Number of ideas in spontaneous speech predicts cognitive impairment and frailty in community-dwelling older adults nine years later.

OBJECTIVE: To investigate the associations between linguistic parameters in spontaneous speech at baseline and cognitive impairment and frailty nine years later. METHODS: A prospective analysis was carried out on data of the Frailty in Brazilian Older People Study (FIBRA) Study, a population-based study on frailty. From a probabilistic sample of 384 individuals aged 65 and older at baseline (2008-2009), 124 aged 73 years and older at follow-up were selected, as they had scored above the cutoff values of cognitive screening for dementia adjusted by years of schooling at baseline and had answered to the question What is healthy aging and had no frailty at baseline. Verbal responses were submitted to content analysis and had its ideas and words counted. Number of ideas corresponded to the frequency of meaning categories and number of words to all identified significant textual elements in the text constituted by the sample answers to that question. RESULTS: Multivariate logistic regression analyses, controlling for the effects of age, sex, and education, showed that individuals with a high number of ideas at baseline had lower chance of having cognitive impairment (OR = 0.39; 95% CI 0.22 - 0.69) and frailty (OR 0.66; 95% CI 0.44 - 0.99) nine years later than those with low number of ideas. CONCLUSIONS: Higher number of ideas, but not number of words, in spontaneous speech seems to be associated to a more positive prognosis in mental and physical health nine years later. Linguistic markers may be used to predict cognitive impairment and frailty in older individuals.

Impact of functional capacity on change in self-rated health among older adults in a nine-year longitudinal study.

The aims of the present study were to estimate the frequency of change in self-rated health (SRH) among community-dwelling older adults, between two measures taken at a 9-year interval; and determine factors associated with a decline and an improvement in SRH, in relation to aspects of physical/emotional health and subjective wellbeing. Data were derived from a community-based study on frailty among Brazilian elderly. Associations were investigated using Pearson's chi-square test and relative risk ratios were estimated using multinomial logistic regression analysis. 39.3% of participants did not change their SRH at both assessment times, 21.7% rated it as worse and 39.0% rated it as better. The relative risk ratio of an improvement in SRH for individuals with disability in basic activities of daily living (ADLs) was lower than for individuals with independence in basic ADLs (IRR=0.22; IC95%: 0.08-0.63). Understanding the complex interactions between self-rated health and the dimensions that influence the improvement of health perception may shed light on key determinants of the wellbeing among older adults.

Low grip strength and gait speed as markers of dependence regarding basic activities of daily living: the FIBRA study.

OBJECTIVE: Marincolo et al. showed that older adults without limitations in basic activities of daily living at baseline presented with an 11.7% concomitant presence of functional dependence, slow gait speed, and low muscle strength at follow-up. Slow gait speed remains a predictor of dependence in basic activities of daily living. To determine whether low muscle strength and low gait speed increase the risk of disability related to basic activities of daily living in community-dwelling older adults. METHODS: A longitudinal study (9 years of follow-up) was conducted with 390 older adults who were independent in basic activities of daily living at baseline and answered the Katz Index at follow-up. Associations were determined using Pearson's χ2 test with a 5% significance level and logistic regression analysis. RESULTS: Increases in prevalence between baseline and follow-up were observed for low muscle strength (17.5%-38.2%), slow gait speed (26.0%-81.1%), and functional dependence (10.8%-26.6%). At follow-up, 11.7% of the participants had concomitant functional dependence, slow gait speed, and low muscle strength. Slow gait speed remained a predictor of dependence in basic activities of daily living (odds ratio=1.90; 95% confidence interval=1.06-3.41). CONCLUSION: Slow gait speed is a predictor of functional dependence, constituting an important variable for screening functional decline.

Frailty and functional status among older adults with cognitive impairment: data from the second wave of the FIBRA study.

Frailty is defined as a recognizable state of increased vulnerability resulting from age-associated decline of function in various physiological systems, such that the ability to deal with acute or everyday stressors is compromised. Objective: The aim of the study was to characterize the sample of older adults with cognitive impairment, according to the frailty status indirectly assessed by family members, other clinical and sociodemographic variables; and to assess the overlap of clinical conditions evaluated in this sample with cognitive impairment. Methods: Data were extracted from the follow-up database of the Frailty in Brazilian Older Adults (FIBRA) study (2016-2017). The sample consisted of 130 elderly people with cognitive impairment assessed by the Mini Mental State Examination (MMSE). The scores for the Clinical Dementia Scale (CDR), Cornell Scale for Depression in Dementia and Functional Activities Questionnaire were described. Frailty was indirectly measured through questions answered by family members about the five criteria that compose the frailty phenotype. Results: The sample consisted mostly of older women (n=91) with a mean age of 82.4 (SD=5.3) years, mean schooling of 3.3 years (SD=3.07), widowed (47.7%) and who lived with children and/or grandchildren (68%). More than half had multimorbidity (74.90%), 39.5% had depression symptoms suggestive of major depression, 57% had impaired functionality, 49.3% were frail, 37.6% pre-frail, and 13.10% robust. Conclusion: Among older adults with cognitive impairment, frailty and functional limitations are common.

A fragilidade é definida como um estado reconhecível de vulnerabilidade aumentada resultante do declínio da função associado à idade em vários sistemas fisiológicos, de modo que a capacidade de lidar com estressores agudos ou cotidianos fica comprometida. Objetivo: Caracterizar uma amostra de pessoas idosas com comprometimento cognitivo, segundo o estado de fragilidade, avaliado de forma indireta por familiares, assim como outras variáveis clínicas e sociodemográficas; e avaliar a sobreposição das condições clínicas avaliadas nesta amostra com o comprometimento cognitivo. Métodos: Os dados foram extraídos do banco de dados de acompanhamento do estudo Fragilidade em Idosos Brasileiros (FIBRA - 2016-2017). A amostra foi composta por 130 idosos com comprometimento cognitivo avaliado pelo Mini-Exame do Estado Mental (MEEM). Foram descritos os escores da Escala Clínica de Demência (CDR), da Escala Cornell de Depressão em Demência e do Questionário de Atividades Funcionais. A fragilidade foi mensurada indiretamente por meio de questões respondidas junto aos familiares sobre os cinco critérios que compõem o fenótipo de fragilidade. Resultados: A amostra foi composta em sua maioria por mulheres idosas (n=91) com idade média de 82,4 (DP=5,3) anos, escolaridade média de 3,3 anos (DP=3,07), viúvas (47,7%) e que viviam com filhos e/ou netos (68%). Mais da metade apresentava multimorbidade (74,90%), 39,5% apresentavam sintomas depressivos sugestivos de depressão maior, 57% tinham funcionalidade prejudicada, 49,3% eram frágeis, 37,6% pré-frágeis e 13,10% robustos. Conclusão: Entre idosos com alterações cognitivas, é comum a co-ocorrência de fragilidade e de limitações funcionais.

[Loneliness and its association with sociodemographic and health indicators in Brazilian adults and older adults: ELSI-Brazil]. / Solidão e sua associação com indicadores sociodemográficos e de saúde em adultos e idosos brasileiros: ELSI-Brasil.

This study aimed to investigate the prevalence of loneliness and its associations with sociodemographic and health indicators in a nationally representative sample of Brazilian adults and older adults. Data from the baseline (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were analyzed, and participants with complete information on the variables of interest (n = 7,957) were included. Loneliness was the outcome variable, which was based on the question "How often do you feel alone or lonely: always, sometimes, or never?" Independent variables included sociodemographic indicators and health behaviors and conditions. The analyses included the Pearson's chi-square test for calculating relative frequencies, and Poisson regression for estimating prevalence ratios (PR) and their respective 95% confidence intervals (95%CI). The prevalence of always feeling lonely was 16.8%; sometimes, 31.7%; and never, 51.5%. Significant associations were observed between always feeling lonely and depression (PR = 4.49; 95%CI: 3.93-5.11), living alone (PR = 2.44; 95%CI: 2.12-2.82), low education level (PR = 1.93; 95%CI: 1.61-2.32), being a woman (PR = 1.53; 95%CI: 1.36-1.72), self-rated poor/very poor health (PR = 1.48; 95%CI: 1.27-1.73), and poor/very poor sleep quality (PR = 1.21; 95%CI: 1.05-1.41). Given its potential to harm quality of life, it is necessary to longitudinally understand the trajectories of loneliness and associated variables, and to use this knowledge to design public policies and health interventions that could benefit the biopsychosocial well-being of Brazilian adults and older adults.

O objetivo foi investigar a prevalência de solidão e suas associações com indicadores sociodemográficos e de saúde em amostra nacionalmente representativa de adultos e idosos brasileiros. Foram analisados dados da linha de base (2015-2016) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil) e incluídos os participantes com informações completas nas variáveis de interesse (n = 7.957). Solidão foi a variável de desfecho, cuja medida baseou-se na pergunta "Com que frequência o(a) senhor(a) se sentiu sozinho(a) ou solitário(a): sempre, algumas vezes ou nunca?". As variáveis independentes compreenderam indicadores sociodemográficos e comportamentos e condições de saúde. As análises incluíram o teste qui-quadrado de Pearson, para cálculo das frequências relativas, e a regressão de Poisson, para estimativa das razões de prevalência (RP) e respectivos intervalos de 95% de confiança (IC95%). A prevalência de sempre sentir solidão foi de 16,8%; de algumas vezes, 31,7%; e de nunca, 51,5%. Foram observadas associações significativas entre sempre sentir solidão e depressão (RP = 4,49; IC95%: 3,93-5,11), morar só (RP = 2,44; IC95%: 2,12-2,82), baixa escolaridade (RP = 1,93; IC95%: 1,61-2,32), sexo feminino (RP = 1,53; IC95%: 1,36-1,72), autoavaliação de saúde ruim/muito ruim (RP = 1,48; IC95%: 1,27-1,73) e qualidade do sono ruim/muito ruim (RP = 1,21; IC95%: 1,05-1,41). Dado seu potencial de prejuízo à qualidade de vida, é necessário conhecer longitudinalmente as trajetórias da solidão e as variáveis associadas e usar esse conhecimento para o delineamento de políticas públicas e intervenções em saúde que poderão beneficiar o bem-estar biopsicossocial de adultos e idosos brasileiros.

El objetivo fue investigar la prevalencia de la soledad y sus asociaciones con indicadores sociodemográficos y de salud en una muestra nacionalmente representativa de adultos y ancianos brasileños. Se analizaron datos de la línea base (2015-2016) del Estudio Longitudinal de la Salud de los Ancianos Brasileños (ELSI-Brasil) y se incluyeron los participantes con información completa en las variables de interés (n = 7.957). La soledad fue la variable de desenlace, cuya medida se basó en la pregunta "¿Con qué frecuencia te sentiste solo(a) o solitario(a): siempre, a veces o nunca?". Las variables independientes incluyeron indicadores sociodemográficos y comportamientos y condiciones de salud. Los análisis incluyeron la prueba de chi-cuadrado de Pearson para calcular las frecuencias relativas, y la regresión de Poisson, para estimar las razones de prevalencia (RP) y los respectivos intervalos de 95% de confianza (IC95%). La prevalencia de sentirse siempre solo fue de 16,8%; a veces, 31,7%; y nunca, 51,5%. Se observaron asociaciones significativas entre sentir siempre soledad y depresión (RP = 4,49; IC95%: 3,93-5,11), vivir solo (RP = 2,44; IC95%: 2,12-2,82), baja escolaridad (RP = 1,93; IC95%: 1,61-2,32), sexo femenino (RP = 1,53; IC95%: 1,36-1,72), autoevaluación de salud mala/muy mala (RP = 1,48; IC95%: 1,27-1,73) y calidad del sueño mala/muy mala (RP = 1,21; IC95%: 1,05-1,41). Dado su potencial para perjudicar la calidad de vida, es necesario conocer longitudinalmente las trayectorias de la soledad y las variables asociadas, y usar ese conocimiento para diseñar políticas públicas e intervenciones en salud que puedan beneficiar el bienestar biopsicosocial de adultos y ancianos brasileños.

Association of Food Consumption According to the Degree of Processing and Sociodemographic Conditions in Older Adults.

Several factors can impact food consumption in older adults, including those of sociodemographic, physiological, and chronic non-communicable diseases. This study aimed to evaluate the association of food consumption according to its degree of processing with sociodemographic conditions in community-dwelling older adults. Food intake was evaluated from 24-h recall data. All food items were classified according to the degree of processing into four groups as follows: in natura or minimally processed, culinary ingredients, processed, and ultra-processed foods. Food groups were considered dependent variables in a quantile regression model, adjusting for sex, age, schooling, ethnicity, and number of residents. Women and individuals with higher levels of education had lower consumption of in natura or minimally processed foods and higher consumption of ultra-processed foods. The yellow or indigenous ethnicity presented the lowest consumption of processed foods; older people who lived with three or more individuals had the highest consumption of culinary ingredients, whereas the older people who lived with one to two people had the highest consumption of processed foods and the lowest consumption of ultra-processed. These groups may be the target of educational and public policies to improve diet quality and contribute to quality of life in older ages.

[Influence of multimorbidity patterns on the activities in the day-to-day lives of the elderly: nine-year follow-up of the Fibra Study]. / Influência de padrões de multimorbidade nas atividades de vida diária da pessoa idosa: seguimento de nove anos do Estudo Fibra.

The scope of this article was to evaluate the influence of multimorbidity and associated effects on the activities in the day-to-day lives of community-dwelling elderly individuals. It involved a cohort study with data from the FIBRA Study, the baseline (2008-2009) and follow-up (2016-2017). The basic activities in daily living (ADL) were evaluated using Katz's index, and the chronic diseases were classified as: (1) multimorbidity and multimorbidity patterns; (2) cardiopulmonary; (3) vascular-metabolic; and (4) mental-musculoskeletal. The chi-square test and Poisson regression data were used for analysis. A total of 861 older adults with no functional dependency at baseline were analyzed. Elderly individuals with multimorbidity (RR = 1.58; 95%CI: 1.19-2.10) and classified according to cardiopulmonary (RR = 2.43; 95%CI: 1.77-3.33), vascular-metabolic (RR = 1.50; 95%CI: 1.19-1.89) and mental-musculoskeletal (RR = 1.30; 95%CI: 1.03-1.65) had a higher risk of presenting functional decline in ADL in the follow-up compared to those who didn't have the same disease patterns. Multimorbidity and its patterns increased the risk of functional disability in older adults over the nine-year period.

O objetivo foi avaliar a influência da multimorbidade e seus padrões nas atividades básicas de vida diária da pessoa idosa residente na comunidade. Trata-se de estudo de coorte com dados provenientes do Estudo FIBRA, linha de base (2008-2009) e seguimento (2016-2017). As atividades básicas de vida diária (ABVD) foram avaliadas pelo questionário de Katz e as doenças crônicas foram classificadas como (1) multimorbidade e padrões de multimorbidade: (2) cardiopulmonar; (3) vascular-metabólico; e (4) mental-musculoesquelético. Para a análise de dados, utilizou-se o teste qui-quadrado e a regressão de Poisson. Foram analisados 861 indivíduos sem limitação para ABVD na linha de base. As pessoas idosas com multimorbidade (RR = 1,58; IC95%: 1,19-2,10) e classificados nos padrões cardiopulmonar (RR = 2,43; IC95%: 1,77-3,33), vascular-metabólico (RR = 1,50; IC95%: 1,19-1,89) e mental-musculoesquelético (RR = 1,30; IC95%: 1,03-1,65) tiveram maior risco de apresentar declínio funcional nas ABVD no seguimento em comparação aos que não tinham os mesmos padrões de doenças. A multimorbidade e seus padrões aumentaram o risco de incapacidade na pessoa idosa ao longo de nove anos.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty.

BACKGROUND: Borim et al. showed that older adults with chronic pain exhibited more depressive symptoms and frailty components. Depressive symptoms were associated with more frailty components, and those with more depressive symptoms and frailty faced greater limitations in IADL performance. Frailty appears to mediate the pathway from chronic pain to functional impairment Chronic pain is directly associated with depressive symptoms and frailty. Chronic pain is not directly associated with functional disability. Depression and frailty are both directly associated with functional disabilities. Frailty mediates the association between chronic pain and functional disability. Depression; Disability evaluation; Frailty; Frail elderly. OBJECTIVE: To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. METHODS: Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. RESULTS: Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. CONCLUSION: The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Cognitive Impairment Predicts Sarcopenia 9 Years Later among Older Adults.

OBJECTIVE: To assess the longitudinal association between cognitive impairment and sarcopenia in a sample of Brazilian community-dwelling older adults. DESIGN: Nine-year observational prospective study. SETTING AND PARTICIPANTS: A total of 521 community-dwelling older adults from 2 Brazilian sites of the Frailty in Brazilian Older Adults (FIBRA in Portuguese) study. METHODS: Sarcopenia was defined as low hand-grip strength and low muscle mass. Cognitive impairment was determined at baseline using the Mini-Mental State Examination, with education-adjusted cutoff scores. The logistic regression model was used to assess the association between cognitive impairment and incident sarcopenia after adjusting for gender, age, education, morbidities, physical activity, and body mass index. Inverse probability weighting was applied to correct for sample loss at follow-up. RESULTS: The mean age of the study population was 72.7 (±5.6) years, and 365 were women (70.1%). Being 80 years and older [odds ratio (OR), 4.62; 95% CI, 1.38-15.48; P = .013], being under- and overweight (OR, 0.29; 95% CI, 0.11-0.76; P = .012, and OR, 5.12; 95% CI, 2.18-12.01; P < .001, respectively) and having cognitive impairment (OR, 2.44; 95% CI, 1.18-5.04; P = .016) at baseline predicted sarcopenia after 9 years. CONCLUSION AND IMPLICATIONS: Cognitive impairment may predict sarcopenia in Brazilian older adults. More studies are necessary to identify the main mechanisms shared by sarcopenia and cognitive decline, which could support the development of prevention interventions.

Eating Behavior of Older Adults with and Without Diabetes: The Vigitel Survey, Brazil, 2016. / Hábito Alimentar de Idosos Diabéticos e não Diabéticos: Vigitel, Brasil, 2016.

BACKGROUND: A healthy diet is a protection factor against type 2 diabetes and plays an important role in the treatment of the disease, as well as associated comorbidities. OBJECTIVE: Characterize the eating habits of older adults (≥ 65 years) with and without diabetes residing in capital cities and the Federal District of Brazil. METHODS: A cross-sectional study was conducted using data from the Surveillance of Risk and Protection Factors for Chronic Diseases Through a Telephone Survey (Vigitel, 2016). The prevalence of diabetes mellitus was estimated according to sociodemographic variables, physical inactivity level, self-rated health status and body mass index. Dietary habits were assessed based on the frequency (weekly and daily) of consumption of healthy and unhealthy foods and the replacement of food by snacks. Differences were determined using Pearson's chi-square test (Rao-Scott), with the significance level set at 5%. RESULTS: A total of 13,649 older adults were interviewed. The prevalence of self-reported diabetes was 27.2% (95% CI: 25.5; 29.0). Compared to non-diabetics, diabetic individuals had a higher consumption of raw vegetables (32.1% vs. 26.5%/3-4 days/week) and lower consumption of chicken (3.8% vs. 6.4%/hardly ever/never), fruit juice (24.0% vs. 29.6%) and sweets (6.8% vs. 16.2%) ≥ 5 days/week. Compared to non-diabetics, diabetic individuals consumed more skim milk (51.5% vs. 44.6%) and diet soda (60.0% vs. 17.3%) ≥ 5 days/week, raw vegetables (9.1% vs. 2.5%/at dinner) and sweets (37.7% vs. 20.5%/twice/day) 3-4 days/week. CONCLUSION: The observed differences emphasize the need for healthy eating interventions for all older adults, as well as specific counseling for those with diabetes.

FUNDAMENTOS: A alimentação saudável é um fator de proteção contra o diabetes tipo 2 e desempenha importante papel no tratamento do diabetes e das comorbidades associadas. OBJETIVO: Caracterizar o hábito alimentar de idosos diabéticos e não diabéticos com 65 anos ou mais, residentes nas capitais brasileiras e no Distrito Federal. MÉTODOS: Estudo transversal com dados da pesquisa Vigilância de Fatores de Risco e Proteção para as Doenças Crônicas por Inquérito Telefônico (Vigitel, 2016). Foram estimadas as prevalências de diabetes melito segundo variáveis sociodemográficas, inatividade física, autoavaliação da saúde e índice de massa corporal (IMC). O hábito alimentar foi avaliado pela frequência (semanal e diária) de consumo de alimentos saudáveis e não saudáveis, e pela substituição da comida por lanches. As diferenças foram verificadas por meio do teste Qui-quadrado de Pearson (Rao-Scott) com nível de significância de 5%. RESULTADOS: Foram entrevistados 13.649 idosos, e a prevalência de diabetes autorreferido foi de 27,2% (IC95%:25,5; 29,0). Nos pacientes diabéticos, observou-se maior consumo de hortaliças cruas (32,1% vs. 26,5%/3-4 dias/semana) e menor de frango (3,8% vs. 6,4%/quase nunca/nunca), suco (24,0% vs. 29,6%) e doces (6,8% vs. 16,2%) ≥5 dias/semana. Os percentuais de idosos com consumo de leite desnatado (51,5% vs. 44,6%) e refrigerante dietético (60,0% vs. 17,3%) ≥5 dias/semana, hortaliças cruas (9,1% vs. 2,5%/no jantar) e doces (37,7% vs. 20,5%/2 vezes/dia) 3-4 dias/semana foram maiores nos diabéticos, comparados aos não diabéticos. CONCLUSÃO: As diferenças observadas sinalizam a necessidade de promover intervenções para alimentação saudável entre todos os idosos, bem como orientações específicas para os diabéticos.

Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community-dwelling older adults: a cross-sectional study.

CONTEXT: Dyspnea is a symptom present in several chronic diseases commonly seen among older adults. Since individuals with dyspnea tend to stay at rest, with consequently reduced levels of physical activity, they are likely to be at greater risk of developing frailty, especially at older ages. DESIGN AND SETTING: Cross-sectional study at community level, Brazil. OBJECTIVE: To analyze the relationships between self-reported dyspnea, health conditions and frailty status in a sample of community-dwelling older adults. METHOD: Secondary data from the follow-up of the Frailty in Brazilian Elderly (FIBRA) study, involving 415 community-dwelling older adults (mean age: 80.3 ± 4.68 years), were used. The variables analyzed were sociodemographic characteristics, reported dyspnea, clinical data and frailty phenotype. Associations between dyspnea and other variables (age, sex, education and body mass index) were verified through the crude (c) and adjusted (a) odds ratios. RESULTS: The prevalence of dyspnea in the entire sample was 21.0%. Dyspnea was more present in individuals with pulmonary diseases, heart disease, cancer and depression. Older adults with multimorbidities (adjusted odds ratio, ORa = 2.91; 95% confidence interval, CI = 1.41-5.99) and polypharmacy (ORa = 2.02; 95% CI = 1.15-3.54) were more likely to have dyspnea. Those who reported dyspnea were 2.54 times more likely to be frail (ORa = 2.54; 95% CI = 1.08-5.97), and fatigue was their most prevalent phenotype component. CONCLUSION: Dyspnea was associated with different diseases, multimorbidities, polypharmacy and frailty. Recognizing the factors associated with dyspnea may contribute to its early identification and prevention of its negative outcomes among older adults.

Vitamin D insufficiency and factors associated: a study with older adults people from primary health care network. / Insuficiência de vitamina D e fatores associados: um estudo com idosos assistidos por serviços de atenção básica à saúde.

This article aims to analyze vitamin D insufficiency and factors associated among older adults using primary health care services. This is a cross-sectional study that evaluated 533 older adults individuals (≥ 60 years old) in three cities in the state of São Paulo, Brazil. Serum level of 25-hydroxyvitamin D (25-OHD) was evaluated by chemiluminescence. The factors evaluated were sociodemographic information (sex, age group, ethnicity, education, income, marital status), health conditions (reported diseases), body composition (BMI, waist circumference), lifestyle (physical activity and smoking), and sun exposure (purpose, duration, frequency, time of exposure, exposed body parts, use of sunscreen, skin type). The prevalence of vitamin D insufficiency was 64.5%, presenting association with female participants, non-white/unreported ethnicity, low weight, high waist circumference (risk for CVD - cardiovascular disease), and physical inactivity. Negative association was observed with habitual sun exposure of hands, arms and legs, during leisure activities, daily commuting and physical activity, and between 9 am and 3 pm. The findings show the relevance of factors such as sex, ethnicity, body composition, physical activity, and sun exposure habits in the high prevalence of inadequate levels of vitamin D among older adults.

O objetivo deste artigo é analisar a insuficiência de vitamina D e fatores associados em idosos assistidos na atenção primária à saúde. Trata-se de um estudo transversal que avaliou 533 idosos (≥ 60 anos) em três cidades do estado de São Paulo, Brasil. Foi avaliada a 25-hidroxivitamina D (25 OH D) sérica por quimioluminescência. Os fatores avaliados foram condições sociodemográficas (sexo, faixa etária, etnia, escolaridade, renda, estado civil), de saúde (doenças referidas), composição corporal (IMC, circunferência da cintura), estilo de vida (atividade física e tabagismo) e exposição solar (finalidade, duração, frequência e horário de exposição, partes expostas, uso de protetor solar, tipo de pele). A prevalência de insuficiência foi de 64,5%, com associação para sexo feminino, etnia não brancos/não declarados, baixo peso, circunferência da cintura elevada (risco para DCV) e inatividade física. Houve associação negativa para exposição solar habitual de mãos, braços e pernas, durante atividade de lazer, deslocamentos diários e atividade física e entre as 9h e 15h. Os achados mostram a relevância de fatores como sexo, etnia, composição corporal, atividade física e hábitos de exposição solar na alta prevalência de níveis inadequados de vitamina D em idosos.

Prevalence of chronic diseases in octogenarians: data from the National Health Survey 2019. / Prevalência de doenças crônicas em octogenários: dados da Pesquisa Nacional de Saúde 2019.

This article aims to estimate the prevalence of chronic diseases/conditions in octogenarians according to sex, age groups and private health insurance, and its relationship with difficulty in performing usual activities. Cross-sectional population-based study with elderly data (n = 6,098) from the National Health Survey (PNS) 2019. Prevalences and 95% confidence intervals were estimated. The prevalences were: hypertension 61.7%, chronic back problem 30.0%, hypercholesterolemia 22.0%, diabetes 20.3%; arthritis/rheumatism 19.4%, heart disease 19.3%, depression 9.4%, cancer 8.9%, cerebrovascular accident (CA) 7.5%, asthma 4.9%, lung disease (LD) 4.2% and kidney failure (KF) 3.0%. Hypertension, chronic back problem, hypercholesterolemia, major arthritis/rheumatism and depression in women, and cancer in men. Major heart disease, hypercholesterolemia, arthritis/rheumatism, KF, cancer and depression in those with private health insurance. Restriction of usual activities 14.8%, more frequent in cardiac patients, with chronic back problem, arthritis/rheumatism, KF, depression, CA, cancer and LD. There were higher prevalences in women and in those who have health insurance. Difficulties in usual activities related to diseases demand the expansion of care for the older adults.

O objetivo deste artigo é estimar a prevalência de doenças/condições crônicas em octogenários segundo sexo, faixas etárias e plano de saúde, e sua relação com a dificuldade para realização de atividades habituais. Estudo transversal de base populacional com dados de idosos (n = 6.098) da Pesquisa Nacional de Saúde 2019. Estimaram-se as prevalências e intervalos de confiança de 95%. As prevalências foram: hipertensão 61,7%, problema de coluna 30,0%, hipercolesterolemia 22,0%, diabetes 20,3%, artrite/reumatismo 19,4%, cardiopatias 19,3%, depressão 9,4%, câncer 8,9%, AVC 7,5%, asma 4,9%, doença pulmonar (DP) 4,2% e insuficiência renal (IR) 3,0%. Hipertensão, problema de coluna, hipercolesterolemia, artrite/reumatismo e depressão maiores nas mulheres, e câncer nos homens. Cardiopatias, hipercolesterolemia, artrite/reumatismo, IR, câncer e depressão maiores naqueles com plano de saúde. Restrição de atividades habituais, 14,8% mais frequente nos cardiopatas, com problema de coluna, artrite/reumatismo, IR, depressão, AVC, câncer e DP. Observaram-se maiores prevalências nas mulheres e nos que possuem plano de saúde. Dificuldades para atividades habituais relacionadas às doenças demandam a ampliação do cuidado aos mais idosos.

[Social vulnerability, survival, and hospital lethality by COVID-19 in patients aged 50 years and over: retrospective cohort of cases in Brazil in 2020 and 2021]. / Vulnerabilidade social, sobrevida e letalidade hospitalar pela COVID-19 em pacientes com 50 anos ou mais: coorte retrospectiva de casos no Brasil em 2020 e 2021.

The outcome of SARS-CoV-2 infection is not only associated with age and comorbidities but is also aggravated by social vulnerability. This study aims to analyze - according to social vulnerability - survival and hospital lethality by COVID-19 in the first 100 days from symptoms to death in individuals aged 50 years or older hospitalized in Brazil. This is a retrospective cohort from Epidemiological Week 11 of 2020 to week 33 of 2021. The Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) provided clinical and epidemiological data. The Geographic Index of the Socioeconomic Context for Health and Social Studies (GeoSES) measured social vulnerability. The Kaplan-Meier curve and the adjusted proportional risk model by Cox were used for survival, with hazard ratio (HR) and 95% confidence intervals (95%CI). Among the 410,504 cases, overall lethality was of 42.2% in general and 51.4% in the most vulnerable. We found a higher lethality according to worse socioeconomic status in all categories by age group; the double is registered for 50-59 years. The adjusted Cox model showed a 32% increase in risk of death (HR = 1.32; 95%CI: 1.24-1.42). Moreover, men, older adults, black or indigenous adults, with multiple comorbidities, and subjected to invasive ventilation, have a higher risk of death after hospitalization. Intersectoral policy measures need to be targeted to alleviate the effects of the COVID-19 pandemic aggravated by social vulnerability.

O desfecho da infecção pelo SARS-CoV-2 não se associa apenas à idade e a comorbidades, mas também agrava-se por vulnerabilidade social. Este estudo tem como objetivo analisar, segundo vulnerabilidade social, a sobrevida e a letalidade hospitalar por COVID-19 para os primeiros 100 dias entre sintomas até o óbito em indivíduos de 50 anos ou mais hospitalizados no Brasil. Trata-se de uma coorte retrospectiva das Semanas Epidemiológicas 11, de 2020, a 33, de 2021. O Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) forneceu dados clínico-epidemiológicos. O Índice Socioeconômico do Contexto Geográfico para Estudos em Saúde (GeoSES) mensurou vulnerabilidade social. Para sobrevida, utilizou-se a curva de Kaplan-Meier e o modelo ajustado de riscos proporcionais de Cox, com hazard ratio (HR) e intervalos de 95% de confiança (IC95%). Dentre os 410.504 casos, a letalidade geral foi de 42,2%, sendo 51,4% os indivíduos mais vulneráveis. Por faixa etária, registra-se a presença de maior letalidade para os piores status socioeconômicos em todas as categorias; para 50-59 anos, registra-se o dobro. O modelo ajustado de Cox mostrou aumento de 32% de risco para óbito (HR = 1,32; IC95%: 1,24-1,42). Ademais, homens, idosos, pretos ou indígenas, com múltiplas comorbidades e submetidos à ventilação invasiva apresentam maior risco de óbito após hospitalização. É necessário que medidas políticas intersetoriais sejam direcionadas para mitigar os efeitos da pandemia de COVID-19 agravados pela vulnerabilidade social.

El pronóstico de la infección por SARS-CoV-2 no sólo está asociado a la edad y a las comorbilidades, sino que también empeora por la vulnerabilidad social. El presente estudio tiene como objetivo analizar, según la vulnerabilidad social, la supervivencia y la letalidad hospitalaria por COVID-19 durante los primeros 100 días entre los síntomas hasta la muerte en individuos de 50 años o más hospitalizados en Brasil. Se trata de una cohorte retrospectiva desde la Semana Epidemiológica 11 de 2020 hasta la 33 de 2021. El Sistema de Información de Vigilancia Epidemiológica de la Gripe (SIVEP-Gripe) proporcionó datos clínico-epidemiológicos. El Índice Socioeconómico del Contexto Geográfico para los Estudios de Salud (GeoSES) midió la vulnerabilidad social. Para la supervivencia se utilizó la curva de Kaplan-Meier y el modelo ajustado de riesgos proporcionales de Cox, con cociente de riesgos (hazard ratio - HR) e intervalos del 95% de confianza (IC95%). Entre los 410.504 casos la letalidad global fue del 42,2%; el 51,4% en los más vulnerables. Por grupos de edad, se registra la presencia de una mayor letalidad a medida que empeora el estatus socioeconómico en todas las categorías; para 50-59 años es el doble. El modelo de Cox ajustado mostró un aumento del 32% en el riesgo de muerte (HR = 1,32; IC95%: 1,24-1,42). Además, los hombres de edad avanzada, de raza negra o indígena, con múltiples comorbilidades y sometidos a ventilación invasiva tienen un mayor riesgo de muerte tras la hospitalización. Es necesario que las medidas políticas intersectoriales se dirijan a mitigar los efectos de la pandemia de COVID-19 agravada por la vulnerabilidad social.

Association between zinc deficiency and cognitive decline in community-dwelling older adults. / Associação entre deficiência de zinco e declínio cognitivo em idosos da comunidade.

This is a cross-sectional study evaluating the association between zinc deficiency and cognitive decline in 591 community-dwelling older adults living in the cities of Campinas, Limeira, and Piracicaba-SP. Cognitive status was evaluated using the Cognitive Abilities Screening Instrument-CASI-S, considering a decline for scores <23 for those aged 60-69 and <20 for those aged ≥70 years. Among the evaluated cognitive domains, older adults with zinc deficiency had significantly lower mean scores on the memory test (p=0.018). For zinc deficiency, values below 70 µg/dL were considered for women and 74 µg/dL for men. The prevalence of zinc deficiency was 3.9%, and cognitive deficit was 9.4%, being significantly higher in those with zinc deficiency compared with those with normal serum zinc concentrations. In adjusted multiple logistic regression analysis, the factors that remained associated with cognitive decline were zinc deficiency (OR=3.80; 95%CI=1.30-11.12), low schooling level (OR=3.12; 95%CI=1.49-6.50), lack of a partner (OR=1.88; 95%CI=1.04-3.42), risk of malnutrition (OR=3.98; 95%CI=2.36-6.71), and a history of encephalic vascular accident (OR=2.70; 95%CI=1.04-6.98). Zinc deficiency was associated with the presence of cognitive decline in older adults. Actions in primary health care are necessary to prevent the deficiency of this nutrient.

Estudo transversal avaliou a associação entre deficiência de zinco sérico e declínio cognitivo em 591 idosos da comunidade residentes nos municípios de Campinas, Limeira e Piracicaba-SP. A cognição foi avaliada pelo Instrumento de Triagem de Habilidades Cognitivas-CASI-S considerando declínio pontuação <23 em idosos de 60-69 anos e <20 em idosos ≥70 anos. Considerou-se deficiência de zinco sérico valor de <70 µg/dL para mulheres e 74 µg/dL para homens. Entre os domínios cognitivos, idosos com deficiência de zinco tiveram pontuação média significativamente menor no teste de memória (p=0,018). A prevalência da deficiência de zinco foi de 3,9%, e de 9,4% de declínio cognitivo, sendo significativamente maior em idosos com deficiência de zinco do que os que não tinham (26,1% e 8,8%, respectivamente). Em análise de regressão logística múltipla ajustada, os fatores que permaneceram associados ao declínio cognitivo foram deficiência de zinco (OR=3,80; IC95%=1,30-11,12), baixa escolaridade (OR=3,12; IC95%=1,49-6,50), não ter companheiro (OR=1,88; IC95%=1,04-3,42), risco de desnutrição (OR=3,98; IC95%=2,36-6,71), e histórico de acidente vascular encefálico (OR=2,70; IC95%=1,04-6,98). A deficiência de zinco foi associada ao declínio cognitivo em idosos. Ações na atenção básica de saúde são necessárias para prevenir a deficiência deste nutriente.

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal.

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors. Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables. Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28). Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08-1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31-3.47) and with scores 24-29 (OR 1.92; 95% CI 1.07-3.43) or 11-23 (OR 2.09; 95% CI 1.15-3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24-9 (OR 2.38; 95% CI 1.31-4.33) or low 11-23 (OR 5.31; 95% CI 2.69-10.45) scores in neuroticism were more likely to evaluate their health as very good/good. Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

Three definitions of probable sarcopenia and associations with falls and functional disability among community-dwelling older adults.

OBJECTIVES: To assess the prevalence of probable sarcopenia according to 3 different definitions ("strength, assistance with walking, rise from a chair, climb stairs, falls"- SARC-F score, low grip strength, and the guidelines indicated by the European Working Group on Sarcopenia in Older People 2 - EWGSOP2) and assess the association of probable sarcopenia with functional disability and falls among community-dwelling older adults. METHODS: Cross-sectional study with 419 older adults. Probable sarcopenia was assessed by 3 definitions: a SARC-F ≥ 4, low grip strength (< 27 kg for men and < 16 kg for women), and the EWGSOP2 criteria. Associations were investigated using Pearson's chi-square test and prevalence ratios were estimated by Poisson regression (P < 0.05). RESULTS: Of the total, probable sarcopenia was identified in 23.0% of participants (SARC-F ≥ 4 score), 33.7% (low grip strength), and 10.4% (EWGSOP2) according to each different definition. In adjusted regression models, having at least 1 instrumental activities of daily living (IADL) disability and having fallen in the last 12 months were significantly associated with a SARC-F ≥ 4 (prevalence ratio, PR = 1.60; and PR = 2.50, respectively) and EWGSOP2 (PR = 1.78; and PR = 2.19, respectively). CONCLUSIONS: IADL disability and falls were associated with a SARC-F ≥ 4 and the EWGSOP2 criteria (SARC-F ≥ 4 and low grip strength). Probable sarcopenia may be used in clinical practice in order to facilitate the diagnosis of definite sarcopenia and to implement early interventions that could prevent functional decline and falls in older people.

Risk of all-cause mortality and its association with health status in a cohort of community-dwelling older people: FIBRA study. / Risco de mortalidade por todas as causas e sua relação com estado de saúde em uma coorte de idosos residentes na comunidade: Estudo FIBRA.

This article aims to estimate the risk of death according to sociodemographic characteristics, chronic diseases, frailty, functional capacity, and social participation in older people as well as determine the median time of death in relation to health status and social participation. A retrospective longitudinal study was conducted with older people (≥65 years) in 2008-09 and 2016-17 in the city of Campinas and the subdistrict of Ermelino Matarazzo in the city of São Paulo. Face-to-face interviews were conducted at community centers and the participants' homes. The cumulative incidence of death was estimated and associations with the predictor variables were analyzed using Poisson multiple regression. The Kaplan-Meier method and the log-rank test were also used. Among the 741 individuals located at follow-up, 192 had deceased. The incidence of death was higher among those who reported having heart disease and those who were dependent on others regarding the performance of instrumental activities of daily living. The incidence of death was lower among women, individuals in the highest income stratum, and those who performed three or more activities related to social inclusion. No differences in median survival times were found. Predictors of mortality can contribute to broadening knowledge on the singularities of the aging process.

O artigo tem por objetivos estimar o risco de óbito segundo características sociodemográficas, doenças crônicas, fragilidade, capacidade funcional e participação social em idosos e verificar, para as variáveis de estado de saúde e participação social, o tempo mediano de ocorrência do óbito. Estudo longitudinal retrospectivo com idosos (≥65 anos), realizado em 2008-09 e 2016-17 em Campinas-SP e Ermelino Matarazzo-SP. Realizaram-se entrevistas face a face em centros de convivência e nos domicílios. Estimou-se a incidência acumulada de óbito e associações com as variáveis preditoras foram analisadas pela regressão múltipla de Poisson. O método de Kaplan-Meier e o teste de Log-rank foram utilizados. Dos 741 idosos localizados no seguimento, 192 faleceram. Observou-se maior incidência de óbito nos mais idosos, nos que relataram doença do coração e nos dependentes para realização de atividades instrumentais da vida diária. Verificou-se menor incidência de óbito nas mulheres, no estrato com maior renda e nos que realizavam três ou mais atividades relacionadas à inserção social. Não se observaram diferenças nos tempos medianos de sobrevida. Os preditores de mortalidade podem contribuir para ampliar o conhecimento sobre as singularidades do processo de envelhecimento.

Probable sarcopenia is associated with cognitive impairment among community-dwelling older adults: results from the FIBRA study.

BACKGROUND: The link between sarcopenia and cognitive impairment has not yet been thoroughly evaluated, especially among older adults. OBJECTIVE: To evaluate the relationship between probable sarcopenia and cognitive impairment among community-dwelling older adults in two Brazilian cities. METHODS: Probable sarcopenia was assessed using the EWGSOP2 (2018) criteria. Thus, participants were classified as probably having sarcopenia if they had SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs and Falls) ≥4 points and low grip strength. Cognitive function was evaluated through the Mini-Mental State Examination (MMSE), verbal fluency (VF) and clock drawing test (CDT). RESULTS: In a sample of 529 older adults (mean age 80.8±4.9 years; mean education 4.2±3.67 years; 70.1% women), 27.3% of the participants had SARC-F≥4, 38.3% had low grip strength and 13.6% were classified as probable sarcopenia cases. After adjusting for possible confounders (age, sex, education, depression, diabetes, hypertension, leisure-time physical activity and obesity), probable sarcopenia was found to be associated with impairment in the MMSE (OR 2.52; 95%CI 1.42‒4.47; p=0.002) and in VF (OR 2.17; 95%CI 1.17‒4.01; p=0.014). Low grip strength was found to be associated with impairment in the MMSE (OR 1.83; 95%CI 1.18‒2.82; p=0.006) and in the CDT (OR 1.79; 95%CI 1.18‒2.73; p=0.006). SARC-F scores were found to be associated with impairment in the MMSE (OR 1.90; 95%CI 1.18‒3.06; p=0.008). CONCLUSION: The results suggested that probable sarcopenia and its components present a significant association with cognitive deficits among community-dwelling older adults. Future longitudinal studies will further explore the causal relationship.

Multimorbidity and use of health services in the oldest old in Brazil.

OBJECTIVE: To estimate the prevalence of multimorbidity in long-lived Brazilian individuals (age ≥80 years) and to associated it with the use of health services. METHODS: Cross-sectional population-based study with data from the 2019 National Survey of Health (n=6,098). Frequencies of use of services were estimated for older people with multimorbidity and according to sex, health insurance ownership, and self-rated health. The prevalence rates, crude and adjusted prevalence ratios, and the respective 95% confidence intervals were calculated. RESULTS: The average age of the older adults was 85 years and about 62% were women; the prevalence of multimorbidity was 57.1%, higher in women, in those who have health insurance, and who reside in the southern region of the country (p<0.05). In the oldest old with multimorbidity, the use of services in the last 15 days reached 64.6%, and more than 70% were hospitalized in the last year or did not carry out activities in the previous two weeks for health reasons. Differences were observed for the indicators of service use in relation to sex, health insurance ownership, and self-rated health, according to multimorbidity. CONCLUSION: Indicators for the use of health services were higher in older individuals who have two or more chronic diseases, regardless of sociodemographic conditions and self-rated health, showing the impact of multimorbidity per se in determining the use of services among the oldest old.