Factors Related to Recurrent Falls Among Older Adults Attending Primary Health Care: A Biopsychosocial Perspective.

The objective of this study was to investigate factors related to recurrent falls among older adults attending primary health care, considering the biopsychosocial perspective. A representative sample of 201 older adults were interviewed in three Primary Health Care units randomly selected in a city in southeastern Brazil. Outcome included self-report of two or more falls in the past 12 months. Exposures included personal and environmental aspects, according to domains of International Classification of Functioning of the World Health Organization (ICF-WHO). Recurrent falls were reported by 24.4% of the participants. Associations with depressive symptoms (p = .003), having osteoporosis (p = .031), chronic musculoskeletal pain (p = .020), frailty (p = .013), sleep satisfaction (p < .001), and functional status (p < .001) were found. In logistic regression models, cognitive status, musculoskeletal pain, and functional status were predictors of recurrent falls; however, only sleep satisfaction remained significant in the final model. Strategies aimed at preventing recurrent falls in primary health care should consider assessments and interventions targeting sleep aspects among older adults.

Social support network, functional capacity and mental health in older adults / Rede de suporte social, capacidade funcional e saúde mental em pessoas idosas / Red de apoyo social, capacidad funcional y salud mental en personas mayores

This study aimed to describe the characteristics of the social networks of older adults and to assess associations between social support, functional capacity and mental health. The sample consisted of 134 community-dwelling older adults, assessed in terms of their social network through the Minimum Map of Older Adult Relationships; functional capacity for performance in activities of daily living; depressive symptoms, assessed through the Geriatric Depression Scale and; anxiety, assessed through the Beck Anxiety Inventory. Cluster analyses were performed. The social network was characterized by being informal, functioning as affective support that occurs through visits. Social support perceived as insufficient was more frequent in men, in those who were dependent regarding instrumental activities of daily living, and in those with anxiety and depressive symptoms. Reduced social support networks and lack of support were associated with limitations in functional capacity and worse mental health, sparking debate about the centrality of the family in the provision of support.(AU)

Este estudo objetivou descrever as características da rede social de pessoas idosas e avaliar associações entre apoio social, capacidade funcional e saúde mental. A amostra foi composta por 134 idosos comunitários, avaliados quanto à rede social pelo Mapa Mínimo das Relações do Idoso; capacidade funcional pelo desempenho em atividades de vida diária; sintomas depressivos, avaliados pela Escala de Depressão Geriátrica e; ansiedade, avaliada pelo Inventário de Ansiedade de Beck. Foram realizadas análises de conglomerados. A rede social caracterizou-se por ser informal, funcionando como suporte afetivo que ocorre por meio de visitas. O apoio social percebido como insuficiente foi mais frequente no sexo masculino, entre idosos dependentes em atividades instrumentais de vida diária, com ansiedade e sintomas depressivos. Redes de suporte social reduzidas e com baixo apoio estão associadas com limitações na capacidade funcional e pior saúde mental, colocando em debate a centralidade da família na provisão de suporte.(AU)

Este estudio tuvo como objetivo describir las características de la red social de personas mayores y evaluar las asociaciones entre el apoyo social, la capacidad funcional y la salud mental. La muestra estuvo compuesta por 134 ancianos comunitarios, quienes fueron evaluados en cuanto a su red social mediante el Mapa Mínimo de Relaciones del Anciano; su capacidad funcional en las actividades de la vida diaria; los síntomas depresivos mediante la Escala de Depresión Geriátrica; y la ansiedad a través del Inventario de Ansiedad de Beck. Se realizaron análisis de conglomerados. La red social se caracterizó por ser informal, funcionando como apoyo afectivo que se manifiesta a través de visitas. El apoyo social percibido como insuficiente fue más frecuente en el sexo masculino, entre los ancianos dependientes en actividades instrumentales de la vida diaria, y aquellos con síntomas de ansiedad y depresión. Las redes de apoyo social reducidas y con bajo apoyo se asocian con limitaciones en la capacidad funcional y un peor estado de salud mental, lo que plantea el debate sobre el papel central de la familia en la provisión de apoyo.(AU)

Factors related to the accumulation of healthy behavior among older adults attending primary Health Care.

The adoption and maintenance of healthy behaviors contribute for its accumulation throughout life, which require more than information disclosure and recommendations. Biopsychosocial factors may work as barriers to adherence to healthier behaviors, and yet have been underexplored. The objective was to investigate the factors related to the accumulation of healthy behavior among older adults attending Primary Health Care. Cross-sectional analysis with 201 older adults from baseline of Longitudinal Investigation of Functioning Epidemiology (LIFE) was performed in a Southeastern Brazilian city. The Healthy Behavior Score (HBS), ranging from 0 to 8, was calculated by the sum of the following habits: Physical activity practice, healthy eating, water consumption, night sleep time, not smoking, not drinking alcohol, frequent social relations, and spirituality. A linear multivariate regression was performed to test the influence of biopsychosocial aspects on HBS, with 95% confidence interval. Higher number of healthy behaviors was related to high social support, better cognitive status, less depressive symptoms and lower functional performance. Additionally, age and resilience score were correlated to healthy behaviors, which were higher among women and those with sufficient income. Multivariate analysis revealed depressive symptoms, functional performance and education as independent predictors of HBS. Depressive symptoms, functional performance and education are predictors of accumulation of health behaviors, independently of health status, contextual and sociodemographic aspects. Higher social support partially contributed to the higher number of healthy behaviors, and should be considered in public health policies for healthy longevity.

Organization and offer of physical therapy care in response to the COVID-19 pandemic in Brazil. / Organização e oferta da assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil.

The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous physical therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in three dimensions: offering physical therapy assistance in PHC, outpatient care, via telehealth. It is concluded that functional rehabilitation depends on the PHC's response capacity; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; although telehealth is a resource and an opportunity to increase the population's access to functional rehabilitation, its use requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

A recuperação das pessoas acometidas pela COVID-19 é um processo que continua para além do quadro agudo da infecção pelo Sars-CoV-2. O comprometimento de diversos sistemas corporais pode acarretar impactos funcionais e demandar assistência fisioterapêutica contínua tanto na atenção ambulatorial quanto na atenção primária à saúde (APS). Neste ensaio, busca-se discutir os desafios da organização e da oferta de assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil. A análise foi sumarizada em três dimensões: oferta da assistência fisioterapêutica na APS e na atenção ambulatorial, e oferta de atenção fisioterapêutica por telessaúde. Conclui-se que: a reabilitação funcional depende da capacidade de resposta da APS; existe um déficit de serviços de reabilitação que antecede a pandemia, e pode comprometer respostas satisfatórias às demandas do atual contexto epidemiológico; faz-se necessária a articulação entre as equipes de fisioterapia ambulatorial e da APS; embora a telessaúde seja um recurso e uma oportunidade para ampliar o acesso da população à reabilitação funcional, sua utilização exige cautela; o fisioterapeuta possui papel crucial em todo o continuum de cuidados da COVID-19.

Influence of personal mastery on mobility disability among older adults: A systematic review.

PURPOSE: Personal mastery is a psychological resource recognized as a domain of quality of life that helps individuals cope with life strains. Despite its relevance, there is a lack surrounding the relationship between mobility disability and personal mastery. This study aimed to investigate the influence of personal mastery on mobility disability among older adults and identify the mechanisms that underlie this influence. METHODS: A systematic review was conducted by searching four databases (i.e., PubMed, Scopus, ScienceDirect, and the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information) using combinations of the following words: mastery, personal mastery, self-control, mobility, disability, older adults, older people, and aging. We summarized and analyzed the findings of cross-sectional and longitudinal/prospective studies. RESULTS: Twenty-one studies were included. There was high heterogeneity in how the studies had assessed mobility disability. Although a majority of the studies had used the Pearlin's Self-Mastery Scale (PSMS) to assess personal mastery, there were variations in the number of response anchors and scoring strategies that were used. Nevertheless, findings revealed that personal mastery influences mobility disability by acting as a protective resource against adverse outcomes among older adults. The authors of the reviewed articles had provided physiological and behavioral explanations for their findings. CONCLUSIONS: Higher level of personal mastery can protect older adults from mobility disability, because it confers a sense of personal control, which in turn promotes positive physiological functioning and health behaviors. This knowledge contributes to the maintenance of physical functioning in old age.

Organização e oferta da assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil / Organization and offer of physical therapy care in response to the COVID-19 pandemic in Brazil

Resumo A recuperação das pessoas acometidas pela COVID-19 é um processo que continua para além do quadro agudo da infecção pelo Sars-CoV-2. O comprometimento de diversos sistemas corporais pode acarretar impactos funcionais e demandar assistência fisioterapêutica contínua tanto na atenção ambulatorial quanto na atenção primária à saúde (APS). Neste ensaio, busca-se discutir os desafios da organização e da oferta de assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil. A análise foi sumarizada em três dimensões: oferta da assistência fisioterapêutica na APS e na atenção ambulatorial, e oferta de atenção fisioterapêutica por telessaúde. Conclui-se que: a reabilitação funcional depende da capacidade de resposta da APS; existe um déficit de serviços de reabilitação que antecede a pandemia, e pode comprometer respostas satisfatórias às demandas do atual contexto epidemiológico; faz-se necessária a articulação entre as equipes de fisioterapia ambulatorial e da APS; embora a telessaúde seja um recurso e uma oportunidade para ampliar o acesso da população à reabilitação funcional, sua utilização exige cautela; o fisioterapeuta possui papel crucial em todo o continuum de cuidados da COVID-19.

Abstract The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous physical therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in three dimensions: offering physical therapy assistance in PHC, outpatient care, via telehealth. It is concluded that functional rehabilitation depends on the PHC's response capacity; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; although telehealth is a resource and an opportunity to increase the population's access to functional rehabilitation, its use requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

Relações entre espiritualidade e comportamentos saudáveis em idosos atendidos na Atenção Primária à Saúde / Relationships between spirituality and healthy behavior in older adults assisted in Primary Health Care / Relaciones entre espiritualidad y comportamientos saludables en ancianos Atendidos en la Atención Básica de Salud

Objetivo: Avaliar as relações entre espiritualidade e comportamentos saudáveis em idosos atendidos na atenção primária à saúde. Métodos: Estudo transversal realizado com amostra de 201 idosos atendidos em três Unidades Matriciais de Saúde (UMS) selecionadas aleatoriamente, em Uberaba, Minas Gerais, Brasil. Avaliou-se a espiritualidade pela Escala de Espiritualidade com cinco itens, cuja pontuação varia de 5 (menor espiritualidade) a 20 (maior espiritualidade). Os comportamentos de saúde incluíram tabagismo, consumo de bebidas alcoólicas, água, frutas e vegetais, satisfação com o sono, relações sociais e prática de atividade física. Os indicadores sociodemográficos englobaram sexo (masculino/feminino), faixa etária (60-74/75+) e escolaridade (até 4 anos/5 anos ou mais). Realizaram-se análises descritivas, teste t Student e regressão linear múltipla, adotando-se o intervalo de confiança de 95%. Resultados: Encontrou-se a média do escore na Escala de Espiritualidade de 16,02±2,71. Observaram se as pontuações maiores entre os idosos que não fumavam (p=0,014); que consumiam frutas (p=0,003), vegetais (p=0,002) e água (p=0,017) em quantidades adequadas; entre aqueles classificados como fisicamente ativos (p<0,001); e entre aqueles que estavam satisfeitos com o sono (p=0,032) e com as relações sociais (p<0,001). Prática de atividade física (ß:0,225; IC=0,507-2,131) e satisfação com as relações sociais (ß:0,190; IC=0,360-2,351) apresentaram-se relacionadas à espiritualidade mais elevada, mesmo após controle por indicadores sociodemográficos. Conclusão: A espiritualidade relaciona-se com comportamentos saudáveis nos idosos investigados atendidos na atenção primária à saúde.

Objective: To evaluate the relationship between spirituality and healthy behaviors in older adults assisted in primary health care.Methods: A cross-sectional study was carried out with a sample of 201 older adults in three randomly selected matrix health units (UMS) in Uberaba-MG. Spirituality was assessed by the Spirituality Scale with five items, whose final score ranges from 5 (less spiritual) to 20 (higher spirituality). Health behaviors included smoking, consumption of alcoholic beverages, water, fruits and vegetables, satisfaction with sleep and social relationships, and physical activity. The sociodemographic indicators were sex (male/female), age group (60-74/75+), and schooling (up to 4/5 years or more). Descriptive analyses, Student's t-test, and multiple linear regression were performed, adopting a 95% confidence interval. Results: The mean score on the Spirituality Scale was 16.02±2.71. Higher scores were observed among participants who did not smoke (p=0.014); who consumed fruits (p=0.003), vegetables (p=0.002), and water (p=0.017) in adequate amounts; among those classified as physically active (p<0.001); who were satisfied with sleep (p=0.032) and with social relationships (p<0.001). Physical activity practice (ß:0.225; CI=0.507-2.131) and satisfaction with social relationships (ß:0.190; CI=0.360-2.351) were related to higher spirituality even after controlling for sociodemographic indicators. Conclusion: Spirituality is related to healthy behaviors in the investigated older adults assisted in primary health care.

Objetivo: Evaluar las relaciones entre espiritualidad y comportamientos saludables en ancianos atendidos en la atención básica de salud. Métodos: Estudio transversal realizado con muestra de 201 ancianos atendidos en tres Unidades Matriciales de Salud (UMS) seleccionadas aleatoriamente, en Uberaba, Minas Gerais, Brasil. Se evaluó la espiritualidad por la Escala de Espiritualidad con cinco puntos, cuya puntuación puede variar de 5 (menos espiritualidad) a 20 (mayor espiritualidad). Los comportamientos de salud incluyeron tabaquismo, consumo de bebidas alcohólicas, agua, frutas y vegetales, satisfacción con el sueño, relaciones sociales y práctica de actividad física. Los indicadores sociodemográficos incluyeron sexo (masculino/femenino), franja etaria (60-74/75+) y escolaridad (hasta 4 años/5 años o más). Fueron realizados análisis descriptivos, test t Student y regresión linear múltiple, adoptando el intervalo de confianza de 95%. Resultados: Se encontró la média del escore en la Escala de Espiritualidad de 16,02 ± 2,71. Se observaron las mayores puntuaciones entre los ancianos no fumadores (p=0,014); que consumían frutas (p=0,003), vegetales (p=0,002) y agua (p=0,017) en cantidades adecuadas; entre aquellos clasificados como físicamente activos (p<0,001); y entre aquellos que estaban satisfechos con el sueño (p=0,032) y con las relaciones sociales (p<0,001). Práctica de actividad física (ß:0,225; IC=0,507-2,131) y satisfacción con las relaciones sociales (ß:0,190; IC=0,360-2,351) se presentaron relacionadas con la espiritualidad más elevada, incluso después de control por indicadores sociodemográficos. Conclusión: La espiritualidad está relacionada con comportamientos saludables en los ancianos investigados atendidos en la atención básica de salud.

Características da dor no joelho em idosos usuários da atenção primária à saúde, segundo aspectos sociodemográficos / Characteristics of knee pain among older adults users of primary health care, according to sociodemographic aspects

Dor no joelho é uma condição reconhecida pelo elevado impacto funcional na população idosa. O conhecimento sobre as características dessas demandas na Atenção Primária à Saúde (APS) é escasso, o que dificulta o planejamento de linhas de cuidados destinadas ao manejo da dor nessa população. O objetivo foi investigar características da dor no joelho em idosos usuários da atenção primária à saúde, segundo aspectos sociodemográficos. Foi realizado estudo transversal com 201 idosos em três unidades de saúde selecionadas aleatoriamente. Dor no joelho foi classificada em crônica (>três meses) e aguda (

Knee pain is a condition recognized for its high functional impact in the older population. Knowledge about the characteristics of these demands in Primary Health Care (PHC) is scarce, which makes it difficult to plan lines of care aimed at pain management in this population. The objective of this study was to investigate characteristics of knee pain among older adults users of primary health care, according to sociodemographic aspects. A cross-sectional study was carried out with 201 older adults in three randomly selected health units. Knee pain was classified as chronic (>3 months) and acute (<3 months). The Analog Pain Scale was applied to assess the intensity, scored from 0 to 10, and questions about the impact of pain on daily life and demand for health services. Gender, age, presence of a partner, and education were recorded. Chronic knee pain was reported by 39.8% of participants; 24.9% reported functional impact and 23.9% sought a health service. Presence of pain (p=0.021) and functional impact (p=0.016) were more frequent among those who did not have a partner and the search for health services was more frequent among those with higher education. Acute knee pain was reported by 37.8% of participants, mean pain intensity was 2.4 (SD:3.6), and was associated with higher education and not having a partner. The demand for care for older adults with knee pain in PHC is high and is characterized as being functionally impactful and stimulating the demand for health services, in addition to being unequal in terms of education and the presence of a partner.

Factors related to self-rated quality of life among women with fibromyalgia according to International Classification of Functioning / Fatores relacionados a qualidade de vida autorrelatada em mulheres com fibromialgia de acordo com a Classificação Internacional de Funcionalidade

ABSTRACT BACKGROUND AND OBJECTIVES Fibromyalgia is characterized by diffuse pain, which may compromise the self-rated quality of life (SRQoL). Little is known about the influence of psychosocial and environmental factors on SRQoL in women with fibromyalgia. The objective was to investigate factors related to SRQol among women with fibromyalgia, according to International Classification of Functioning domain. METHODS A cross-sectional population-based study was performed with 1,557 women. Those who self-reported fibromyalgia answered the Fibromyalgia Impact Index. SRQoL was evaluated by questions ranging from 1 (unsatisfied) to 3 (very satisfied). Exposures included personal and environmental factors distributed in four blocks according to hypothesized influence on outcome. Multiple linear regression was performed, considering 95% of confidence interval, using IBM SPSS version 24. RESULTS Income sufficiency was related to higher SRQoL in model 1. Physical environment was related to SRQoL in model 2, 3 and 4. Functional capacity measurement was related to SRQoL in model 4. In the final model, only depressive symptoms (ß:-0.374; CI: -0.037/ -0.004) and number of painful body areas (ß: 0.204; CI: -0.102/-0.001) remained significantly related to SRQoL, explaining 27% of the variance. CONCLUSION SRQoL was related to depressive symptoms and number of painful body areas even after controlled by socioeconomic, environment and health status. However, other aspects may mediate or moderate that outcome, deserving attention in a biopsychosocial approach. The results highlighted the relevance of biopsychosocial aspects on quality of life of women with fibromyalgia, addressing factors that could be approached in clinical practice to promote health and well-being.

RESUMO JUSTIFICATIVA E OBJETIVOS Fibromialgia é caracterizada por dor difusa, que pode comprometer a qualidade de vida autorrelatada (QVAR). Sabe-se pouco sobre a influência de fatores psicossociais e ambientais na QVAR em mulheres com fibromialgia. O objetivo deste estudo foi investigar fatores relacionados à QVAR entre mulheres com fibromialgia, segundo o domínio da Classificação Internacional de Funcionalidade. MÉTODOS Estudo transversal de base populacional realizado com 1.557 mulheres. Aquelas que se autorrelataram com fibromialgia responderam ao Índice de Impacto da Fibromialgia (n=115). A QVAR foi avaliada por questões que variavam de 1 (insatisfeita) a 3 (muito satisfeita). As exposições incluíram fatores pessoais e ambientais distribuídos em quatro blocos de acordo com a influência hipotética no desfecho. Foi realizada regressão linear múltipla, considerando 95% do intervalo de confiança, utilizando-se a versão 24 do IBM SPSS. RESULTADOS Suficiência de renda foi relacionada à maior QVAR no modelo 1. Ambiente físico estava relacionado à QVAR nos modelos 2, 3 e 4. Medição da capacidade funcional esteve relacionada à QVAR no modelo 4. Apenas sintomas depressivos (ß:-0,374; IC: -0,037/ -0,004) e número de áreas corporais dolorosas (ß: 0,204; IC: -0,102/-0,001) mantiveram-se significativamente relacionado à QVAR, explicando 27% da variância. CONCLUSÃO QVAR esteve relacionada a sintomas depressivos e número de áreas corporais dolorosas mesmo depois de controlada por condição socioeconômica, ambiental e saúde. Outros aspectos podem mediar esse desfecho, merecendo atenção na abordagem biopsicossocial. Os resultados destacaram relevância dos aspectos biopsicossociais na qualidade de vida das mulheres com fibromialgia, recorrendo a fatores que poderiam ser abordados na prática clínica para promover saúde e bem-estar.

Relações entre atividade física, aptidão física e mortalidade em idosos: Estudo Fibra / DOI: 10.15343/0104-7809.202044290299Relationships between physical activity, physical fitness and mortality among the elderly: Fibra Study

Ser fisicamente ativo e manter ótima aptidão física protege os idosos contra a morte precoce. No entanto, não está claro através de quais mecanismos tais relacionamentos ocorrem ou se a aptidão física é necessária para evitar a mortalidade nessa população. O objetivo foi investigar as relações entre atividade física, aptidão física e ocorrência de morte entre idosos residentes em uma comunidade e explorar os efeitos mediadores. Foi realizado um estudo transversal do banco de dados do Estudo FIBRA, coletado na cidade de Campinas, SP, Brasil entre 2008 e 2009. A ocorrência de óbito foi verificada em agosto de 2017 no Sistema de Informações sobre Mortalidade (SIM). A atividade física foi mensurada por meio de autorrelato, enquanto a aptidão física foi mensurada por meio de testes de desempenho físico com 800 participantes, com idade de 65 anos ou mais. Foi elaborado um modelo para testar as relações e os efeitos mediadores entre atividades físicas domésticas globais, de lazer, aptidão física, e mortalidade, controladas por sexo e idade. Os resultados demonstraram três principais achados: 1) o efeito direto da atividade física global na morte e seu efeito indireto mediado pela lentidão; 2) o efeito direto da atividade doméstica na morte e seu efeito mediado pela fraqueza; e 3) o efeito direto da lentidão na morte. Idosos fisicamente inativos, fracos e lentos têm maior probabilidade de morte. Além disso, os benefícios da atividade física provavelmente estão além da aptidão física.(AU)

Being physically active and maintaining great physical fitness protect older adults against early death. However, is not clear through which mechanisms such relationships occur or whether physical fitness is required to prevent mortality in this population. The objective was to investigate relationships between physical activity, physical fitness and occurrence of death among the elderly residing in a community and explore the mediating effects. A cross-sectional study from FIBRA Study database, collected in Campinas city, in Sao Paulo state, Brazil between 2008 and 2009 was performed. The occurrence of death was verified in August 2017 in the Mortality Information System (MIS). Physical activity was measured through self-reporting while physical fitness was measured through physical performance tests with 800 participants aged 65 years or older. A model was drawn to test relationships and mediating effects between global, leisurely, domestic physical activities, physical fitness, and mortality, controlled by sex and age. The results demonstrated three main findings: 1) the direct effect of global physical activity on death and its indirect effect mediated by slowness; 2) the direct effect of domestic activity on death and its mediated effect through weakness; and 3) the direct effect of slowness on death. Physically inactive, weak and slow elderly have a greater probability of death. Moreover, the benefits of physical activity are probably beyond physical fitness.(AU)

Contextual factors associated with life-space mobility in community-dwelling older adults based on International Classification of Functioning, Disability and Health: protocol for a systematic review.

INTRODUCTION: Mobility decline compromises functionality and quality of life in old age. Life-Space Assessment (LSA) evaluates mobility considering interaction between person and environment. The International Classification of Functioning, Disability and Health (ICF) is a reference to identify and categorise the personal and environmental contextual factors associated to the LSA. Our objective is identifying contextual factors that may influence life-space mobility of older community-dwelling adults based on ICF. METHODS AND ANALYSIS: A systematic review of literature will be performed to identify studies published between 1 January 2001 and 10 May 2017 which investigates life-space mobility among older adults. Keywords will be entered into the electronic databases of MEDLINE (PubMed), EMBASE (OVID), CINHAL (EBSCO), Cochrane Central Register of Controlled Trials Cochrane Central (OVID), PsycINFO (EBSCO) and COCH (OVID). Five investigators will work on search databases and standardised screening of the articles. Mobility predictors will be separated into personal and environmental aspects, according to the ICF model. The results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and then a meta-analysis will be performed, if applicable. DISCUSSION: Knowledge about life-space mobility in community-dwelling older adults by examining related risk and protective aspects may help practitioners better approach older adults' mobility and prevent their decline in old age. Furthermore, researchers will have more clues for investigations into factors related to life-space mobility. TRIAL REGISTRATION NUMBER: CRD42017064552.

Factors related to low social participation in older adults: findings from the Fibra study, Brazil / Fatores relacionados à baixa participação social em idosos: resultados do estudo Fibra, Brasil

Abstract Objective To investigate the factors related to low social participation in older adults. Method A hierarchical model was drawn using data from 2,251 participants of the Fibra study, aged 65 years or more, without cognitive impairment suggestive of dementia, who were living in seven Brazilian cities. Three blocks of variables were considered: macrostructural, socioeconomic and health conditions. Results Factors related to low social participation were low perceived social support (OR:2.18;CI:0.73-1.53; <0.001), vision impairment (OR:2.04; CI:1.16-3.61;0.014), age over 80 years (OR:2.03;CI:1.22-3.38;0.006), depressive symptoms (OR:1.86;CI:1.29-2.68; <0.001), low cognitive status (OR:1.85;CI:1.20-2.85;0.005) and slowness (OR:1.83;CI:1.26-2.65;0.001). Older adults with those conditions have higher odds to be less socially engaged than their counterparts. Conclusion Personal conditions, such as socioeconomic and health status were predictors of low social participation in older adults. Initiatives aiming at active aging promotion should focus primarily on vulnerable elderly, especially those with health and/or social disadvantages.

Resumo Objetivo Investigar os fatores relacionados à baixa participação social em idosos. Métodos Um modelo hierárquico foi testado utilizando dados de 2.251 participantes do estudo Fibra, com 65 anos ou mais, sem comprometimento cognitivo sugestivo de demência, residentes em sete cidades brasileiras. Três blocos de variáveis foram consideradas: macroestrutural, socioeconômica e condições de saúde. Resultado Os fatores relacionados à baixa participação social foram: baixa percepção de apoio social (OR=2,18; IC=0,73-1,53; <0,001), déficit visual (OR=2,04; IC=1,16-3,61; 0,014), idade acima de 80 anos (OR=2,03; IC=1,22-3,38; 0,006), sintomas depressivos (OR=1,86; IC=1,29-2,68; <0,001), baixo status cognitivo (OR=1,85; IC=1,20-2,85; 0,005) e lentidão para marcha (OR=1,83; IC=1,26-2,65; 0,001). Idosos nessas condições têm maiores probabilidades de serem menos socialmente engajados. Conclusão Condições pessoais, tais como estado de saúde e socioeconômico, foram preditores de baixa participação social em idosos. Iniciativas destinadas à promoção do envelhecimento ativo deverão ser dirigidas, principalmente, aos idosos vulneráveis, em especial àqueles com desvantagens de saúde e/ou sociais.

Trajectories of social participation in old age: a systematic literature review / Trajetórias da participação social na velhice: uma revisão sistemática da literatura

Abstract Objective: the present study aimed to identify patterns of social participation in old age and the theories used to explain them. Method: A systematic review was performed using the Medical Literature Analysis and Retrieval System Online (MEDLINE / PUBMED), Scientific Electronic Library Online (Scielo) and Web of Science (ISI Web of Knowledge) databases. The keywords used were: social participation, social engagement, social involvement and social activities; combined with seniors, the elderly, older adults, older people and aging. Research was performed between January and February. Results: thirty-one longitudinal studies on social participation among old and healthy middle-aged adults were included for analysis. In three studies social engagement levels increased, especially at the beginning of old age (up to 75 years). Twenty-one studies presented results that described the reduction of social engagement levels in old age, and five studies found that there was no change in levels of social involvement. The most used theories were: the activity theory, the social disengagement theory, the continuity theory and the theory of socioemotional selectivity. Conclusion: the results point to the need for reflection on what is envisioned and what is practiced in terms of policies and practices aimed at achieving successful aging. Future attempts should include not only incentives to remain active, but a description of factors that influence the social disengagement associated with poor adaptation in old age.

Resumo Objetivo: identificar trajetórias de participação social na velhice e as teorias utilizadas para explicá-las. Método: revisão sistemática da literatura nas bases de dados Medical Literature Analysis e Retrieval System Online (MEDLINE/PubMed), Scientific Eletronic Library Online (SciELO) e Web of Science (ISI Web of Knowledge). Os seguintes descritores foram utilizados: social participation, social engagement, social involvement e social activities; combinados com seniors, elderly, older adults, older people e aging. A pesquisa foi realizada no período entre janeiro e fevereiro de 2016. Resultados: trinta e um estudos longitudinais sobre participação social em idosos e adultos de meia-idade saudáveis foram incluídos para análise. Verificou-se que em três estudos, os níveis de engajamento social aumentaram, principalmente no início da velhice (até os 75 anos). Vinte e um estudos apresentaram resultados correspondentes à diminuição dos níveis de engajamento social na velhice. Cinco estudos divulgaram resultados sobre ausência de mudanças nos níveis de envolvimento social. As teorias mais utilizadas foram: a teoria da atividade, a teoria do desengajamento social, a teoria da continuidade e a teoria da seletividade socioemocional. Conclusão: os resultados apontam para a necessidade de reflexão sobre o que é idealizado e o que é praticado em termos de políticas e práticas para alcançar o envelhecimento bem sucedido. Os esforços futuros devem contemplar não apenas o incentivo à atividade, mas os aspectos que influenciam o desengajamento social associado à má adaptação dos idosos.

Relationships between levels of social participation, self-rated health and life satisfaction in older adults according to gender / Las relaciones entre los niveles de participación social, la autopercepción de la salud y la satisfacción de la vida en los adultos mayores en función del sexo / Relações entre níveis de participação social, autoavaliação de saúde e satisfação com a vida em idosos de acordo com gênero

This study aimed to identifying the influence of levels of social participation on self-rated health and life satisfaction in older adults. Data came from Fibra Study, a cross-sectional, multicenter study designed to investigate frailty in a randomly selected sample of people aged 65 years or older, recruited in seven Brazilian cities. Results showed that different social activities and levels of social participation played diverse influences on self-rated health and life satisfaction in old age and those influences differ according to gender.

Este estudio tuvo como objetivo identificar la influencia de los niveles de participación social autopercepción de la salud en la satisfacción con la vida y en los adultos mayores. Los dados proceden del estudio Fibra, un estudio transversal, multicéntrico diseñado para investigar la fragilidad en una muestra seleccionada al azar de personas de 65 años o más, reclutados en siete ciudades brasileñas. Los resultados muestran que los diferentes actividades sociales y los niveles de participación social influyen en la autoevaluación de la salud y la satisfacción con la vida en la vejez y estas influencias difieren entre los sexos.

Este estudo teve como objetivo identificar a influência dos níveis de participação social na autoavaliação de saúde e satisfação com a vida em idosos. Os dados são oriundos do Estudo Fibra, um estudo transversal, multicêntrico, desenvolvido para investigar fragilidade, em uma amostra aleatória de pessoas com 65 anos ou mais, recrutadas em sete cidades brasileiras. Os resultados mostraram que diferentes atividades sociais e níveis de participação social desempenharam influências diversas sobre a autoavaliação de saúde e satisfação com a vida na velhice, e essas influências diferem entre os sexos.

The influence of physical and mental health on life satisfaction is mediated by self-rated health: A study with Brazilian elderly.

Chronic diseases, signals and symptoms of health problems and objective losses in functionality are seen as strongly related to low levels of life satisfaction in old age. Among seniors, self-rated health is associated with both quality of health and life satisfaction, but its relationships with objective health measures are controversial. This study aimed at identifying the influence of self-rated health as a mediator of the relationships between objectives indicators of physical and mental health and the elderly's life satisfaction. Self-reporting and physical performance measures were derived from the data basis of the FIBRA Study, which investigated frailty and associated variables in a cross-sectional sample of 2164 subjects aged 65 and above, randomly selected in seven Brazilian cities. A model considering satisfaction as a dependent variable, the number of diseases, frailty, cognitive status and depressive symptoms as predictors and self-rated health as a mediating variable was tested through path analysis. The model fit the data well and explained 19% of life satisfaction's variance. According to the bootstrapping method, indirect effects were significant for all trajectories, suggesting that self-rated health is a mediator variable between physical and mental health and elderlýs life satisfaction. In conclusion, adverse conditions of physical and mental health can influence the elderlýs life satisfaction, mostly when they determine a decrease in their levels of self-rated health.

Factors associated with low life life satisfaction in community-dwelling elderly: FIBRA Study.

The objectives were to identify factors associated with decreased life satisfaction in community-dwelling elderly and describe such factors according to gender and age bracket. The study interviewed 2,472 elderly individuals 65 years or older without cognitive deficits suggestive of dementia, in probabilistic samples from seven Brazilian cities. All measures were self-reported except for functional performance, indicated by handgrip and gait speed. Women had more chronic diseases, worse functional performance, and greater social involvement when compared to men. The oldest participants showed worse functional performance and less social involvement when compared to the youngest. Low satisfaction was associated with three or more diseases, memory problems, low social involvement, low handgrip strength, and urinary incontinence. The authors conclude that health, functional performance, and social involvement interact with well-being, so interventions targeting these areas can favor quality of life for the elderly.

Doenças crônicas, capacidade funcional, envolvimento social e satisfação em idosos comunitários: Estudo Fibra / Chronic diseases, functional ability, social involvement and satisfaction in community-dwelling elderly: the Fibra study

O objetivo deste artigo é descrever variações em medidas de doenças crônicas, capacidade funcional, envolvimento social e satisfação com relação à memória, capacidade de resolver problemas, relações sociais, ambiente, serviços de saúde e transportes, conforme gênero, idade e renda familiar, e analisar correlações entre envolvimento social e capacidade funcional, conforme gênero e idade, em idosos independentes, com 65 anos e mais, recrutados na comunidade. Foram submetidos 2.472 idosos sem déficit cognitivo, integrantes de amostras probabilísticas de sete localidades brasileiras a medidas de autorrelato sobre todas as variáveis, com exceção de força de preensão palmar e velocidade da marcha, avaliadas por testes objetivos. A idade média foi 72,2 ± 5,5 anos e a renda 3,9 ± 4,9 SM; 65,7% eram mulheres, que apresentaram mais doenças, pior desempenho funcional e maior envolvimento social do que os homens. Os de 80 anos ou mais e os mais pobres tiveram pior desempenho funcional e menor envolvimento social. Houve correlação entre capacidade funcional e envolvimento social. Renda relacionou-se com satisfação com memória, solução de problemas, serviços de saúde e transportes. Saúde e satisfação interagem na velhice, influenciando padrões de atividade e de envolvimento social.

The scope of this article is to describe variations in the measurement of chronic diseases, functional ability, social involvement and satisfaction with respect to memory, problem solving, social relationships, environment, health services and transportation. This is done according to gender, age and income. It analyzes correlations between social involvement and functional ability in independent community dwelling-elderly aged 65 and above. 2,472 seniors without cognitive deficit, from probabilistic samples of seven Brazilian locations, were submitted to self-reported measurement concerning all variables, with the exception of grip strength and gait speed assessed by objective tests. Mean age was 72.2 ± 5.5 years and mean income was 3.9 ± 4.9 MW; 65.7% were women, who had more diseases, worse functional performance and greater social involvement than men; those aged 80 and above and the poorest participants had worse functional performance and less social involvement. Correlations were observed between functional ability and social involvement. Level of income was related to satisfaction concerning memory, problem solving, health and transport services. Health, functionality and satisfaction interact in old age, influencing patterns of activity and social involvement.

Factors associated with low life life satisfaction in community-dwelling elderly: FIBRA Study / Fatores associados à baixa satisfação com a vida em idosos residentes na comunidade: Estudo FIBRA / Factores asociados con baja satisfacción con la vida en adultos mayores viviendo en la comunidad: Estudio FIBRA

The objectives were to identify factors associated with decreased life satisfaction in community-dwelling elderly and describe such factors according to gender and age bracket. The study interviewed 2,472 elderly individuals 65 years or older without cognitive deficits suggestive of dementia, in probabilistic samples from seven Brazilian cities. All measures were self-reported except for functional performance, indicated by handgrip and gait speed. Women had more chronic diseases, worse functional performance, and greater social involvement when compared to men. The oldest participants showed worse functional performance and less social involvement when compared to the youngest. Low satisfaction was associated with three or more diseases, memory problems, low social involvement, low handgrip strength, and urinary incontinence. The authors conclude that health, functional performance, and social involvement interact with well-being, so interventions targeting these areas can favor quality of life for the elderly.

Os objetivos foram identificar fatores associados à baixa satisfação com a vida em idosos da comunidade e descrevê-los segundo sexo e faixa etária. Foram entrevistados 2.472 idosos com 65 anos ou mais, sem déficit cognitivo sugestivo de demência, de amostras probabilísticas de sete localidades brasileiras. As medidas foram autorrelatadas, exceto o desempenho funcional, indicado por testes de força de preensão palmar e velocidade de marcha. As mulheres apresentaram mais doenças, pior desempenho funcional e maior envolvimento social quando comparadas aos homens. Os mais velhos tiveram pior desempenho funcional e menor envolvimento social em comparação com os mais jovens. Associaram-se à baixa satisfação ter três ou mais doenças, problemas de memória, baixo envolvimento social, baixa força de preensão e incontinência urinária. Concluímos que saúde, desempenho funcional e envolvimento social interagem com o bem-estar, por isso a intervenção nesses aspectos favorece a qualidade de vida dos idosos.

Los objetivos fueron identificar los factores asociados a la baja satisfacción en adultos mayores y describirlas en función del sexo y la edad. Se entrevistó a 2.472 personas de 65 años o más, sin deterioro cognitivo sugestivo de demencia, de muestras aleatorias de siete ciudades en Brasil. Las medidas fueron auto-reporte, excepto el desempeño funcional indica en las pruebas de fuerza de agarre y velocidad de la marcha. Las mujeres tenían más enfermedades, rendimiento funcional peor y mayor participación social, en comparación con los hombres. Los participantes de más edad mostraron peor desempeño funcional y menos participación social que los más jóvenes. Se asociaron con una baja satisfacción: tres o más enfermedades, problemas de memoria, el bajo nivel de participación social, baja fuerza de prensión y la incontinencia urinaria. La salud, el rendimiento funcional y la interación social interactúan con el bienestar, por lo que la intervención en estos aspectos favorecen la calidad de vida de los ancianos.

[Chronic diseases, functional ability, social involvement and satisfaction in community-dwelling elderly: the Fibra study]. / Doenças crônicas, capacidade funcional, envolvimento social e satisfação em idosos comunitários: Estudo Fibra.

The scope of this article is to describe variations in the measurement of chronic diseases, functional ability, social involvement and satisfaction with respect to memory, problem solving, social relationships, environment, health services and transportation. This is done according to gender, age and income. It analyzes correlations between social involvement and functional ability in independent community dwelling-elderly aged 65 and above. 2,472 seniors without cognitive deficit, from probabilistic samples of seven Brazilian locations, were submitted to self-reported measurement concerning all variables, with the exception of grip strength and gait speed assessed by objective tests. Mean age was 72.2 ± 5.5 years and mean income was 3.9 ± 4.9 MW; 65.7% were women, who had more diseases, worse functional performance and greater social involvement than men; those aged 80 and above and the poorest participants had worse functional performance and less social involvement. Correlations were observed between functional ability and social involvement. Level of income was related to satisfaction concerning memory, problem solving, health and transport services. Health, functionality and satisfaction interact in old age, influencing patterns of activity and social involvement.