Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis.

The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.

Association between sleep problems and functional disability in community-dwelling older adults.

BACKGROUND: Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults. METHODS: This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest. RESULTS: Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems. CONCLUSIONS: Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Factors associated with fear of falling in older women with knee osteoarthritis: A cross-sectional study.

Knee instability in patients with knee osteoarthritis (KOA) is associated with fear of falling (FoF). This study aimed to investigate the prevalence and the factors associated with FoF in older women with KOA. A cross-sectional study was conducted with 93 older women with KOA. Sociodemographic variables, medical conditions, handgrip strength, and anthropometric and body composition measurements were assessed. The Short Physical Performance Battery was used to measure functional performance. The Western Ontario and McMaster Universities Osteoarthritis Index was applied to assess pain, stiffness, and disability. FoF was assessed by the Falls Efficacy Scale-International. The prevalence of FoF was high (88.2 %). Disability, history of falls, handgrip strength, obesity, number of medications, and pain were independently associated with FoF. Our findings suggest that health professionals should investigate FoF when evaluating older women with KOA and address these risk factors when developing strategies to prevent or minimize FoF in this population.

Association Between Typologies of Sedentary Behavior and Muscle Strength, Gait Speed, and Balance in Community-Dwelling Older Adults.

Knowledge of how the different types of sedentary behaviors (SB) are associated with functional limitations can guide professionals who work with older adults on better recommendations about the amount of daily time that should be encouraged in each type of SB. The objective was to estimate the associations between two SB typologies (SB television [TV] and SB computer/internet) and the presence of handgrip strength, lower limb strength, gait speed, and balance limitations in Brazilian community-dwelling older adults. This is a cross-sectional study with 1,298 community-dwelling older adults (≥60 years). SB was assessed by self-reporting daily time spent watching TV or using computer/internet (categorized into <2, 3-4, and ≥5 hr/day). Outcomes were handgrip strength, lower limb strength, gait speed, and balance limitations considering referenced cutoff points. Older adults in SB TV ≥5 hr/day had 1.75 (95% confidence interval [CI] [1.07, 2.86]) and 1.88 (95% CI [1.02, 3.46]) times more chances of handgrip strength and gait speed limitations, respectively. On the other hand, those who spent 3-4 and ≥5 hr/day in SB computer/internet had 0.45 (95% CI [0.20, 0.99]) and 0.37 (95% CI [0.15, 0.93]) had less chances of lower limb strength and balance limitations, respectively. In conclusion, functional limitations would be associated differently depending on the type of SB in the older adults sampled.

Self-perception of the neighborhood environment, cognitive impairment and functional limitations in community-dwelling older adults: A cross-sectional study.

AIMS: It is important to identify the association between characteristics of the neighborhood environment, cognitive impairment and functional limitations to organize early and effective intervention strategies. METHODS: A cross-sectional survey of 308 community-dwelling older adults was conducted. Logistic Regression analyses were performed to verify the associations between self-perceived characteristics of the neighborhood environment (Neighborhood Environment Walkability Scale), cognitive impairment (Mini-Mental State Examination) and functional limitations (mobility, lower limb muscle strength and balance). RESULTS: Significant negative associations were observed: (1) better infrastructure, traffic and safety and mobility limitation; (2) better infrastructure and muscle weakness; (3) better safety and balance limitation; and (4) better streets/sidewalks and cognitive impairment. On the other hand, positive associations were observed between poor safety with mobility limitation and muscle weakness. CONCLUSIONS: Our findings contribute to greater knowledge about neighborhood characteristics regarding mental and physical health in community-dwelling older adults.

Circadian rhythm alterations affecting the pathology of neurodegenerative diseases.

The circadian rhythm is a nearly 24-h oscillation found in various physiological processes in the human brain and body that is regulated by environmental and genetic factors. It is responsible for maintaining body homeostasis and it is critical for essential functions, such as metabolic regulation and memory consolidation. Dysregulation in the circadian rhythm can negatively impact human health, resulting in cardiovascular and metabolic diseases, psychiatric disorders, and premature death. Emerging evidence points to a relationship between the dysregulation circadian rhythm and neurodegenerative diseases, suggesting that the alterations in circadian function might play crucial roles in the pathogenesis and progression of neurodegenerative diseases. Better understanding this association is of paramount importance to expand the knowledge on the pathophysiology of neurodegenerative diseases, as well as, to provide potential targets for the development of new interventions based on the dysregulation of circadian rhythm. Here we review the latest findings on dysregulation of circadian rhythm alterations in Parkinson's disease, Alzheimer's disease, Huntington's disease, amyotrophic lateral sclerosis, multiple sclerosis, spinocerebellar ataxia and multiple-system atrophy, focusing on research published in the last 3 years.

Association between sleep problems and multimorbidity patterns in older adults.

BACKGROUND: Sleep problems are frequent in older adults and are associated with chronic diseases. However, the association with multimorbidity patterns is still unknown. Considering the negative impacts that multimorbidity patterns can have on older adults' life, knowledge of this association can help in the screening and early identification of older adults with sleep problems. The objective was to verify the association between sleep problems and multimorbidity patterns in older Brazilian adults. METHODS: This was a cross-sectional study conducted with data from 22,728 community-dwelling older adults from the 2019 National Health Survey. The exposure variable was self-reported sleep problems (yes/no). The study outcomes were: multimorbidity patterns, analyzed by self-report of the coexistence of two or more chronic diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; (3) musculoskeletal; (4) coexisting patterns. RESULTS: Older adults with sleep problems had 1.34 (95%CI: 1.21; 1.48), 1.62 (95%CI: 1.15; 2.28), 1.64 (95%CI: 1.39; 1.93), and 1.88 (95%CI: 1.52; 2.33) greater odds of presenting vascular-metabolic, cardiopulmonary, musculoskeletal, and coexisting patterns, respectively. CONCLUSIONS: These results suggest that public health programs aimed at preventing sleep problems in older adults are essential to reduce possible adverse health outcomes, including multimorbidity patterns and their negative consequences for older adults' health.

Are history of falls and fear of falling associated with mobility in community-dwelling older adults?

Evidence has suggested that a history of falls and fear of falling (FOF) are associated with reduced mobility among older adults. Although many studies have explored the association between the history of falls and FOF in the context of decreased mobility, most have had small sample sizes, limiting the generalizability of the results. Therefore, this study sought to contribute to the body of knowledge around these constructs to further support the previous findings. To investigate the association between a history of falls and FOF with low mobility in community-dwelling older adults. This cross-sectional study included 308 older adults (69.9 ± 7.1 years, 57.8% female). The Timed Up and Go (TUG) test was used to classify mobility limitations in participants and the Falls Efficacy Scale-International - Brazil was used to quantify FOF. Participants were also asked if they had fallen in the previous 12 months. Multivariable logistic regression was used. The prevalence rates of a history of falls and FOF were 32.7 and 48.4%, respectively. Older adults with a history of falls and FOF had 2.20 (95%CI: 1.20; 4.02) and 3.80 (95%CI: 1.90; 7.58) greater odds of presenting low mobility than older adults without these health problems, respectively. History of falls and FOF are associated with higher odds of low mobility in community-dwelling older adults. Therefore, it is of the utmost importance to introduce public health programs aimed at preventing falls in older adults to reduce possible adverse health outcomes, including low mobility.

Prevalence of sarcopenia in older women and level of agreement between the diagnostic instruments proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2).

BACKGROUND: The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposed the use of different diagnostic tools to assess sarcopenia. This study aimed to determine prevalence rates of sarcopenia according to the diagnostic instruments proposed by EWGSOP2 and to assess their level of agreement in older Brazilian women. METHODS: A cross-sectional study with 161 community-dwelling older Brazilian women. Probable sarcopenia was assessed through Handgrip Strength (HGS) and the 5-times sit-to-stand test (5XSST). In addition to reduced strength, Appendicular Skeletal Muscle Mass (ASM) (obtained by Dual-energy X-ray absorptiometry) and ASM/height² were considered for diagnosis confirmation. Sarcopenia severity was determined by reduced muscle strength and mass and poor functional performance assessed by Gait Speed (GS), Short Physical Performance Battery (SPPB), and Timed Up and Go test (TUG). McNemar's test and Cochran's Q-test were used to compare sarcopenia prevalence. Cohen's Kappa and Fleiss's Kappa tests were used to assess the level of agreement. RESULTS: The prevalence of probable sarcopenia was significantly different (p < 0.05) when using HGS (12.8%) and 5XSST (40.6%). Regarding confirmed sarcopenia, the prevalence was lower when using ASM/height² than with ASM. Regarding severity, the use of SPPB resulted in a higher prevalence in relation to GS and TUG. CONCLUSION: There were differences in the prevalence rates of sarcopenia and low agreement between the diagnostic instruments proposed by the EWGSOP2. The findings suggest that these issues must be considered in the discussion on the concept and assessment of sarcopenia, which could ultimately help to better identify patients with this disease in different populations.

A nationwide study on pain manifestations and sleep problems in community-dwelling older adults: findings from ELSI-Brazil.

PURPOSE: Sleep problems are common and affect approximately 36-70% of older adults worldwide and can be associated with negative outcomes such as pain. There is believed to be a bidirectional relationship between sleep problems and pain, modulated by inflammation and stress. The objective was to investigate the association between self-reported sleep problems and pain manifestations. METHODS: A cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (2019-2021) was conducted. The exposure variables were self-reported sleep problems: poor sleep quality, insomnia (initial, intermediate, and final), and daytime sleepiness. The outcomes were self-reported pain manifestations: frequent pain, moderate/intense/strong pain, and pain-related disability. Logistic regressions were performed to verify the association between exposures and outcomes. RESULTS: A total of 6875 community-dwelling older adults participated in this study (71.1 ± 8.3 years; 54.4% female). Older adults with self-reported poor sleep quality, initial, intermediate and final insomnia, and daytime sleepiness had, respectively, 1.99 (95% CI 1.57-2.53), 1.47 (95% CI 1.11-1.97), 1.65 (95% CI 1.27-2.14), 1.69 (95% CI 1.29-2.22), and 1.76 (95% CI 1.35-2.29) greater odds of reporting frequent pain. The odds of moderate/intense/strong pain were higher in older adults that reported poor sleep quality (OR: 2.21; 95% CI 1.08-4.51). Older adults with self-reported poor sleep quality, initial, intermediate and final insomnia, and daytime sleepiness had, respectively, 1.84 (95% CI 1.11-3.02), 1.73 (95% CI 1.14-2.62), 1.80 (95% CI 1.19-2.73), 1.58 (95% CI 1.07-2.34), and 1.63 (95% CI 1.11-2.39) greater odds of reporting pain-related disability. CONCLUSION: Self-reported sleep problems are associated with pain manifestations in older adults. The results may help in the proposition of programs and public health policies.

How much time of sedentary behavior is associated with depressive symptoms in community-dwelling older adults in southern Brazil?

AIMS: Identify sedentary behavior (SB) cut-off points to screen for depressive symptoms in older adults and verify the association between these conditions. METHODS: A cross-sectional survey of 308 community-dwelling older adults was conducted. The outcome was the presence of depressive symptoms (≥6 points on the Geriatric Depression Scale-15). The exposure was SB using the self-reported time on a weekday and weekend (International Physical Activity Questionnaire). The cut-off points for SB categorization were determined by the receiver operating characteristic curve and multivariate logistic regression to verify the association. RESULTS: Older adults who spent ≥4.5 hours/day in SB (sensitivity = 48.8%; specificity = 67.8%) were 1.81 times more likely (95%CI: 1.03;3.15) to have depressive symptoms compared to those who stayed for shorter periods. CONCLUSIONS: There was an association between SB and depressive symptoms; therefore, older adults must have SB <4.5 hours/day to reduce the chances of developing depressive symptoms.

Accuracy of handgrip and respiratory muscle strength in identifying sarcopenia in older, community-dwelling, Brazilian women.

Certain cut-off points for sarcopenia screening and diagnosis are arbitrary and based on European populations, with normative references often obtained from healthy young adults. Although respiratory skeletal muscle strength tests represent low-cost clinical measures commonly performed in clinical practice by health professionals, a gap remains regarding whether respiratory skeletal muscle strength tests are adequate and sensitive measures for sarcopenia screening. This study aimed to verify the value of handgrip and respiratory muscle strength as possible discriminators to identify sarcopenia and to establish cut-off points for sarcopenia screening in community-dwelling, Brazilian women. In a cross-sectional study, 154 community-dwelling, Brazilian women (65-96 years) were assessed for appendicular skeletal muscle mass, handgrip (HGS), and respiratory muscular strength, including maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). The data were analyzed using the ROC curve and the Youden Index determined cut-off points. Statistical significance was set at 5%. 88 participants (57%) were sarcopenic. MEP (OR 0.98 [95%CI 0.97, 1.00], p = 0.023) and HGS (OR 0.82 [95% CI 0.75, 0.90], p < 0.001) were independent factors for sarcopenia in older. The optimal cut-off points for identifying sarcopenia were ≤ 77 cmH2O for MEP (AUC = 0.72), and ≤ 20 kg for HGS (AUC = 0.80). Simple muscular strength tests, including HGS and MEP, may be considered in the identification of sarcopenia in older, community-dwelling, Brazilian women. Future work is still needed to assess external validation of the proposed cut-offs before the clinical application.

Perceived Characteristics of the Built Neighborhood Environment and Negative Self-Rated Health in Brazilian Community-Dwelling Older Adults.

INTRODUCTION: Research indicates that self-rated health is associated with worse health outcomes in older adults. Thus, it is important to assess the association between built neighborhoods and self-rated health to establish strategies to improve the quality of life in the older adult population. OBJECTIVE: To evaluate the association between the perceived characteristics of the built neighborhood and the negative self-rated health in Brazilian community-dwelling older adults. METHODS: A cross-sectional study for finite random samples was performed with older adults who used the municipal public health service. The outcome was negative self-rated health using the question "How do you perceive your health?" The regular, bad, and very bad responses were grouped as negative self-perception. The exposure variables were the perceived characteristics of the built neighborhood, which was evaluated by the adapted version of the Neighborhood Environment Walkability Scale. RESULTS: A total of 308 older adults were analyzed. Living close to food establishments (OR: 0.46; 95% CI: 0.25;0.85), fitness/bodybuilding gyms and/or clubs (OR: 0.51; 95% CI: 0.28;0.93), and safety to walk during the day (OR: 0.37; 95% CI: 0.16;0.87) and night (OR: 0.47; 95% CI: 0.26;0.84) were protective against negative self-rated health. CONCLUSION: Therefore, living in neighborhoods with better characteristics was less associated with negative self-rated health, demonstrating the importance of promoting strategies to improve the neighborhood infrastructure and this population's perception of health.

How much time in sedentary behavior is associated with probable sarcopenia in older adults?

Sedentary activities, such as watching television and using the computer, are frequent conditions in older adults and can be associated with sarcopenia. The objectives of this study were: (a) to establish sedentary behavior (SB) cutoff values for screening probable sarcopenia in community-dwelling older adults and (b) to verify the association between SB and probable sarcopenia according to the established cutoff point. This was a cross-sectional study including 1,165 community residents in Florianopolis/SC. SB was assessed using the International Physical Activity Questionnaire. The outcome was probable sarcopenia (assessed by time ≥ 15 s in the Five times sit-to-stand test). The cut-off points found for SB were time > 120 min/day [AUC: 0.54 (95%CI: 0.51; 0.57)] watching TV or video/DVD and ≤ 20 min/day [AUC: 0.59 (95%CI: 0.56;0.62)] using computer/internet. Older adults with SB had 1.30 (95% CI: 1.01; 1.66) and 1.46 (95% CI: 1.08; 1.96) greater chances of having sarcopenia, respectively.

Plasma levels of myokines and inflammatory markers are related with functional and respiratory performance in older adults with COPD and sarcopenia.

This study investigated whether blood-based biomarkers were related to functional test performance and respiratory muscle strength in older adults with COPD and sarcopenia. The participants included in this cross-sectional study were from both sexes and sixty years or older. Based on clinical assessment, participants were categorized in COPD (n = 43) and non-COPD (NCOPD) (n = 43) groups. They were also assessed for body composition and muscular mass by dual-energy X-ray absorptiometry, using the relative skeletal muscle index for the diagnosis of sarcopenia. A series of functional tests, including short physical performance battery (SPPB), 6-minute walking test (6MWT), maximal inspiratory and expiratory pressures (MIP and MEP), were carried out. Plasma levels of myokines (Irisin and BDNF), and soluble TNF receptors (sTNFR1 and sTNFR2) were determined by ELISA. In the multivariate analysis, 6MWD was associated with age, COPD-related sarcopenia and BDNF (R2 = 0.29; f2 = 0.41). SPPB score was associated with COPD-related sarcopenia and sTNFR1 (R2 = 0.25; f2 = 0.33). MIP value was associated with sex, COPD-related sarcopenia, sTNFR2 and Irisin (R2 = 0.24; f2 = 0.31). Finally, MEP value was associated with sex COPD-related sarcopenia (R2 = 0.18; f2 = 0.22). Plasma levels of myokines and inflammatory markers are related with functional and respiratory performance in older adults with COPD and sarcopenia.

Are multimorbidity patterns associated with fear of falling in community-dwelling older adults?

BACKGROUND: Multimorbidity is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in the same individual and can be grouped into different patterns based on the type of disease. These patterns are associated with poorer quality of life and premature death. It is believed that these patterns entail functional limitations, which may contribute to the fear of falling; however, this association remains unknown. Identifying this possible association is fundamental for developing individual and collective care approaches aimed at preventing the different patterns of chronic diseases in older adults in order to decrease the fear of falling. The objective of this study was to investigate the association between multimorbidity patterns and fear of falling in older adults. METHODS: This was a cross-sectional study including 308 older adults. The exposure variables were the presence of three multimorbidity patterns (cardiopulmonary, musculoskeletal, and vascular-metabolic) and pattern association assessed by self-report of two or more similar coexisting chronic diseases. The outcome was fear of falling assessed by the Brazilian version of Falls Efficacy Scale-International (cut-off point ≥ 23 points). Multivariable logistic regression was used to analyze the association between variables. RESULTS: Older adults with cardiopulmonary, musculoskeletal, vascular-metabolic patterns and pattern association had 3.49 (95%CI 1.13; 10.78), 2.03 (95%CI 1.13; 3.64), 2.14 (95%CI 1.20; 3.82), and 4.84 (95%CI 2.19; 10.68), respectively, greater chances of presenting fear of falling when compared to older adults without the patterns. CONCLUSIONS: The presence of multimorbidity patterns is associated with higher chances of reporting fear of falling. It is emphasized that the introduction of public health programs aimed at preventing multimorbidity patterns is essential to reduce possible adverse health outcomes, including fear of falling and its negative consequences for older adult health.

Association Between Fear of Falling and Frailty in Community-Dwelling Older Adults: A Systematic Review.

BACKGROUND/OBJECTIVE: Fear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and frailty. METHODS: All the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age ≥60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and cross-sectional studies, respectively. RESULTS: The initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89). CONCLUSION: FoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty. PROSPERO: CRD42021276775.

Gender differentiated score on the Falls Efficacy Scale International (FES-I Brazil) to assess self-efficacy in falls in community-dwelling older adults.

BACKGROUND: Since fear of falling is associated with a history of falls and is more prevalent in women, it is important to define cut-off points differentiated between genders on the Falls Efficacy Scale International Brazil (FES-I Brazil) to implement early prevention and/or rehabilitation strategies. AIMS: To determine cut-off points on the FES-I Brazil differentiated between genders which discriminate falls and verify their association with the history of falls. METHODS: This was a cross-sectional study including 306 community-dwelling older adults. Fear of falling score from the FES-I Brazil was the independent variable and the outcome was the history of falls in the last 12 months. The cut-off points differentiated between genders were established according to sensitivity and specificity values evaluated by the Receiver Operating Characteristic Curves (ROC). The multivariable logistic regression was used to verify the association between fear of falling and history of falls. RESULTS: The cut-off points on the FES-I Brazil to discriminate falls were > 25 points [AUC: 0.67 (95% CI 0.59-0.73)] for women, and > 19 points [AUC: 0.66 (95% CI 0.57-0.74) for men, suggesting that women present a greater fear of falling than men, due to the higher cut-off point found for women. Women and men with fear of falling, respectively, had 2.14 (95% CI 1.11-4.13) and 2.62 (95% CI 1.10-6.85) higher odds of suffering falls compared to those without this condition. CONCLUSIONS: The FES-I can be used to discriminate falls in the elderly and shows that women have a higher cut-off point than men on the scale.

Cognitive and behavioral factors associated to probable sarcopenia in community-dwelling older adults.

BACKGROUND: Sarcopenia has a high prevalence in older adults and is associated with chronic aggravations to health, so therefore it is important to identify older adults who are affected by sarcopenia in order to establish preventative strategies or early interventions. OBJECTIVE: To estimate the prevalence of probable sarcopenia and verify its association with cognitive impairment, fear of falling, depressive symptoms and health self-perception in community-dwelling older adults. METHODS: A cross-sectional study with simple random sampling including 306 older adults of both genders. The outcome variable was probable sarcopenia evaluated by the Five times sit-to-stand test (5XSST) considering probable sarcopenia when the measured time was > 15 seconds, following the recommendation of the European Working Group on Sarcopenia in Older People. The predictor variables were cognitive impairment, fear of falling, depressive symptoms and self-perception of health. Multivariate Logistic Regression was performed to verify associations between the variables. RESULTS: The prevalence of probable sarcopenia was 50.00%. The older adults had significantly higher chances of presenting probable sarcopenia when displaying cognitive impairment (OR 2.49; 95%CI 1.46-4.24), fear of falls (OR 4.23; 95%CI 2.51-7.12), depressive symptoms (OR 2.20; 95%CI 1.32-3.67), poor (OR 2.48; 95%CI 1.19-5.16) and fair self-perception of health (OR 2.11; 95%CI 1.22-3.63) when compared to those who did not have the same conditions. CONCLUSION: The prevalence of probable sarcopenia in this study was 50.00%, and was associated with the presence of depressive symptoms, cognitive impairment, fear of falls and negative self-perception of health.

How Much Time in Sedentary Behavior Should Be Reduced to Decrease Fear of Falling and Falls in Community-Dwelling Older Adults?

Fear of falling and history of falls are frequent situations in older adults, which can be aggravated by sedentary behavior (SB). The objective was to establish SB cutoff values which discriminate falls and fear of falling in older adults and verify the association between these conditions. This was a cross-sectional study including 308 community-dwelling older adults. The SB was assessed by International Physical Activity Questionnaire. The outcomes were history of falling in the last 12 months and fear of falling (higher or equal than 23 points in Falls Efficacy Scale International-Brazil). The cutoff points found were >4.14 (area under curve = 0.60, 95% confidence intervals [CIs] [0.54, 0.65]) and >3.90 hr per day (area under curve = 0.59, 95% CI [0.53, 0.64]) for fear of falling and history of falls, respectively. Older adults with SB had 1.71 (95% CI [1.03, 2.84]) and 1.75 (95% CI [1.06, 2.89]) greater odds of having greater fear of falling and suffering falls, respectively.