A Regression Tree Analysis to Identify Factors Predicting Frailty: The International Mobility in Aging Study.

INTRODUCTION: Frailty is a complex geriatric syndrome with a multifaceted etiology. We aimed to identify the best combinations of risk factors that predict the development of frailty using recursive partitioning models. METHODS: We analyzed reports from 1,724 community-dwelling men and women aged 65-74 years participating in the International Mobility in Aging Study (IMIAS). Frailty was measured using frailty phenotype scale that included five physical components: unintentional weight loss, weakness, slow gait, exhaustion, and low physical activity. Frailty was defined as presenting three of the above five conditions, having one or two conditions indicated prefrailty and showing none as robust. Socio-demographic, physical, lifestyle, psycho-social, and life-course factors were included in the analysis as potential predictors. RESULTS: 21% of pre-frail and robust participants showed a worse stage of frailty in 2014 compared to 2012. In addition to functioning variables, fear of falling (FOF), income, and research site (Canada vs. Latin America vs. Albania) were significant predictors of the development of frailty. Additional significant predictors after exclusion of functioning factors included education, self-rated health, and BMI. CONCLUSIONS: In addition to obvious risk factors for frailty (such as functioning), socio-economic factors and FOFs are also important predictors. Clinical assessment of frailty should include measurement of these factors to identify high-risk individuals.

Cardiovascular risk burden and disability: findings from the International Mobility in Aging Study (IMIAS).

BACKGROUND: The association of cardiovascular risk burden with disability is unclear. We examined the association between trajectories of the Framingham general cardiovascular disease risk score (FGCRS) with the trajectories of limitations of physical function in older adults. METHODS: A total of 1219 participants with no disabilities from the International Mobility in Aging Study (IMIAS) study who had up to three repeated measures of FGCRS between 2012-2016 and without a history of stroke or coronary heart disease at baseline and follow-up were included. FGCRS at baseline was assessed and categorized into tertiles. Physical function was evaluated with the Short Physical Performance Battery (SPPB). The data were analyzed using linear mixed-effects models. RESULTS: At baseline, FGCRS ranged between 3-94 (mean score: 24 ± 15.8), participants were 32 (2.6%), 502 (41.2%) and 685 (56.2%) in lowest, middle, and highest tertiles, respectively. In the trajectories of limitations of physical function, the lowest FGCRS had no differences, while the middle and highest had a decrease in physical performance between 2012-2014 (P = 0.0001). Age, being female, living in Andes Mountains, having middle and highest FGCRS, higher alcohol consumption, being obese, lack of exercise and cognitive impairment increase the probability of disability (P < 0.05). Alternatively, living in more developed regions and having a higher educational level reduced the probability of disability during the follow-up time (P < 0.05). CONCLUSIONS: Higher cardiovascular risk burden is associated with decreased physical performance, especially in gait. Results suggest SPPB may provide a measure of cardiovascular health in older adults.

HbA1c and physical performance in older adults from different aging epidemiological contexts: Longitudinal findings of the International Mobility in Aging Study (IMIAS).

OBJECTIVE: This study aimed to assess the longitudinal predictions between glycated hemoglobin A1c (HbA1c) and physical performance scores in different epidemiological contexts of aging. MATERIAL AND METHODS: Longitudinal data of 1,337 older people from three countries (Canada, Brazil and Colombia) of the International Mobility in Aging Study (IMIAS) were used to assess the relationship between HbA1c and Short Physical Performance Battery (SPPB) scores between 2012 and 2016. Linear Mixed Models grouped by sex and adjusted by Age, Study site, Chronic Conditions, Anthropometric Measures, and Inflammatory Level were used to estimate the influence of HbA1c and covariates on SPPB scores. RESULTS: At the IMIAS baseline, Latin American (LA) cities had higher HbA1c averages compared to Canadian cities, with Natal (Brazil) being the city with the highest HbA1c averages in men and women (6.32 ± 1.49; 6,56 ± 1.70 respectively). SPPB scores were significantly lower in LA cities, and older people in Natal had lower SPPB averages in men (9.67 ± 2.38; p-value < 0.05) and women (8.52 ± 2.33; p-value <0.05). In the multivariate mixed linear models of longitudinal analyses, HbA1c was significantly associated with lower SPPB scores in men (ß = -0.25, 95% CI: -0.39 to -0.12, p-value = 0.02) but not in women. CONCLUSION: High HbA1c levels at baseline were longitudinally associated in older adults from different countries, and this association was observed only in men and not in women. This study highlights a possible influence of gender on this relationship.

Gender-Specific Associations between Late-Life Disability and Socioeconomic Status: Findings from the International Mobility and Aging Study (IMIAS).

Disability is a dynamic process and can be influenced by a sociocultural environment. This study aimed to determine whether the associations between socioeconomic status and late-life disability differ by gender in a multi-sociocultural sample from different countries. A cross-sectional study was developed with 1362 older adults from The International Mobility in Aging Study. Late-life disability was measured through the disability component of the Late-Life Function Disability Instrument. Level of education, income sufficiency and lifelong occupation were used as indicators of SES. The results indicated that a low education level ß = -3.11 [95% CI -4.70; -1.53] and manual occupation ß = -1.79 [95% -3.40; -0.18] were associated with frequency decrease for men, while insufficient income ß = -3.55 [95% CI -5.57; -1.52] and manual occupation ß = -2.25 [95% CI -3.89; -0.61] played a negative role in frequency for women. For both men ß = -2.39 [95% -4.68; -0.10] and women ß = -3.39 [95% -5.77; -1.02], insufficient income was the only factor associated with greater perceived limitation during life tasks. This study suggested that men and women had different late-life disability experiences. For men, occupation and education were associated with a decrease in the frequency of participation, while for women this was associated with income and occupation. Income was associated with perceived limitation during daily life tasks for both genders.

Validity and reliability of the Brazilian activities-specific balance confidence scale and determinants of balance confidence in community-dwelling older adults.

Introduction: The Activities-specific Balance Confidence scale is the most used tool to quantify balance confidence, a psychological factor related to balance impairment among older adults. Objective: To investigate the validity and reliability of the original and short versions of the Brazilian Activities-specific Balance Confidence scales, to determine cutoff points for balance impairments and to identify the determinants of balance confidence of community-dwelling older adults.Methods: The validity of both versions of the scales was verified by correlating its results with postural balance, fear of falling and mobility (n = 105). Both scales were administered with a 30 min (interrater reliability, n = 158) and 1-week intervals (intrarater reliability, n = 105). Receiver operating characteristic curve was used to determine the cutoff points, and linear regression was applied to identify the determinants of balance confidence.Results: The Brazilian versions of the scale correlated to postural balance, fear of falling and mobility (p < .05). Excellent interrater (α = 0.946, 95% CI: 0.902-0.976; α = 0.932, 95% CI: 0.918-0.960) and intrarater reliability (α = 0.946, 95% CI: 0.905-0.960; α = 0.952, 95% CI: 0.921-0.965) were found for the original and short versions.  Values of ≤67% (sensitivity: 81%, specificity: 77.4%) and ≤44% (sensitivity: 87.5%, specificity: 82.1%) were observed to identify balance impairments for the original and short versions of the scale. Physical inactivity, fear of falling, imbalance sensation, and number of falls are the main determinants of balance confidence.Conclusion: Both scales are valid and reliable to assess balance confidence. Cutoff points to identify balance impairments were determined and some factors may act as possible predictors of balance confidence.

Frailty syndrome and risk of cardiovascular disease: Analysis from the International Mobility in Aging Study.

OBJECTIVE: To investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score, FRS) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS). MATERIAL AND METHODS: This cross-sectional study used data from the IMIAS, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). A total of 1724 older adults aged 65-74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. The FRS was calculated to estimate the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high-density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Confounders included measures of childhood social and economic adversity, as well as mid-life and adult adversity. RESULTS: After adjustment for adversities which occurred during in early, adult or current life, frail individuals presented higher FRS values (ß = 3.81, 95 %CI: 0.97-6.65, p-value <0.001) when compared to robust participants. A statistically significant relationship was also observed in prefrail participants with FRS (ß = 1.61, 95 % CI: 0.72-3.02, p-value <0.05). CONCLUSION: Frailty and prefrailty were associated to FRS, independent of life course adversities. Screening cardiovascular risk factors should be a target, mainly in those who present frailty syndrome.

Allostatic load and stress biomarkers in a sample of community-dwelling older adults.

BACKGROUND: The idea that cumulative levels of stress can have deleterious effects on health and longevity has led investigators to discuss individual differences in the accumulation of Allostatic Load (AL) during life. Our aim was to evaluate the AL indices and stress biomarkers between genders and to determine which factors were more associated with AL indices. METHODS: We evaluated 256 subjects, including 88 men and 168 women, aged 65 years or more. AL was measured by 10 biomarkers, including systolic and diastolic blood pressure, waist-hip ratio, glycosylated hemoglobin, salivary cortisol, salivary dehydroepiandrosterone sulphate, urinary epinephrine and norepinephrine, total cholesterol and total cholesterol/HDL. Sociodemographic and clinical characteristics, cognitive function and physical functional variables were additionally analyzed. RESULTS: The mean age of the participants was 74.1 ± 6.7 years. The AL index was 2.30 ± 1.68, without a significant difference between gender. The final linear regression model controlling for gender, age, years of study and living arrangement showed that AL was associated to a number of chronic conditions (ß = 0.24; 95 % CI: 0.08-0.40), mobility disability (ß = 0.58; 95 % CI: 0.06-1.14), and handgrip strength (ß = 0.06; 95 % CI: 0.06-1.14). CONCLUSION: As a result of this investigation, Allostatic load was shown to be associated with poor health or physical function for community-dwelling older adults.

Relação entre medidas fornecidas por smartwatches e a identificação de síndrome da fragilidade em idosos: revisão de escopo / Relationship between measures provided by smartwatches and identification of frailty syndrome in older adults: a scoping review

Resumo Objetivo Esta Revisão de Escopo teve como objetivo descrever e mapear as medidas disponibilizadas pelos smartwatches como ferramenta para identificação da Síndrome de Fragilidade em idosos. Métodos Foram incluídos estudos publicados em qualquer idioma, sem restrição de data de publicação, que descrevessem o uso de medidas fornecidas por smartwatches na avaliação da Síndrome de Fragilidade e/ou seus critérios em idosos. Descritores em inglês para smartwatches, smartbands, Síndrome da Fragilidade e envelhecimento foram utilizados para desenvolver uma estratégia de busca abrangente, que foi então aplicada para pesquisar nas seguintes bases de dados: COCHRANE LIBRARY, EMBASE, SCOPUS, PUBMED/MEDLINE, LILACS, WEB OF SCIENCE e PEDRO. Resultados A busca inicial identificou um total de 156 artigos e foram identificados 2 artigos a partir da busca manual nas referências dos estudos elegíveis. Em seguida, foram incluídos 4 estudos que utilizaram medidas diárias de contagem de passos para síntese descritiva, e três dos quatro também utilizaram dados relacionados ao sono e FC para avaliar a fragilidade em idosos. Os resultados obtidos nesta revisão indicam que parâmetros derivados de smartwatches têm sido utilizados para identificar estágios de fragilidade em diferentes ambientes, sendo a maioria dos estudos associados a outras condições clínicas. Conclusão Os smartwatches são uma excelente ferramenta de monitoramento de fragilidade por meio de medições diárias de contagem de passos, dados de sono e frequência cardíaca. Os resultados obtidos com o uso desses dispositivos podem sugerir uma avaliação mais ampla dos idosos que enfrentam risco aumentado de desenvolver a Síndrome da Fragilidade.

Abstract Objective This scoping review aimed to describe and map the measures provided by smartwatches as a tool for identifying Frailty Syndrome in older adults. Methods Studies published in any language, without publication date restrictions, that described the use of measures provided by smartwatches in evaluating or identifying Frailty Syndrome and/or its criteria in older adults were included. English descriptors for smartwatches, smartbands, Frailty Syndrome and Older Adults were used to develop a comprehensive search strategy, which was then applied to search the following databases: COCHRANE LIBRARY, EMBASE, SCOPUS, PUBMED/MEDLINE, LILACS, WEB OF SCIENCE and PEDRO. Results The initial search identified a total of 156 articles and 2 articles were identified from the manual search in the references of eligible studies. Next, 4 studies that used daily step count measurements for descriptive synthesis were included, and three of the four also used sleep and heart rate data to assess frailty in older adults. The results obtained in this review indicate that parameters derived from smartwatches have been used to identify stages of frailty in different areas, with the majority of studies being associated with other clinical conditions. Conclusion Smartwatches are an excellent frailty monitoring tool through daily measurements of step count, sleep data and heart rate. The results obtained with the use of these devices may suggest a broader evaluation of older adults who face an increased risk of developing Frailty Syndrome.

Social and Economic Predictors of Worse Frailty Status Occurrence Across Selected Countries in North and South America and Europe.

BACKGROUND: Frailty, a state of vulnerability to poor resolution of homoeostasis after a health stressor, may be a result of cumulative decline in many physiological systems across the life course and its prevalence and incidence rates vary widely depending on the place and population subgroup. OBJECTIVE: This study aims to examine social and economic factors as predictors of worse frailty status over 2 years of follow-up in a sample of community-dwelling older adults from the International Mobility in Aging Study. METHODS: We analyzed 2012 baseline and 2014 follow-up (n = 1,724) data on participants from a populational-based, longitudinal study conducted in 4 countries (e.g., Brazil, Colombia, Albania, and Canada). Frailty was defined according to the Fried's phenotype and Poisson regression models with robust standard errors were performed to estimate the relative risks of becoming frail. RESULTS: In our study, 366 (21.2%) participants migrated to a worse stage of frailty. After statistical adjustment (e.g., participant age, sex, and study site), insufficient income (RR = 1.40; 95% CI = 1.00-1.96) and having partner support (RR = 0.80; 95% CI = 0.64-1.01) were predictors of incident frailty status. CONCLUSION: Notably, transitions in frailty status were observed even in a short range of time, with sociodemographic factors predicting incident frailty.

Depressive symptoms and functional decline in an elderly sample of urban center in Northeastern Brazil.

OBJECTIVE: To examine the association between depressive symptoms and functional status in elderly people living in an urban center in northeastern Brazil. METHODS: In this cross-sectional, observational, analytic study, 313 community-dwelling elderly (age≥65 years) individuals of both sexes who resided in Natal, Rio Grande do Norte, were evaluated. The Brazilian version of the Center for Epidemiologic Studies Depression Scale was used to screen for depressive symptoms. Physical performance was assessed using the Short Physical Performance Battery. A multivariate linear regression model adjusted for clinical and socioeconomic variables was used to analyze the association between depressive symptoms and functional performance. RESULTS: Our findings showed that the presence of depressive symptoms influenced functional performance, even when analyses controlled for variables such as age, sex, poor perceived health, cognitive status, and body mass index (BMI). CONCLUSION: The results of this study reinforce the association between depressive symptoms and functional performance in an elderly population in an urban center in northeastern Brazil. These findings provide useful information for the identification of potential targets for research and therapeutic interventions aimed at preventing a decline in mobility in elderly individuals.