Multimorbidity, frailty and functional disability in octogenarians: A structural equation analysis of relationship.

Path analysis allows for an understanding of the complex interrelationships between multiple variables and interactions in the octogenarians. The aim of this study was to estimate the isolated and combined prevalence of multimorbidity, frailty and functional disability and the direct and indirect association of these conditions in octogenarians. A cross-sectional study was conducted with 166 community-dwelling individuals aged 80 years or older participating in the FIBRA80+ epidemiological study. Multimorbidity was defined by three or more chronic diseases, frailty according to 3 or more components of physical frailty phenotype and functional disability as aid needed to perform one or more activities of daily living (ADLs). Associations were tested by Pearson's chi-square test; the relationship between the variables of interest and the mediating variables was tested with structural equation (path) analysis. We observed a higher prevalence of seniors with disability and multimordibity/disability. In path analysis, number of chronic diseases mediated the relation between sex and number of frailty components (p = 0.031), and these mediated the relation between number of diseases and disability (p = 0.008). The study points out the relationship between the simultaneous presence and interaction between multimorbidity, functional disability and frailty. Through path analysis, our findings provide characteristics in relation to the health-disease process, mainly mediation and interaction among octogenarians.

Comparison of Two Models of Frailty for the Prediction of Mortality in Brazilian Community-Dwelling Older Adults: The FIBRA Study.

BACKGROUND: Prevalence of frailty is significant in Latin America. However, no previous study evaluated mortality prediction using the two most used frailty models in Brazil. OBJECTIVES: The aim of the present study was to compare the frailty phenotype and the frailty index with regard to accuracy in the prediction of mortality among community-dwelling older adults. METHODS: A cohort study was conducted involving 674 older adults. Thirty-five variables (signs, symptoms, chronic diseases and disabilities) were used for the construction of the frailty index (FI). The frailty phenotype index (FPI) was defined based on the criteria proposed in the Cardiovascular Health Study. Periodic verifications were performed in the databank of the Mortality Information System. Cox regression was used to estimate the relative risk (RR) of mortality and Kaplan-Meier survival curves were used in the analysis. RESULTS: The prevalence of frailty was greater based using the FI (16.3%) compared to the FPI (5.34%). Older adults classified as frail by the FPI had a greater risk of death (RR: 10.03; 95% CI: 4.43-22.74) that those classified as frail by the FI (RR: 0.87; 95% CI: 0.25-3.00). The lowest survival rate was found in the group of older adults classified as frail based on the FPI and classified as pre-frail and robust based on the FI. CONCLUSION: The FPI demonstrated greater accuracy in predicting the risk of mortality among Brazilian older adults than the FI. The validation of frailty measures is fundamental to the identification of older adults who are more vulnerable to adverse health events.

Influence of blood pressure profile on frailty phenotype in community-dwelling elders in Brazil - FIBRA study.

Frailty is a clinical condition associated with pathological aging and biological vulnerability. In the spectrum of events related to frailty, aging of the cardiocirculatory system and abnormalities in arterial blood pressure (BP) partly explain the changes in tissue perfusion and, potentially, the decrease in physiological reserves. This study investigated the relationship between BP levels, systemic arterial hypertension (SAH) and the frailty phenotype by analyzing frailty criteria in a cross-sectional model into the FIBRA network, a populational sample of community-dwelling elders in Southeastern Brazil. Study participants with ≥65 years were selected by probabilistic sampling of residents in the urban area of the municipality of Campinas (n=900). Considering frailty as a whole and the difference between genders, there was a greater proportion of frail or pre-frail individuals among women than men. Analysis of individual frailty criteria showed that weight loss and fatigue were more common among women (18.3% vs. 12.5%, p=0.034 and 22.5% vs. 11.9%, p<0.001, respectively). Comparison of individuals with or without SAH failed to reveal any differences related to frailty criteria. Nevertheless, averages of diastolic blood pressure (DBP) and mean arterial blood pressure values were lower among elderly individuals with reduced grip strength, physical activity and the frailty classification as a whole (OR 0.986, IC 0.975-0.997) (for every 1 mmHg reduction in MBP values, the likelihood of being frail increased 1.4%). Our findings corroborate the relationship between BP values and frailty in the elderly and contribute to an understanding of the pathophysiological mechanisms of the syndrome.

Epidemiology of hepatitis D virus (HDV) infection in an urban area of northern Italy.

OBJECTIVES: The introduction of vaccination against hepatitis B initially reduced the number of HBV (hepatitis B virus) and HDV (hepatitis delta virus) infections, but the decreasing trend of HDV infection seems to have stopped. The aim of this study was to assess the prevalence of HDV infection in the general population living in the catchment area of Legnano Hospital in northern Italy. METHODS: Of the 22,758 subjects tested in 2007-2008, the 488 who were HBsAg (hepatitis B surface antigen)-positive [including 107 (21.9%) of non-Italian origin] were subsequently tested for anti-HDV antibodies. RESULTS: Of the 488 subjects who tested positive for HBsAg, 24 (4.9%) were anti-HDV positive, all aged between 30 and 60 years. The difference in prevalence between males (7.1%) and females (1.9%) was statistically significant (p < 0.05), but not that between Italian (5.0%) and non-Italian patients (4.7%). The differences in anti-HDV seropositivity between the patients with acute (0%) and chronic infections (6.3%), and between the incident (2.5%) and prevalent cases (7.4%), were not statistically significant, but there was a significant difference (p < 0.01) between those with asymptomatic (2.1%) and clinically symptomatic infections (10.3%). Intravenous drug abuse was the main source of infection. CONCLUSIONS: In the catchment area of our hospital, the prevalence of HDV infection does not seem to be due to patients of non-Italian origin, but to Italian patients who are not vaccinated against HBV and who survived the HDV epidemic of the 1970s and 1980s. Nevertheless, the increase in the number of immigrants from non-EU countries in recent years is soon likely to lead to a change in the epidemiology of HDV.

Frailty criteria and cognitive performance are related: data from the FIBRA study in Ermelino Matarazzo, São Paulo, Brazil.

OBJECTIVES: To assess the relationship between the CHS frailty criteria (Fried et al., 2001) and cognitive performance. DESIGN: Cross sectional and population-based. SETTING: Ermelino Matarazzo, a poor sub district of the city of São Paulo, Brazil. PARTICIPANTS: 384 community dwelling older adults, 65 and older. MEASUREMENTS: Assessment of the CHS frailty criteria, the Brief Cognitive Screening Battery (memorization of 10 black and white pictures, verbal fluency animal category, and the Clock Drawing Test) and the Mini-Mental State Examination (MMSE). RESULTS: Frail older adults performed significantly lower than non-frail and pre frail elderly in most cognitive variables. Grip strength and age were associated to MMSE performance, age was associated to delayed memory recall, gait speed was associated to verbal fluency and CDT performance, and education was associated to CDT performance. CONCLUSION: Being frail may be associated with cognitive decline, thus, gerontological assessments and interventions should consider that these forms of vulnerability may occur simultaneously.

Nivel de atividade fisica e desconfortos musculo-esqueleticos percebidos em homens e mulheres, adultos e idosos / Physical activity and musculosketal disconforts among male and female young adults and aged people

A literatura de pesquisa e a pratica profissional tem revelado forte relacao entre bem-estar fisico, genero, idade e a pratica de atividade fisica.Este estudo teve por objetivo caracterizar as relacoes entre nivel de atividades fisicas e desconfortos musculos-esqueleticos percebidos em adultos jovens e em idosos masculinos e femininos. Foram avaliados 200 voluntarios que formaram dois grupos com 100 individuos cada, um de 20 a 35 anos e o outro de 60 a 70 anos, cada um composto por 50 homens e 50 mulheres, metade sedentaria e metade ativa. Os instrumentos incluiram um questionario de caracterizacao sociodemografica e ocupacional, de pratica de atividades fisicas e doencas e um questionario de queixas relativas a desconforto musculo-esqueleticos percebidos nos ultimos anos e nos ultimos sete dias. Foram realizadas analises estatisticas descritivas, testes de contraste (goodman) e de hipotese (Mann-Whitney). Os resultados indicaram que 1) os idosos, as mulheres e os sedentarios relataram mais desconfortos musculo-esqueleticos nos ultimos seis meses e nos ultimos sete dias. Investigacoes nesse dominio podem melhorar o bem estar fisico e psicologico de adultos jovens e idosos e aumentar as chances de uma velhice satisfatoria

Endothelium-derived factors in microalbuminuric and nonmicroalbuminuric essential hypertensives.

Previous evidence has demonstrated a relationship between growth factors and cardiovascular diseases. This study was aimed at evaluating levels of some endothelium-derived growth factors, and their relationship with microalbuminuria (MAU), in essential hypertension. Ninety-nine mild-moderate essential hypertensives (EH) and 25 healthy controls were studied. All patients underwent 24-h blood pressure monitoring, serum endothelin-1 (ET-1), basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF), and 24-h MAU assays. Later, EH were divided into two subsets consisting of microalbuminurics (MAU >11 microg/min) and nonmicroalbuminurics (MAU <11 microg/min). In microalbuminuric EH, circulating ET-1, bFGF, and PDGF were significantly higher than in nonmicroalbuminurics (P < .0001, P < .0001, P < .005, respectively) or in controls. In the group of 99 EH, significant positive correlations of MAU with both ET-1 and bFGF (r = 0.35, P < .001, and r = 0.34, P < .001, respectively) were found. ET-1 and bFGF correlated significantly (r = 0.31, P < .002). Circulating bFGF also correlated significantly with MAU in the microalbuminuric EH subset (r = 0.49, P < .01). Our results show that in microalbuminuric EH circulating levels of certain growth factors are increased. In human essential hypertension these factors are linked with MAU, an early cardiovascular and renal damage marker.

Influence of vascular load on plasma endothelin-1, cytokines and catecholamine levels in essential hypertensives.

In vitro studies demonstrated a relationship between ET-1 and basic Fibroblast Growth Factor (bFGF), and of bFGF with Platelet Derived Growth Factor (PDGF). The present study was carried out to investigate in vivo the behaviour after vascular stress of circulating ET-1, bFGF and PDGF, and catecholamines, and their relationship. In 12 healthy normotensives (NTs) and 15 essential hypertensives (Ehs) venous blood samples to determine circulating ET-1, bFGF and PDGF, and catecholamine (EPI and NE) levels were drawn before and at the third minute of a handgrip test. Blood pressures (BP) and heart rate were automatically recorded before starting, and at 1, 2, and 3 minutes during the test. The NTs showed, in basal condition, lower values than the EHs of all the examined parameters; later, the handgrip test induced significant increases in circulating levels of ET-1, bFGF and catecholamine. In the EHs at the third minute of the exercise significant increases in plasma ET-1 (p < 0.002), bFGF (p < 0.006), and EPI and NE (p < 0.0005) levels were observed. Systolic and diastolic BP significantly increased after handgrip test in NTs and EHs. Plasma ET-1 correlated with bFGF both before (p < 0.01) and at the acme (p < 0.05) of the isometric exercise. Our results show that in EHs plasma ET-1 and bFGF correlate each other, indicating that in human hypertension a linkage between ET-1 and bFGF exists.