Effectiveness of a multiple intervention programme for the prevention of falls in older adults persons from a University of the Third Age / Efetividade de uma intervenção múltipla para a prevenção de quedas em idosos participantes de uma Universidade Aberta à Terceira Idade

ABSTRACT OBJECTIVE: To evaluate the effectiveness of a multiple intervention programme for the prevention of falls in older adults from a University of the Third Age (U3A). METHOD: A quasi-experimental, non-controlled, longitudinal and quantitative study was performed. 69 older adults were allocated into three groups: Control (CG), Physical Exercise (PEG) and Multiple Intervention (MIG). The instruments/tests used were: sociodemographic questionnaire, Geriatric Depression Scale (15-items), Mini-Mental State Examination, Timed-Up and Go (TUG), Sit-to-Stand and Hand-Grip Strength, Falls Efficacy Scale-International and Falls Risk Awareness Questionnaire (FRAQ).The PEG and MIG groups underwent physical training (walking, muscular resistance, and balance) for 16 weeks (2x/week, 60 min/session). In the same period, the MIG also participated in educational sessions (1x/week, 60min/session). Covariance analysis was used for group comparisons. The effect size of the interventions was also calculated. The level of significance was set at p<0.05. RESULTS: 51 older adults (67±6.2 years and 76.3% women), of whom 15 were in the CG, 20 in the PEG and 16 in the MIG, concluded the study. TUG time in both intervention groups was reduced, but FRAQ score improved in the MIG only. Both interventions had a small effect on TUG time, while multiple intervention had a large effect on FRAQ. CONCLUSION: Multiple intervention brought additional benefits to the older adults from this U3A. In addition to improving balance, the older adults who underwent the multiple intervention increased their knowledge about risk factors for falls.

OBJETIVO: Avaliar a efetividade de uma intervenção múltipla para a prevenção de quedas em idosos participantes de uma Universidade Aberta à Terceira Idade (UnATI). MÉTODO: Estudo quase experimental, não controlado, de caráter longitudinal e quantitativo. Foram alocados 69 idosos em três grupos: Controle (GC), Exercício Físico (GEF) e Intervenção Múltipla (GIM). Os instrumentos/testes utilizados foram: questionário sociodemográfico, Escala de Depressão Geriátrica (15-itens), Miniexame do Estado Mental, Timed Up and Go (TUG), Levantar e Sentar da Cadeira e Força de Preensão Palmar, Falls Efficacy Scale-International e Falls Risk Awareness Questionnaire (FRAQ). Os grupos GEF e GIM foram submetidos ao treinamento físico (caminhada, resistência muscular e equilíbrio) por 16 semanas (duas vezes por semana, 60 min/sessão). No mesmo período, o GIM participou também de sessões educativas (uma vez por semana, 60min/sessão). Na comparação dos grupos, utilizou-se a análise de covariância. O tamanho do efeito das intervenções também foi calculado. O nível de significância estabelecido foi de p<0,05. RESULTADOS: Cinquenta e um idosos [67 (±6,2) anos; 76,3% mulheres], sendo 15 do GC, 20 do GEF e 16 do GIM concluíram o estudo. Ambos os grupos intervenção reduziram o tempo do TUG, mas somente o GIM melhorou a pontuação da FRAQ. Ambas as intervenções tiveram efeito pequeno no tempo do TUG, enquanto a intervenção múltipla apresentou efeito grande na FRAQ. CONCLUSÃO: A intervenção múltipla trouxe benefício adicional aos idosos dessa UnATI. Além da melhora no equilíbrio, os idosos submetidos à intervenção múltipla aumentaram o conhecimento sobre fatores de risco para quedas.

Cognitive screening test in primary care: cut points for low education.

OBJECTIVE: To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS: Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS: Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS: The GPCOG-Br is clinically well-suited for use in primary care.

Cognitive screening test in primary care: cut points for low education

ABSTRACT OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.

The Geriatric Anxiety Inventory in primary care: applicability and psychometric characteristics of the original and short form

Abstract Background Generalized anxiety disorder (GAD) has negative implications for people’s lives, but is often underdiagnosed in the elderly. There is a shortage of instruments to assess geriatric anxiety. Objectives To analyze the applicability and psychometric properties of the Portuguese version of the Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) within primary care. Methods Fifty-five seniors were classified as non-demented by a multidisciplinary panel. The protocol included the GAI, the Self-Reporting Questionnaire (SRQ-20), the Depression Scale D-10, Mini-Mental State Examination (MMSE), Bayer Scale for Activities of Daily Living (B-ADL) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). A sub-sample also completed the Beck Anxiety Inventory (BAI). Results The GAI and GAI-SF showed good internal consistency (0.89; 0.62, respectively) and test-retest stability (0.58, 0.97). The GAI and GAI-SF correlated significantly with the SRQ-20 (0.74, 0.55) and BAI (0.75, 0.58). Discussion The psychometric characteristics of the Brazilian versions of the GAI and GAI-SF suggest these instruments are suitable for application in the Brazilian elderly population within the primary care setting.

Relations between memory complaints, depressive symptoms and cognitive performance among community dwelling elderly / Relações entre queixas de memória, sintomas depressivos e desempenho cognitivo em idosos residentes na comunidade

Backgroun: Memory complaints are quite common among the elderly; yet, the clinical relevance of these complaints to diagnose cognitive decline is debatable, since several different factors could be associated with them. Objective: The present paper examined the correlations between memory complaints, depressive symptoms and cognitive performance in a group of 301 elderly individuals who lived in the district of Ermelino Matarazzo, São Paulo, and who participated in the population-based survey entitled Profiles of Frailty in Elderly Brazilians by the FIBRA Network. Methods: Cognitive performance was assessed with the memorization test involving 10 common pictures, the Mini Mental State Examination (MMSE), the Verbal Fluency (VF) test, and the Clock Drawing Test, which comprise the Brief Cognitive Screening Battery (BCSB). Memory complaints were assessed with the Memory Complaint Questionnaire (MAC-Q), and depressive symptoms with the Geriatric Depression Scale (GDS). Results: Female participants had higher rates of memory complaints when compared to male participants (p = 0.013). Subjects with less years of schooling had more severe memory complaints and poorer cognitive performance than those with more years of schooling (p < 0.003). The presence of depressive symptoms was associated with poorer memory assessment scores (r = 0.39, p < 0.001). Discussion: Memory complaints were correlated with sex, schooling and depressive symptoms among elderly individuals residing in the community. No correlation was found between complaints and cognitive performance.

Contexto: A queixa de memória é comum entre pessoas idosas, entretanto sua relevância clínica para o diagnóstico de alterações cognitivas é questionável, visto que diversos fatores podem se associar às queixas. Objetivo: O presente estudo avaliou a relação entre queixas de memória, sintomas depressivos e desempenho cognitivo em 301 idosos residentes em Ermelino Matarazzo que participaram da pesquisa de base populacional Perfis de Fragilidade em Idosos Brasileiros da Rede FIBRA. Objetivo: O presente estudo avaliou a relação entre queixas de memória, sintomas depressivos e desempenho cognitivo em 301 idosos residentes em Ermelino Matarazzo que participaram da pesquisa de base populacional Perfis de Fragilidade em Idosos Brasileiros da Rede FIBRA. Métodos: O desempenho cognitivo foi avaliado por meio dos testes de memorização de 10 figuras comuns, Miniexame do Estado Mental (MEEM), Fluência Verbal (FV) e Teste do Desenho do Relógio, que compõem a Bateria Breve de Rastreio Cognitivo (BBRC). As queixas de memória foram avaliadas pelo Questionário de Queixas de Memória (MAC-Q) e os sintomas depressivos, pela Escala de Depressão Geriátrica (EDG). Resultados: Participantes do sexo feminino apresentaram maior índice de queixas de memória, comparado ao dos homens (p = 0,013). Idosos menos escolarizados apresentaram queixas de memória mais intensas e pior desempenho cognitivo, comparados aos de maior escolaridade (p < 0,003). A presença de sintomas depressivos associou-se à pior avaliação da memória (r = 0,39, p < 0,001). Conclusão: As queixas de memória se associaram a sexo, escolaridade e sintomas depressivos, entre idosos residentes na comunidade. Não houve associação entre queixas e desempenho cognitivo. Conclusão: As queixas de memória se associaram a sexo, escolaridade e sintomas depressivos, entre idosos residentes na comunidade. Não houve associação entre queixas e desempenho cognitivo.

Training of executive functions in healthy elderly: Results of a pilot study.

Executive functions (EF) refer to the cognitive skills necessary to formulate a goal, plan, execute plans effectively, and to perform self-monitoring and self-correction. Several aspects of EF change during the normal aging process. OBJECTIVES: To train skills associated with executive functions in the elderly and to detect possible impact on objective EF tests and self-reports of functional status. METHODS: A cross-sectional study involving an intervention and pre and post testing was carried out. Study participants included 26 seniors assigned to an experimental group (EG) and given six sessions of cognitive intervention, and 17 seniors assigned to a control group (CG) who completed pre and post testing only. All participants were enrolled in an Open University for the Third Age. The following tests were used to measure outcome: the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the Story subtest of the Rivermead Behavioral Memory Test (RBMT) (versions A and B), semantic verbal fluency fruit category, and verbal fluency with phonological constraints (FAS), WAIS-III Digit Span, Clock Drawing Test (CDT), Trail Making Part A and the Pfeffer Functional Assessment Questionnaire (PFAQ). Delta scores were calculated (post-test score minus pretest score) to assess the impact of the intervention. RESULTS: In the post test, the CG showed significant improvement on the RBMT Story recall and Digit Span but a decline in verbal fluency. The EG remained stable in terms of pre and post test scores. CONCLUSIONS: The intervention did not enhance performance on the EF tests. It is noteworthy that the EG received only a small number of sessions which may not have been sufficient to generate improvement. Alternatively, the lack of group differences observed could be associated to participation in other workshops offered at the university.

As funções executivas (FE) representam as capacidades cognitivas necessárias para formular um objetivo, planejar, executar planos de modo eficiente, monitorizar-se e autocorrigir-se. As FE sofrem alterações durante o processo de envelhecimento normal. OBJETIVOS: Treinar habilidades relacionadas às funções executivas em idosos e detectar impactos em testes objetivos de FE e em autorrelato de desempenho funcional. MÉTODOS: Trata-se de um estudo transversal, com intervenção e pré e pós testagem. Participaram do estudo 26 idosos que compuseram o grupo experimental (GE) que receberam intervenção cognitiva de seis sessões e 17 idosos do grupo controle (GC) que completaram apenas pré e pós testagem, matriculados em atividades em uma Universidade Aberta à Terceira Idade. Como medida de eficácia foram usados o Mini-Exame do Estado Mental (MEEM), Escala de Depressão Geriátrica (EDG), o subteste História do Teste Comportamental de Memória de Rivermead (versões A e B), fluência verbal categoria semântica frutas (FV), e com restrição fonológica (FAS), Dígitos da bateria WAIS-III, o Teste do Desenho do Relógio (TDR), Trilha A e o Questionário de Avaliação Funcional de Pfeffer (PFAQ). Para a avaliação do impacto da intervenção foram calculados deltas (escore do pós-teste menos o escore do pré-teste). RESULTADOS: No pós-teste o GC apresentou melhora no resgate da História e no desempenho nos Dígitos, entretanto, apresentou pior desempenho em fluência verbal. A pontuação do GE permaneceu inalterada. CONCLUSÕES: Os dados sugerem que a intervenção não gerou impacto nos testes associados ao conceito de FE. Destaca-se que os idosos do GE receberam um número limitado de sessões que pode não ter sido suficiente para gerar alterações. Alternativamente, a ausência de diferença entre os grupos pode estar associada à participação em outras oficinas oferecidas na universidade.