. Alterations in LAG3 and PDCD1 gene expression in cutaneous lesions of young MB patients were also observed, when compared to elderly patients. Such data suggest that the age-related alterations of T lymphocyte subsets can facilitate the onset of leprosy in elderly patients, not to mention other chronic inflammatory diseases.

Prevalence of Sarcopenic Obesity and its Association with Functionality, Lifestyle, Biomarkers and Morbidities in Older Adults: the FIBRA-RJ Study of Frailty in Older Brazilian Adults

OBJECTIVES

To assess the prevalence of sarcopenic obesity and its association with functionality, lifestyle, biomarkers, and morbidities in older adults.

METHODS

The study analyzed cross-sectional data from 270 older adults who participated in phase III of the Frailty in Brazilian Older People Study (Fragilidade em Idosos Brasileiros-Rio de Janeiro, FIBRA-RJ study-2013). They took part in a home interview surveying socioeconomic, demographic, lifestyle, morbidities, and functional data. Blood was collected for biochemical marker analysis and participants' body composition was determined by dual-energy X-ray absorptiometry. For women, the diagnosis of sarcopenic obesity was defined at a body fat percentage ≥38% and appendicular skeletal muscle mass index (ASMMI) <5.45 kg/m2. For men, a fat percentage ≥27% and ASMMI <7.26 kg/m2 was defined as sarcopenic obesity. Multivariate analysis was performed using a multinomial regression model (95% confidence intervals), with sarcopenic obesity as the outcome.

RESULTS

The prevalence of sarcopenic obesity was 29.3%. In the final fitted model, the variables that displayed statistically significant association with sarcopenic obesity were lower gait speed, self-reported medical diagnosis of arthrosis or arthritis, and high levels of glycemia.

CONCLUSION

The study showed a high prevalence of sarcopenic obesity in non-institutionalized older adults in Brazil. The finding that this condition was associated with modifiable risk factors may provide insights into measures directed at prevention and reduction of the risk of sarcopenic obesity in this population subgroup.

Incidence, persistence and risk factors of fear of falling in older adults: cohort study (2008-2013) in Rio de Janeiro, Brazil

OBJECTIVE

To evaluate the incidence and persistence of fear of falling in older adults and the clinical/functional, psychosocial and lifestyle-related risk factors.

METHODS

A longitudinal study with 393 community-dwelling older adults aged 65 years and over (110 men/ 283 women) resident in the North Zone of the city of Rio de Janeiro, Brazil. The fear of falling was assessed by the Falls Efficacy Scale-I-BR. The explanatory variables assessed were: number of comorbidities and medicines, history of falls, fracture from falling, use of walking aids, functional dependence in basic and instrumental activities of daily living, hearing and visual impairment, hand grip strength, walking speed, self-rated health, body mass index, depressive symptoms, cognitive impairment, living alone and activity level. Incidence, persistence and risk factors were estimated. Multivariate analysis was performed using Poisson Regression, obtaining relative risks (RR) and corresponding to 95% confidence intervals.

RESULTS

Among the 393 participants, fear of falling occurred in 33.5% and was persistent in 71.3%. Incidence was found to associate with using seven or more medicines and reporting worse activity level than the prior year. Risk factors for persistent fear were: using seven or more medicines, a history of one or two falls, reduced walking speed, hearing impairment, cognitive impairment, depressive symptoms and poor or very poor self-rated health.

CONCLUSION

Fear of falling is a frequent and persistent condition. Many factors related to persistent fear showed no association with the incidence of fear, emphasizing the need for focused strategies to reduce risk factors that may be associated with the chronification of fear of falling.

Frailty syndrome in Brazilian older people: a population based study

This article aims to categorize elderly non-frail (NF), pre-frail (PF) and frail (FF) as to fast and slow gait speed. Compare NF, PF and FF, and analyze associations between fast or slow gait speed with clinical, functional and mental factors. 5,501 elderly (65 years or over; to the Frailty in Brazilian Older People Study), classified as NF, PF and FF (Fried´s frailty phenotype) and, in relation to fast gait speed (≥ 0.8m/s) and slow (< 0.8m/s). Age, sex, body mass index, muscular strength, advanced, instrumental and basic activities of daily living, falls, fear of falling and depressive symptoms were evaluated. Logistic regression analysis investigated associations between variables. The proportion of the slow elderly increased with fragility (NF = 12.39%, PF = 37.56%, FF = 88.83%, p < 0.01). Be woman, performance in activities of daily living, muscle strength and fall were associated with fragility syndrome. The association between frailty and adverse health outcomes reinforces its primacy as an indicator of the functional health of the elderly. Functional capacity, muscular strength, and falls should be evaluated considering their potential for reversibility.

Declínio da velocidade da marcha e desfechos de saúde em idosos: dados da Rede Fibra

RESUMO A velocidade da marcha (VM) tem sido considerada um marcador de saúde em idosos capaz de predizer desfechos adversos de saúde, mas a compreensão de fatores associados a ela ainda é limitada e controversa. O objetivo deste trabalho é identificar desfechos adversos de saúde relacionados ao declínio da velocidade de marcha em idosos comunitários. Trata-se de estudo transversal e multicêntrico, que avaliou o autorrelato de doenças crônicas e de hospitalização no último ano, polifarmácia e velocidade de marcha. Utilizou-se análise de regressão logística para estimar os efeitos de cada variável independente na chance de os idosos apresentarem declínio na velocidade de marcha inferior (VM<0,8m/s) (α=0,05). Participaram da pesquisa 5.501 idosos. A menor velocidade da marcha mostrou-se associada a portadores de doenças cardíacas (OR=2,06; IC: 1,67-2,54), respiratórias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) e/ou depressão (OR=2,51; IC: 2,10-3,14), hospitalizados no último ano (OR=1,51; IC: 1,21-1,85) e polifarmácia (OR=2,14; IC: 1,80-2,54). Assim, os resultados indicaram que idosos com velocidade de marcha menor que 0,8m/s apresentam maior risco de eventos adversos de saúde. Dessa forma, sugere-se que a velocidade de marcha não seja negligenciada na avaliação de idosos comunitários, inclusive na atenção básica.

Strength training with blood flow restriction - a novel therapeutic approach for older adults with sarcopenia? A case report

Introduction

A 91-year-old sedentary man presenting exhaustion, lower-limb weakness, hypertension, and history of multiple falls was diagnosed with sarcopenia – appendicular skeletal muscle mass index (ASM) of 7.10 kg/m².

Purpose

To investigate the effects of strength training performed with low intensity in isolation (LI) or with blood flow restriction (LI-BFR) on strength, muscle mass, IGF-1, endothelial function, microcirculation, inflammatory biomarkers, and oxidative stress.

Methods

In the first 3 months, LI was performed with intensity corresponding to 30% of 1 repetition maximum, followed by 1 month of inactivity, and another 3 months of LI-BFR (similar load than LI concomitant to BFR equivalent to 50% of resting systolic blood pressure).

Results

LI-BFR, but not LI improved muscle mass, ASM, handgrip strength, isokinetic peak torque, IL-6, and IGF-1. Endothelial function, red blood cell velocity, and concentrations of C-reactive protein, and soluble intercellular adhesion molecules-1 improved after both LI and LI-BFR. Endothelin-1 and oxidative stress increased after LI-BFR, and lowered after LI.

Conclusion

LI-BFR, but not LI improved strength, muscle mass, IGF-1, endothelial function, and selected inflammatory markers in a nonagenarian sarcopenic patient. These results are promising and suggest that LI-BFR should be considered as an alternative to prevent muscle loss and improve functional fitness in frail older populations.

Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies

OBJECTIVES

Sarcopenia is a common treatable geriatric condition. The aim of this study was to estimate the prevalence of sarcopenia and its associated factors in community-dwelling elderly living in Rio de Janeiro, Brazil, and to discuss the impact of different muscle mass, handgrip strength and gait speed cut-off values on the reported frequency of sarcopenia.

METHODS

The health habits, functional capacity, and anthropometric measurements of 745 individuals aged ≥65 years from the Frailty in Brazilian Older People study were analyzed. The participants were classified into the following four groups: no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia. Univariate and multivariate regression analyses were performed. Muscle mass, handgrip strength and gait speed cut-off thresholds tailored to the sample and those proposed by the European Working Group on Sarcopenia in Older People were used to compare the prevalence rates of sarcopenia.

RESULTS

Seventy-three percent of the participants were female, 61.9% were Caucasian, and the mean age was 76.6 years. The prevalence rates of sarcopenia were 10.8% and 18% using the sample-tailored and European consensus cut-off values, respectively. Sarcopenia was associated with advanced age (OR: 37.2; CI95%12.35-112.48), Caucasian race (OR: 1.89; CI 95% 1.02-3.52), single marital status (OR:6; CI95% 2.2-16.39), low income (OR:3.64; CI 95% 1.58-8.39), and the presence of comorbidities (OR:3.26; CI 95%1.28-8.3).

CONCLUSION

In this study, the estimated prevalence of sarcopenia was similar to that reported in most studies after the tailored handgrip strength and gait speed cut-off values were adopted. A higher prevalence was observed when the cut-off values suggested by the European consensus were used. This indicates that the prevalence of sarcopenia must be estimated using population-specific reference values.

Prevalência e fatores associados à fragilidade em uma amostra de idosos que vivem na comunidade da cidade de Juiz de Fora, Minas Gerais, Brasil: estudo FIBRA-JF

Resumo Fragilidade é um estado de vulnerabilidade fisiológica multissistêmica relacionada à idade e a um risco aumentado de desfechos adversos. O objetivo do presente estudo foi avaliar a prevalência e os fatores associados à fragilidade no estudo FIBRA em Minas Gerais, Brasil. Selecionou-se uma amostra aleatória, estratificada por unidade territorial, sexo e idade, de 461 indivíduos, com 65 anos ou mais. A fragilidade foi estabelecida pela presença de três ou mais de cinco itens: sensação de exaustão, baixa força de preensão manual, velocidade da marcha lenta, perda de peso e baixo gasto calórico. A média de idade foi de 74,4 anos (DP± 6,8), 69,6% eram mulheres e 71,9% brancos. A prevalência de fragilidade foi de 5,2%; 49,9% foram de indivíduos pré-frágeis. Idade avançada (OR: 6,4; IC 1,76-23,8), comprometimento das atividades básicas de vida diária (OR: 5,2; IC 1,1-23,1) e auto percepção de saúde ruim (OR: 0,13; IC 0,03-0,4), foram associados à fragilidade. No presente estudo, um número substancial de indivíduos apresentou-se frágil, enquanto que metade da amostra estava sob risco de progressão para esta condição, sugerindo que é urgente a adoção de medidas de saúde pública com objetivo de prevenção e redução de complicações.

[Dimensional structure of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR)]

This study aimed to assess the dimensional structure and internal consistency of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) for measurement of functional capacity in the elderly, based on the informant's report. This was a cross-sectional study with 525 non-institutionalized elderly informants, in which confirmatory factor analyses (CFA) and exploratory/confirmatory factor analyses (E/CFA) modeled according to CFA principles were used to identify the most parsimonious model and that with the best fit. The internal consistency of the FAQ-BR was assessed by composite reliability, and correlations between its dimensions were examined to investigate discriminant factor validity. CFA did not corroborate the unidimensional structure as originally proposed. Next, E/CFA fit a bidimensional structure that was reassessed by CFA, displaying a model without cross loads as the most parsimonious and with adequate fit indices. The internal consistency of FAQ-BR was considered satisfactory, and the correlation between its dimensions was acceptable. These findings are important, since they demonstrate the scale's capacity to capture the elderly's functional capacity construct in a different sociocultural context from that in which it was originally developed. The FAQ-BR can thus be considered an appropriate bidimensional instrument for measuring the elderly's functional capacity based on the informant's report, and its use in studies with similar populations is recommended.

Permanence in the labour market and life satisfaction in old age

Population aging is a global trend that has drawn attention to policies to encourage a productive life and delayed retirement. Thus, it is necessary to expand our understanding of the effects of work on health indicators and well-being in old age. The purpose of this study was to determine the association of permanency in the labor market with sociodemographic and medical factors and life satisfaction in elders. We used the database from Study FIBRA-RJ including elderly (aged > 65) clients of a private health care plan who resided in northern districts of the municipality of Rio de Janeiro. Among the 626 participants, 82 (13,1%) maintained paid jobs. Multiple logistic regression showed that the odds of remaining working among the elderly were higher for men; and those with 9 years of studies or more, and those with high income; and those with no disabling clinical conditions and with higher satisfaction with life. This study confirms that work activities in old age are associated with better social and physical health conditions. Moreover, we observed that the maintenance of work activities was associated with higher life satisfaction, independent of socioeconomic and clinical characteristics in old age.

The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country

OBJECTIVE

Previous studies have indicated that dementia and depression have a considerable impact on the functional capacity of older adults, also influencing awareness about ability. The purpose of the current study was to investigate the impact of dementia, depression and awareness on activities of daily living (ADL) in a sample from a middle-income country.

METHODS

The current study explored impairments in basic, instrumental and advanced ADL using a factorial design comparing four groups: people with dementia and depression, people with dementia without depression, older adults with depression but no dementia and healthy older adults. For each type of ADL, self-report and informant report was contrasted in order to investigate the issue of lack of awareness in relation to ADL.

RESULTS

Results indicate that dementia is associated with impairments in all types of ADL. Advanced ADL were also reduced in depressed participants. In addition, in the case of instrumental and basic ADL, informant report indicated less preserved abilities than participant self-report, particularly in people with dementia.

CONCLUSIONS

The findings highlight the importance of developing interventions and compensatory strategies to prevent loss of ADL in dementia, also suggesting that early intervention in older adults with depression should focus on advanced ADL to prevent social isolation and withdrawal. Finally, the findings indicate that self-information about ADL may be compromised in dementia, so clinicians exploring disability should consider fully different aspects of ADL in this group. Copyright © 2017 John Wiley & Sons, Ltd.

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR=1.70 [95%CI, 1.18-2.45]; I2=66%) and pre-frail (HR=1.23 [95%CI, 1.07-1.36]; I2=67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults.

Elderly patients on hemodialysis have worse dietary quality and higher consumption of ultraprocessed food than elderly without chronic kidney disease

OBJECTIVES

The multiple dietary restrictions recommended to patients on hemodialysis (HD), coupled with conditions imposed by aging, may lead to poor dietary quality in these patients. The aim of this study was to investigate the dietary quality and consumption of ultraprocessed food by elderly patients on HD and those without chronic kidney disease (CKD). Additionally, diets on the day of dialysis and on nondialysis days were evaluated.

METHODS

This was a cross-sectional study conducted with 153 noninstitutionalized elderly patients on HD (Elder-HD) and 47 non-CKD elderly (Elder-Healthy) aged ≥60 y. From a 3-d food record, the dietary quality was assessed using the Brazilian Healthy Eating Index Revised (BHEI-R) and the energy contribution of food-processing groups.

RESULTS

Compared with the Elder-Healthy group, the Elder-HD group showed a lower total BHEI-R score (P < 0.05). On the weekdays, the Elder-HD group showed lower scores (P < 0.05) of whole fruit, dark green vegetables and legumes, meat, eggs, and legumes, whereas total cereals showed a higher score (P < 0.05). When furthering the analysis on the Elder-HD group, although the total BHEI-R score did not differ among the days assessed, the components whole fruit, dark green vegetables, and legumes had lower scores (P < 0.05) on the day of dialysis, and the opposite was observed for milk and dairy products. Moreover, the Elder-HD showed a higher (P < 0.05) contribution of processed and ultraprocessed foods and lower (P < 0.05) contribution of natural or minimally processed foods.

CONCLUSION

The Elder-HD group showed poorer dietary quality and higher consumption of processed and ultraprocessed foods than the Elder-Healthy group. Moreover, when compared with the nondialysis day, these patients exhibited worse dietary quality, on the day of dialysis.

Body composition and frailty profiles in Brazilian older people: Frailty in Brazilian Older People Study-FIBRA-BR

OBJECTIVE

To determine the association between body composition and frailty in older Brazilian subjects.

MATERIAL AND METHODS

This is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n=5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio.

RESULTS

The lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9kg/m². Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR)=3.10; 95% CI: 2.06-4.67) and (OR=1.15; 95% CI: 1.03-1.27), respectively. Being overweight was protective for pre-frailty (OR=0.48; 95% CI: 0.4-0.58) and frailty (OR=0.77; 95% CI: 0.67-0.9). Obese older people presented a higher risk of pre-frailty only (OR=1.29; 95% CI: 1.09-1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range.

CONCLUSION

Undernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI.

Fenótipo de fragilidade: influência de cada item na determinação da fragilidade em idosos comunitários – Rede Fibra

Resumo O fenótipo de fragilidade é uma ferramenta utilizada para avaliação da fragilidade em idosos, composto pelos itens perda de peso, exaustão, baixo nível de atividade física, fraqueza muscular e lentidão na marcha. O objetivo deste estudo foi avaliar a participação de cada item na determinação da fragilidade em idosos brasileiros. A análise foi feita pela Regressão Logística Multinomial. A amostra total de 5532 idosos, selecionados aleatoriamente em diversas cidades brasileiras entre dezembro de 2008 e setembro de 2009, foi avaliada pelo fenótipo de fragilidade. Os itens mais frequentes na amostra foram o nível de atividade física, seguido da fraqueza muscular e lentidão da marcha. Os itens que apresentaram maior chance para o desenvolvimento da fragilidade foram a lentidão na marcha (OR = 10,50, IC95%8,55-12,90, p < 0,001) e a fraqueza muscular (OR = 7,31, IC95%6,02-8,86, p < 0,001). O modelo com os cinco itens explicou 99,6% da fragilidade na amostra. Tais resultados sugerem que o nível de atividade física, fraqueza muscular e lentidão na marcha são os itens que mais influenciam na determinação da fragilidade, mas a aplicação de todos os itens do fenótipo em conjunto é a melhor forma para a avaliação.

Lifetime Occupation and Late-Life Cognitive Performance Among Women

We examined whether women who had regular jobs throughout life performed better cognitively than older adult housewives. Linear regression was used to compare global cognitive performance scores of housewives (G1) and women exposed to work of low (G2) and high (G3) complexity. The sample comprised 477 older adult Brazilian women, 430 (90.4%) of whom had performed lifelong jobs. In work with data, the G2 group's cognitive performance scores were 1.73 points higher (p =.03), and the G3 group scored 1.76 points (p =.02) higher, than the G1. In work with things and with people, the G3 scored, respectively, 2.04 (p <.01) and 2.21 (p <.01) cognitive test points higher than the G1. Based on our findings we suggest occupation of greater complexity is associated with better cognitive performance in women later in life.

Re-assessing the dimensional structure of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): empirical evidence for a shortened Brazilian version

BACKGROUND

The dimensional structure, effective number of item responses and item redundancies are controversial features of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) requiring more light. The aims of the present study are to revisit the dimensional structure and propose a shorter version of the instrument.

METHODS

The sample comprised 652 elderly and their informants, either attending a geriatric service of a public university clinic or enrolled in a health care provider database in Rio de Janeiro, Brazil. A Confirmatory Factor Analysis (CFA) first tested the originally proposed one-dimensional structure comprised of 26 items. This was followed by sequential Exploratory Structural Equation Model (ESEM) to evaluate alternative models, in particular a bi-dimensional solution. The identification of residual correlations (RC) lead to a shortened 20-item model, which was tested further via CFA.

RESULTS

The original model fitted poorly (RMSEA = 0.073; 90% CI: 0.069-0.077). Regarding the two-dimensional model, the exploratory procedure (ESEM) indicated several RCs and a lack of factor-based discriminant validity. The ensuing CFA on the one-dimensional model with freely estimated RCs showed an adequate fit (RMSEA = 0.051; 90% CI: 0.047-0.055). Addressing the identified RCs, the CFA on the abridged 20-item version also showed an adequate fit (RMSEA = 0.058; 90% CI: 0.053-0.064) and no further RCs.

CONCLUSION

A one-factor dimensional structure and a reduced version with 20 locally independent items were the most tenable solution. However, although promising, this simpler structure requires further examination before it may be fully supported and recommended.

Performance of the European Working Group on Sarcopenia in Older People algorithm in screening older adults for muscle mass assessment

BACKGROUND

There is a lack of consensus on the diagnosis of sarcopenia. A screening and diagnostic algorithm was proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).

OBJECTIVE

To assess the performance of the EWGSOP algorithm in determining the proportion of subjects suspected of having sarcopenia and selected to undergo subsequent muscle mass (MM) measurement.

DESIGN

A cross-sectional study.

SETTING

The cohorts, Frailty in Brazilian Older People Study-Rio de Janeiro (FIBRA-RJ), Brazil; Coyoacan Cohort (CC), Mexico City, Mexico; and Toledo Study for Healthy Aging (TSHA), Toledo, Spain.

SUBJECTS

Three thousand two hundred and sixty community-dwelling individuals, 65 years and older.

METHODS

Initially, the EWGSOP algorithm was applied using its originally proposed cut-off values for gait speed and handgrip strength; in the second step, values tailored for the specific cohorts were used.

RESULTS

Using the originally suggested EWGSOP cut-off points, 83.4% of the total cohort (94.4% in TSHA, 75.5% in FIBRA-RJ, 67.8% in CC) would have been considered as suspected of sarcopenia. Adapted cut-off values lowered the proportion of abnormal results to 34.2% (quintile-based approach) and 23.71% (z-score approach).

CONCLUSIONS

The algorithm proposed by the EWGSOP is of limited clinical utility in screening older adults for sarcopenia due to the high proportion of subjects selected to further undergo MM assessment. Tailoring cut-off values to specific characteristics of the population being studied reduces the number of people selected for MM assessment, probably improving the performance of the algorithm. Further research including the objective measure of MM is needed to determine the accuracy of these specific cut-off points.

Food intake assessment of elderly patients on hemodialysis

OBJECTIVE

To investigate whether the dietary intake of elderly patients on hemodialysis (HD) is lower than that of elderly individuals with normal renal function. In addition, we also assessed whether the dietary intake of elderly on HD is lower on the dialysis day (DD) than on nondialysis days (non-DD).

DESIGN

A cross-sectional and observational study including elderly on HD and non-chronic kidney disease (non-CKD) elderly.

SUBJECTS

We assessed 54 noninstitutionalized elderly patients on HD (study group) and 47 non-CKD elderly (control group) aged ≥60 years.

MAIN OUTCOME MEASURES

All participants had their dietary intake assessed by 3-day food diaries. As a sensitivity analysis, we also assessed the dietary intake in the adequate reporters, which were identified when the ratio-energy intake-to-estimated basal metabolic rate-was above 1.27 (Goldberg index).

RESULTS

When comparing dietary intake between the study and control groups, adjusted for sex and underreporting, it was noted that only the intake of protein (β: -9.9; P: .01) and phosphorus (β: -104; P: .04) were significantly lower in the study group. In addition, when furthering the analysis in the study group by comparing DD with non-DD, it was observed that energy (18 ± 7 vs. 21 ± 8 kcal/kg/day), protein (0.8 ± 0.4 vs. 1.0 ± 0.4 g/kg/day), lipids (41 ± 20 vs. 48 ± 23 g/day), potassium (1371 ± 587 vs. 1540 ± 484 mg/day), and phosphorous intake (647 ± 312 vs. 789 ± 287 mg/day), but not carbohydrate (155 ± 54 vs. 167 ± 55 g/day) and calcium (470 ± 345 vs. 518 ± 333 g/day) were significantly lower on DDs than on non-DDs, respectively.

CONCLUSIONS

Except for protein and phosphorous, energy and nutrient intake of elderly patients on HD are similar to that of non-CKD elderly. In addition, the dietary intake is lower on DDs, highlighting the importance of focusing efforts to improve nutritional intake mainly during the day of dialysis treatment.

Spectral analyses of systolic blood pressure and heart rate variability and their association with cognitive performance in elderly hypertensive subjects

Systolic hypertension is associated with cognitive decline in the elderly. Altered blood pressure (BP) variability is a possible mechanism of reduced cognitive performance in elderly hypertensives. We hypothesized that altered beat-to-beat systolic BP variability is associated with reduced global cognitive performance in elderly hypertensive subjects. In exploratory analyses, we also studied the correlation between diverse discrete cognitive domains and indices of systolic BP and heart rate variability. Disproving our initial hypothesis, we have shown that hypertension and low education, but not indices of systolic BP and heart rate variability, were independent predictors of lower global cognitive performance. However, exploratory analyses showed that the systolic BP variability in semi-upright position was an independent predictor of matrix reasoning (B = 0.08 ± .03, P-value = 0.005), whereas heart rate variability in semi-upright position was an independent predictor of the executive function score (B = -6.36 ± 2.55, P-value = 0.02). We conclude that myogenic vascular and sympathetic modulation of systolic BP do not contribute to reduced global cognitive performance in treated hypertensive subjects. Nevertheless, our results suggest that both systolic BP and heart rate variability might be associated with modulation of frontal lobe cognitive domains, such as executive function and matrix reasoning.

[Cognitive performance and frailty in older adults clients of a private health care plan]

OBJECTIVE

To investigate the association between frailty syndrome and cognitive performance in the older adults and the effect of schooling and age on this association.

METHODS

Data on frailty in older adults from Phase 1 of the FIBRA-RJ Study were analyzed, relating to 737 customers of a private health care provider, aged 65 and over, living in Rio de Janeiro, Southeastern Brazil, between January 2009 and January 2010. Data on socioeconomic and demographic characteristics, medical conditions and functional capacity were collected. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE). Individuals who exhibited three or more of the following features were considered to be frail: unintentional weight loss (≥ 4.5 kg in the last year); feeling self-reported exhaustion, low grip strength, low physical activity level and slowness. The association between frailty and cognitive performance was evaluated using multivariate logistic regression, with adjustment for medical conditions, activities of daily living and socioeconomic variables. We evaluated the age and schooling as possible effect modifiers in this association.

RESULTS

The frail subjects had a higher prevalence of low cognitive performance, compared to not frail or pre-frail, in the three age groups studied (65-74; 75-84; ≥ 85 years), p < 0.001. After adjustment, the association between frailty and cognitive performance was found among older adults individuals aged 75 and older, with an OR(adj)= 2.78 (95%CI 1.23;6.27) for those aged 75 to 84 and OR(adj)= 15.62 (95%CI 2.20;110.99) for 85 and older. The age variable was an effect modifier in the association between frailty and cognitive performance, χ²(5) = 806.97, p < 0.0001; the same was not the case with schooling.

CONCLUSIONS

Frailty syndrome is associated with cognitive performance in the aging. Age proved to be an effect modifier in this association. The oldest patients showed a more significant association between the two phenomena.

Accuracy of the Brazilian version of the informant questionnaire on cognitive decline in the elderly at screening for dementia in community-dwelling elderly participants: findings from FIBRA-RJ study

OBJECTIVES

To determine the accuracy of the Brazilian version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-BR) for screening for dementia and to analyze the association of sociodemographic variables of the elderly participants and informant, as well as the mental health of the informant, in the scores of the questionnaire.

METHODS

A cross-sectional study was carried out with 417 elderly participants and their informants from the sample of the Frailty in the Brazilian Elderly Study, Rio de Janeiro, Brazil. The older individuals were assessed by clinical, functional, and neurocognitive evaluation, and the diagnosis of dementia was established according to Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition) criteria. The informants were evaluated by Mini-Mental State Examination (MMSE), Center of Epidemiologic Studies--Depression Scale, and Burden Interview Scale. The Cambridge Cognitive Examination Test--Revised (CAMCOG-R) was used for convergent validity analysis. The association between IQCODE-BR and the study variables was determined by multivariate logistic regression analysis.

RESULTS

The best cutoff point was 3.26; the sensitivity, specificity, and area under the receiver-operating characteristic curve were 89%, 72%, and 0.88 (95% confidence interval: 0.837-0.917), respectively. The CAMCOG-R and the MMSE showed a moderate and negative association with IQCODE-BR.

CONCLUSION

The IQCODE-BR is an instrument with good accuracy for the detection of dementia syndrome in Brazilian older person.

Relationship between activities of daily living and cognitive ability in a sample of older adults with heterogeneous educational level

INTRODUCTION

A number of studies have shown the impact of cognitive abilities on instrumental activities of daily living, in particular executive functions. Nevertheless, it is not clear to what extent these results can be generalized, given that most samples studied have not included people with a low educational level.

OBJECTIVES

The current study aims to investigate the association between cognitive abilities and activities of daily living in older adults - with and without dementia - from a middle-income country.

SAMPLE

The sample consisted of 48 healthy older adults and 29 people with dementia, who were evaluated in an Outpatient Care Unit in a University Reference Center in Rio de Janeiro.

RESULTS

Regression analyses indicated that the best predictors for activities of daily living were performance in immediate verbal memory in the case of controls and in a categorical fluency task in the patient group. The educational level itself was not a significant predictor of functional ability in either sample, but showed moderate correlation with the predictors.

CONCLUSIONS

These results suggest that educational level may be a mediating factor in the association of cognitive variables and activities of daily living, and indicate a potential dissociation in terms of predictors according to the diagnostic status, pointing to relevant treatment directions.

Is the Cambridge Cognitive Examination - revised a good tool for detection of dementia in illiterate Brazilian older adults?

AIMS

Few studies have been published on the use of the Cambridge Cognitive Examination Test - Revised (CAMCOG-R) for cognitive assessment of low educational level older adults. The aim of the present study was to determine the accuracy of the Brazilian version of the CAMCOG-R (Br-CAMCOG-R) within a sample of low educational level and illiterate older adults.

METHODS

The Br-CAMCOG-R was administered to outpatients in a public geriatric clinic. The diagnosis of dementia was based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria. The receiving operator characteristic curves were plotted, and the best trade-offs between sensitivities and specificities were calculated.

RESULTS

A total of 189 participants were evaluated. The mean age was 77 ± 6.9 years. The mean educational level was 3.1 ± 2.2 years. The mean test score was 66.5 ± 13.1 points; there were 56 (29.6%) participants with dementia. The best cut-off score for illiterate participants was 50/51; sensitivity, specificity and area under the curve (AUC) were 69%, 69% and 0.75, respectively; for participants with a low educational level, the best cut-off point was 60/61; the sensitivity, specificity and AUC were 83%, 85%, and 0.93, respectively; for participants with a middle educational level, the best cut-off point was 69/70; the sensitivity, specificity and AUC were 90%, 76% and 0.91, respectively.

CONCLUSIONS

The Br-CAMCOG-R was useful for identifying cases of dementia among older adults with middle and low levels of literacy, but inadequate for the illiterate individuals.

Prevalence of dementia in elderly clients of a private health care plan: a study of the FIBRA-RJ, Brazil

AIMS

To describe the overall prevalence of dementia syndrome and its major subtypes among elderly clients of a private health care plan and to ascertain the association between this syndrome and socioeconomic characteristics.

METHODS

A survey was organized in two stages: screening for cognitive impairment and diagnostic evaluation. The study population comprised 683 elderly subjects (aged >67 years), an expanded sample of 7,486 individuals, of the database of the FIBRA-RJ, which evaluated clients of a private health care plan residing in northern districts of the municipality of Rio de Janeiro, Brazil. The diagnosis of dementia was obtained according to DSM-IV criteria.

RESULTS

A total of 115 individuals were diagnosed with dementia, resulting in a prevalence of 16.9% (95% CI = 14.4-19.8). The association was strongest among older age groups, i.e. 85-89 years old (prevalence ratio = 8.85; 95% CI = 2.11-37.11) and 90 or more years old (prevalence ratio = 8.85; 95% CI = 2.11-37.11), and among illiterate people (prevalence ratio = 2.77; 95% CI = 1.07-7.19). Sex, personal income and marital status displayed no association with dementia.

CONCLUSION

The prevalence of dementia was higher than found by population-based studies. These findings point to a possibility of a high demand for specialized services among older adults served by the private health care sector.

Rede FIBRA-RJ: fragilidade e risco de hospitalização em idosos da cidade do Rio de Janeiro, Brasil

O objetivo do estudo foi determinar o perfil de risco e fatores associados à fragilidade em idosos da comunidade. A população-fonte constituiu-se de indivíduos com 65 anos ou mais, residentes nos bairros da zona norte da cidade do Rio de Janeiro, Brasil, e clientes de uma operadora de saúde. O estudo foi transversal, na linha de base de uma coorte, com amostra estratificada por sexo e idade, composta por 764 indivíduos. Para a estratificação de risco, utilizou-se o instrumento de rastreio probabilidade de internações repetidas (PIR). A análise de regressão logística foi realizada para estudar a associação entre a PIR e um conjunto de variáveis sociodemográficas, de estado de saúde, funcionais e cognitivas, após a análise bivariada. Encontraram-se 6,7% de idosos com alto risco de internação. Associaram-se ao risco de internação câncer, quedas, doença pulmonar obstrutiva crônica e medicamentos usados, bem como as seguintes condições: receber visita de profissional da saúde, ter estado acamado no domicílio, morar só e praticar as atividades de vida diária. O instrumento parece ser útil na estratificação de risco dos idosos.

Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study

OBJECTIVE

Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual's capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan.

METHODS

We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis.

RESULTS

The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3); 43.6% (95% CI, 40.3-47) of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8) were considered pre-frail (p<0.001). The frail individuals tended to be older (odds ratio [OR] 13.2, 95% CI, 8.7-20) and have lower education levels (OR 2.1, 95% CI, 1-4.6), lower cognitive performance (OR 0.76, 95% CI, 0.73-0.79) and reduced health perception (OR 65.8, 95% CI, 39.1-110.8). Frail individuals also had a greater number of comorbidities (OR 6.6, 95% CI, 4.4-9.9) and worse functional capacity (OR 3.8, 95% CI, 2.9-5).

CONCLUSION

The prevalence of frailty was similar to that seen in other international studies and was significantly associated with educational level, cognition, comorbidities, functional capacity, perception of health and old age.

Elderly hypertensives show decreased cognitive performance compared with elderly normotensives

BACKGROUND

Essential hypertension has been associated with decreased cognitive performance; however, the literature is conflicting.

OBJECTIVE

This study aims at comparing cognitive performance between elderly normotensives ("N"; n = 17; age 68 ± 1; blood pressure = 133 ± 3/74 ±2 mmHg) and hypertensives ("H"; n = 28; age 69 ± 1, blood pressure = 148 ± 4/80 ± 1mmHg) with at least 5 years of education.

METHODS

The comprehensive neuropsychological assessment was comprised of the Cambridge Cognition-Revised (CAMCOG-R), the Trail Making Test A and B (TMT A and B) and the Rey Auditory Verbal Learning Test (RAVLT).

RESULTS

Elderly hypertensives presented lower CAMCOG-R global scores (N = 87.6 ± 1.8; H = 78.6 ± 1.4; p = 0.002). The hypertensive's performance was slower in the TMT A and B (TMT A: N = 39 ± 3s; H = 57 ± 3s; p = 0.001; TMT B: N = 93 ± 7s; H = 124 ± 7s; p = 0.006), which was also reflected in smaller percentiles achieved by hypertensives in these tests. Hypertensive subjects exhibited a significantly lower RAVLT summation score (N = 51.8 ± 1.7; H = 40.7 ± 1.5; p < 0.0001). Even when adjusted for age, sex, education and depression symptoms, hypertension was an independent predictor of cognitive performance as measured by CAMCOG-R global score, TMT A and RAVLT summation score.

CONCLUSION

Cognitive performance is lower in elderly hypertensives as compared with elderly normotensives.

Fatores associados a sintomas depressivos em idosos atendidos em ambulatório público de Geriatria

OBJETIVO: Investigar fatores biopsicossociais associados à presença de sintomatologia depressiva em idosos atendidos em ambulatório público de Geriatria, na cidade do Rio de Janeiro, Brasil. MÉTODO: Estudo retrospectivo, de revisão de prontuários dos idosos atendidos na Policlínica Piquet Carneiro, no período de 1º de maio de 2004 a 31 de abril de 2006. Como instrumento de pesquisa, foi elaborado um roteiro para transcrever as informações contidas nos prontuários.Os dados foram analisados utilizando-se programa SAS version 9.1, e a técnica de regressão utilizada foi a regressão logística multinomial (stepwise). RESULTADOS: Aproximadamente 53% da população apresentaram sintomas depressivos. Na análise multivariada, identificou-se associação significativa entre a sintomatologia depressiva e as variáveis: idade, distúrbio do sono, mobilidade e equilíbrio, e número de enfermidades crônicas presentes. Após o ajuste do modelo, permaneceram as variáveis idade (OR=2,8 IC 95% 3,1 - 2,4) e mobilidade e equilíbrio (OR=1,8 IC 95% 2,0 - 1,52). CONCLUSÃO: A idade, o número de comorbidades e as alterações de mobilidade e equilíbrio estão associados à sintomatologia depressiva neste grupo.