Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach.

BACKGROUND: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. OBJECTIVE: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. METHODS: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeirão Prêto, São Paulo, Brazil, and involved 20 older adults of both genders who were aged ≥60 years and enrolled in the Physical Education Program for the Elderly at the University of São Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. RESULTS: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90% (18/20) of the participants owned smartphones. However, 20% (4/20) of the participants faced installation challenges and 30% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89% to 70.65%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. CONCLUSIONS: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults.

Family caregivers' satisfaction with telerehabilitation and follow-up intervention for older people with dementia: Randomized clinical trial.

The present study aimed to assess caregiver satisfaction with a telerehabilitation program and remote monitoring for older adults with dementia and their caregivers during the COVID-19 pandemic, as well as to identify the factors influencing caregiver satisfaction. This study adopted a mixed-methods approach and was part of a randomized clinical trial, with blinded assessors, comprising two groups: the Intervention Group (IG) receiving a telerehabilitation program involving standardized physical exercises for older adults with dementia, along with caregiver guidelines for the caregiver; and the Control Group (CG) receiving remote monitoring. At baseline, factors related to older adults with dementia and their caregivers were measured. After 12 weeks, caregiver satisfaction with the interventions was assessed. The final sample consisted of 64 pairs of family caregivers and older people with dementia. Caregivers in the IG showed higher satisfaction levels with the intervention, Internet-based treatment, and healthcare received compared to caregivers in the CG. Both groups expressed positive views towards the treatment, with excellent ratings for audio and video quality, and a preference for Internet-based treatment over face-to-face. In the IG, only the amount of time dedicated to caregiving influenced satisfaction with the intervention, whereas in the CG, cognitive and functional performance of the older people influenced satisfaction with remote monitoring. Our findings suggest the potential of the program in providing effective care for older people with dementia and their caregivers.

Effects of telehealth on functional capacity, mental health and quality of life among older people with dementia: LAPESI telehealth protocol for a randomized controlled trial.

BACKGROUND: Telehealth can be an alternative action at a distance that can help as a form of motor intervention, alleviating the deleterious effects arising from social distancing on functional capacity, mental health and quality of life among older people with dementia during the COVID-19 pandemic. PURPOSE: We aim to analyze the effects of a telehealth program on functional capacity, mental health and quality of life among older people with dementia and their caregivers. METHODS: seventy-eight individuals with mild and moderate dementia and their caregivers will answer an anamnesis and be evaluated through Clinical Dementia Assessment Score. They will also be evaluated by blinded examiners in terms of functional capacity (Activities of Daily Living Questionnaire and World Health Organization Disability Assessment Schedule 2.0), mental health (Mini-Mental State Examination, Clock Drawing Test, Verbal Fluency test and the Neuropsychiatric Inventor) and quality of life (Quality of Life in Alzheimer's Disease scale). Afterward, the volunteers will be randomized into the telehealth training group and the control group. The TR will perform systematic physical and cognitive exercises in 50-min sessions three times a week with professional monitoring, while the CG will receive non-systematized guidance, both for 12 weeks. Participants will be evaluated at baseline, immediately after the three-month interventions and with a 12-week follow- up. DISCUSSION: Technological approaches such as telehealth can be a viable alternative in home care service during times of pandemic. We expect that older people with dementia and their caregivers have high adherence to the telehealth program and improve their functional capacity, mental health and quality of life of older people with dementia. Telehealth is an alternative that can contribute to public policies and the development of effective intervention strategies that neutralize adverse outcomes. It can also be presented as an alternative to home care services, which could reduce demands for health resources.

Change in the pattern of frailty among socially vulnerable older adults over a 36-month period and associated factors: a follow-up study / Mudança do padrão de fragilidade entre idosos socialmente vulneráveis no período de 36 meses e fatores associados: um estudo de seguimento

OBJECTIVE: To investigate changes in the frailty levels of older adults in a context of high social vulnerability. METHODS: We conducted a prospective cohort study. Data were collected from 2 surveys conducted in 2015 and 2018. The frailty phenotype and sociodemographic and health characterization instruments were used. Descriptive statistical analysis was performed, including non-parametric tests, test for equality of proportions, and multivariate multinomial logistic regression. The use of the database was authorized, and the research was approved by the Ethics Committee. RESULTS: In 2015, 346 community-dwelling older adults participated in the study. After 36 months, a final sample of 223 participants was obtained. In 2015, the prevalence of non-frail, pre-frail, and frail older adults was 13.0%, 56.5%, and 30.5%, respectively. In 2018, 22.9% were non-frail, 56.0% were pre-frail, and 21.1% were frail. Higher education and better quality of life reduced the likelihood of becoming pre-frail and frail, respectively. CONCLUSION: There was a change in the pattern of frailty among socially vulnerable older adults over a 36-month period.

OBJETIVO: Verificar alterações nos níveis de fragilidade de pessoas idosas em contexto de alta vulnerabilidade social. METODOLOGIA: Trata-se de um estudo de coorte prospectivo. Foram coletados dados de dois inquéritos realizados em 2015 e 2018. Utilizou-se o Fenótipo de Fragilidade e instrumentos de caracterização sociodemográfica e de saúde. Análises estatísticas descritivas foram realizadas, incluindo testes não-paramétricos, teste de igualdade de proporções e regressão logística multinomial multivariada. O uso do banco de dados foi autorizado, e a pesquisa foi aprovada pelo Comitê de Ética. RESULTADOS: Em 2015, 346 idosos comunitários participaram do estudo. Após o período de 36 meses, obteve-se uma amostra final de 223 participantes. Em 2015, a prevalência de não frágeis, pré-frágeis e frágeis foi de 13,0, 56,5 e 30,5%, respectivamente. Em 2018, 22,9% eram não frágeis, 56,0% pré-frágeis e 21,1% frágeis. Maior escolaridade e qualidade de vida diminuíram a probabilidade de se tornar pré-frágil e frágil, respectivamente. CONCLUSÃO: Observou-se uma mudança do padrão de fragilidade entre idosos socialmente vulneráveis no período de 36 meses.

Hearing handicap and frailty in community-dwelling older adults living. / Handicap auditivo e fragilidade em idosos da comunidade.

PURPOSE: To verify the relationship between hearing handicap and frailty in community-dwelling older adults. METHODS: A cross-sectional study was carried out with 238 older adults (aged ≥ 60 years) in 2018. The Hearing Handicap Inventory for the Elderly - Screening version - HHIE-S was applied to assess the hearing handicap. To assess frailty, the Frailty Phenotype proposed for Fried and co-workers was adopted, objectively evaluating 5 criteria: unintentional weight loss, reported fatigue, reduced grip strength, reduced walking speed and low physical activity. It was investigated whether the hearing handicap were related with frailty using Kruskal-Wallis and Spearman test. RESULTS: Worse perception of the hearing handicap was found in pre-frail and frail individuals, compared to non-frail individuals. In addition, hearing handicap showed a positive and statistically significant correlation with frailty. CONCLUSION: Hearing handicap is related to frailty in community-dwelling older adults.

OBJETIVO: Verificar a relação entre o handicap auditivo e fragilidade em idosos residentes da comunidade. MÉTODO: Estudo transversal realizado com 238 idosos (idade ≥ 60 anos), no ano de 2018. O questionário Hearing Handicap Inventory for the Elderly - Screening version - HHIE-S, foi aplicado para quantificar o handicap auditivo. A fragilidade foi avaliada segundo o Fenótipo de Fragilidade proposto por Fried e colaboradores, utilizando os 5 critérios: perda de peso não intencional, fadiga relatada, redução da força de preensão, redução da velocidade de caminhada e baixa atividade física. A relação entre o handicap auditivo e a fragilidade foi realizada por meio dos Testes Kruskal-Wallis e Spermann. RESULTADOS: Maior percepção do handicap auditivo foi verificado nos indivíduos pré-frágeis e frágeis, comparados aos não frágeis. O handicap auditivo apresentou correlação positiva e estatisticamente significante com maiores níveis de fragilidade. CONCLUSÃO: O handicap auditivo está relacionado a fragilidade em idosos da comunidade.

Satisfação no trabalho de trabalhadores da atenção primária à saúde: um estudo exploratório / Satisfacción laboral de los trabajadores de atención primaria de salud: un estudio exploratorio / Job satisfaction of primary health care workers: an exploratory study

RESUMO Objetivo: identificar os fatores relacionados à (in)satisfação no trabalho de trabalhadores da Atenção Primária à Saúde (APS). Métodos: estudo exploratório com abordagem quantitativa, conduzido em 23 unidades da APS no estado de São Paulo. Foi utilizada a Escala de Satisfação no Trabalho, que abrange o grau de contentamento com chefia, colegas, salário, promoções e trabalho realizado, além de um questionário sócio-ocupacional. Resultados: participaram 70 trabalhadoras, sendo a grande maioria auxiliares de Enfermagem e agentes comunitárias de saúde, com idade média de 45±10,6 anos. Constatou-se indiferença nos campos colegas, chefia e natureza do trabalho. Por outro lado, verificou-se insatisfação com os campos salário e promoções. Conclusão: foi constatada insatisfação no trabalho na APS, e os achados demonstram a necessidade de revisão do plano de carreira e ajustes salariais.

RESUMEN Objetivo: identificar los factores relacionados con la (in)satisfacción laboral de los trabajadores de la Atención Primaria de Salud (APS) Métodos: estudio exploratorio con enfoque cuantitativo, realizado en 23 unidades de APS del estado de São Paulo. Se utilizó la Escala de Satisfacción Laboral, que abarca el grado de satisfacción con la dirección, los compañeros, el salario, las promociones y el trabajo realizado, además de un cuestionario sociolaboral. Resultados: participaron 70 trabajadoras, la gran mayoría auxiliares de enfermería y agentes de salud comunitarios, con una edad media de 45±10,6 años. Hubo indiferencia en los compañeros de campo, el liderazgo y la naturaleza del trabajo. Por otro lado, se comprobó la insatisfacción con los campos salariales y las promociones. Conclusión: se ha constatado la insatisfacción laboral en APS, los resultados demuestran la necesidad de revisar el plano de carrera y los ajustes salariales.

ABSTRACT Objective: to identify factors related to (dis)satisfaction at work among Primary Health Care (PHC) workers. Methods: exploratory study with a quantitative approach, conducted in 23 PHC units in the state of São Paulo, Brazil. The Job Satisfaction Scale was used, which covers the degree of satisfaction with management, colleagues, salary, promotions, and work performed, in addition to a socio-occupational questionnaire. Results: 70 workers participated, most of them Nursing assistants and community healthcare agents, with a mean age of 45±10.6 years. Indifference was found in the fields of colleagues, management, and nature of work. On the other hand, there was dissatisfaction with the salary and promotions fields. Conclusion: job dissatisfaction was found in PHC, and the findings demonstrate the need to review the career plan and salary adjustments.

Frailty in younger-old and oldest-old adults in a context of high social vulnerability / Fatores associados à fragilidade em idosos jovens e mais velhos em contexto de alta vulnerabilidade social

Objective: To analyze the factors associated with physical frailty in community-dwelling younger-old (60 to 74 years) and oldest-old (75 years or older) adults in a region of high social vulnerability. Social vulnerability refers to the absence of or difficulty obtaining social support from public institutions, situations that hinder the realization of or deny citizens their social rights and affect their social cohesion, and the ability to react to high-risk social situations ­ associated health and illness. In this study, we used the São Paulo Social Vulnerability Index developed by the SEADE Foundation, which classifies social vulnerability based on socioeconomic and demographic conditions. Methods: Quantitative analytical study of 303 older adults. Fried frailty phenotype assessment was performed and the Mini Mental State Examination, Geriatric Depression Scale, Katz Index of Independence in Activities of Daily Living, and the Lawton Scale of Instrumental Activities of Daily Living were administered. Descriptive statistics and logistic regression were used to analyze data. Results: Of the older adults, 12.21% were nonfrail, 60.72% were prefrail, and 27.06% were frail. The single factor most associated with frailty was depressive symptoms (OR = 2.65; 95%CI 1.38 ­ 5.08) in the younger-old and illiteracy (OR = 14.64; 95%CI 1.82 ­ 116.51) in the oldest old. Conclusion: The factor most associated with frailty in younger-old adults (aged 60 to 74 years) was depressive symptoms, whereas in the oldest old (aged 75 or older), the factor most associated with frailty was being illiterate. The results of this investigation should prompt health professionals and managers to discuss and program new strategies for health promotion and prevention of factors that may aggravate frailty, respecting the differences found between older adults in early and later old age.

Objetivo: Analisar os fatores associados à fragilidade física de idosos jovens (de 60 a 74 anos) e mais velhos (75 anos ou mais) que vivem na comunidade em uma região de alta vulnerabilidade social. A vulnerabilidade social refere-se à ausência ou dificuldade de assistência de instituições de segurança social, situações que dificultam ou negam o exercício dos direitos sociais de cada indivíduo e afetam sua coesão social, e a capacidade de reagir a situações de risco social ­ associados a saúde e doença. Nesta pesquisa, foi utilizado o Índice Paulista de Vulnerabilidade Social elaborado pela Fundação SEADE, que classifica a vulnerabilidade social com base em dimensões socioeconômicas e demográficas. Metodologia: Estudo quantitativo transversal, realizado com 303 idosos. Aplicaram-se avaliação da fragilidade física (fenótipo de Fried), miniexame do estado mental, escala de depressão geriátrica, índex de Katz ­ Atividades Básicas de Vida Diária, e escala de Lawton e Brody ­ Atividades Instrumentais de Vida Diária, além de terem sido avaliadas as características sociodemográficas e de saúde. Para a análise dos dados foram realizadas estatística descritiva e regressão logística. Resultados: Dos 303 idosos, 12,21% eram não frágeis, 60,72% pré-frágeis e 27,06% frágeis. O fator associado à fragilidade nos idosos jovens foi ter sintomas depressivos (odds ratio ­ OR = 2,65; intervalo de confiança de 95% ­ IC95% 1,38 ­ 5,08), e nos mais velhos, ser analfabeto (OR = 14,65; IC95% 1,82 ­ 116,51). Conclusão: O fator associado à fragilidade no grupo de idosos jovens foi ter sintomas depressivos. No grupo de idosos mais velhos, o fator que se associou à fragilidade foi ser analfabeto. Os resultados desta investigação poderão instigar profissionais e gestores de saúde sobre as necessidades de se discutir e programar novas estratégias de promoção à saúde e prevenção de fatores agravantes da fragilidade respeitando-se as diferenças encontradas a idosos durante seu envelhecimento.

Factors related to the adoption and adherence of physical activity mobile applications by older people: a scoping review protocol.

INTRODUCTION: Ageing is a natural process marked by physiological changes and declines in functional capacity. One strategy to encourage healthy habits in older people is the use of applications on mobile devices to promote physical activity (PA). An immediate challenge is for these applications to be accessible to older people themselves, while a second challenge is to retain their interest and engagement in connection with PA itself. Therefore, the purpose of this review is to map the factors related to the adoption and adherence of PA mobile applications by older people. METHODS AND ANALYSIS: Five databases will be searched where articles and reviews, available between 2010 and present, in English, Portuguese or Spanish, at full text, will be included. In addition, two additional strategies will be performed, including grey literature. The search terms adoption, adherence, factors, mobile application, PA, older people and other terms related to them will be used in the search strategy. This review will include studies that identify factors related to the adoption and adherence to PA mobile applications by people over 60 years. The selection of studies will be carried out by two reviewers in five stages: identification of studies and duplicate removal; pilot test; selection by reading abstracts; inclusion by reading the full text and search in additional sources. Disagreements will be resolved by a third reviewer. Data will be extracted using a data extraction tool. Quantitative data will be described in a narrative manner and qualitative data will be categorised through inductive thematic analysis. ETHICS AND DISSEMINATION: Ethical approval is not required for this scoping review. Plans for the dissemination of the review include the presentation of the results at relevant scientific conferences and the submission and publication in significant journals.

Frailty state transitions among non-frail and vulnerable older adults: Does mobility performance really matter?

We assessed the predictors of becoming frail between non-frail and vulnerable community-dwelling older adults in a retrospective cohort study with adults (n=346) aged 60 years or older recruited from primary healthcare centers. Edmonton Frailty Scale assessed frailty status, and Kaplan-Meier estimated the frailty-free probability and compared it between groups. Cox regression models explored predictors of becoming frail. At baseline, there were 32.3% individuals classified as Frail according to the EFS, whereas 32.4% were vulnerable and 35.3% non-frail. We observed 82 incident cases of frailty, 65.8% among those classified as vulnerable and 37.8% in the non-frail group (p < 0.05). Female sex, years of education, and an overall score of < 45 on the Berg Balance Scale were the only independent predictors of becoming frail. Although frailty is not only correlated with mobility, static and dynamic balancing abilities appear to have the same impact as a vulnerable state to becoming frail.

Are body fat and inflammatory markers independently associated with age-related muscle changes?

BACKGROUND & AIMS: A growing number of studies have shown that body fat and inflammation are associated with age-related changes in body muscle composition. However, most of these studies did not control for potential confounders. The aim was to determine whether there is an association between body fat and inflammatory cytokines with muscle mass/strength decline in community-dwelling older adults. METHODS: Anthropometric, physical and functionality variables were collected. Nutritional status was assessed by the MNA form. Dynapenia was assessed with handgrip strength on the dominant hand using a dynamometer. Sarcopenia was determined using adapted criteria from the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Inflammatory cytokines were evaluated in plasma using a multiplex assay. Associations to muscle mass/strength decline were analyzed using a multinominal logistic regression, adjusted for potential confounders. RESULTS: We recruited a convenience sample of 311 adults aged 60 years or older. Most of subjects were sufficiently active females with a median age of 68 years (interquartile range [IQR], 64-74 years), whereas about a half (46.3%) were at risk of malnutrition. The prevalence of dynapenia was 38.3%, whereas sarcopenia was 13.2%. After controlling for potential confounders, we found that relative fat mass index is independently associated with sarcopenia. Loss of strength was independently associated only with female sex, lower physical activity, worse nutrition and IL-10/TNF-α ratio, whereas female sex, an insufficiently active lifestyle and relative fat mass index were the key determinants of sarcopenia. CONCLUSIONS: These findings highlight the importance of physical activity and healthy diet as effective interventions to prevent muscle mass/strength decline, and points to IL-10/TNF-α ratio and body fat as independently associated factors for dynapenia and sarcopenia, respectively.

Use of a Smartphone App to Increase Physical Activity Levels in Insufficiently Active Adults: Feasibility Sequential Multiple Assignment Randomized Trial (SMART).

BACKGROUND: The sequential multiple assignment randomized trial (SMART) design allows for changes in the intervention during the trial period. Despite its potential and feasibility for defining the best sequence of interventions, so far, it has not been utilized in a smartphone/gamified intervention for physical activity. OBJECTIVE: We aimed to investigate the feasibility of the SMART design for assessing the effects of a smartphone app intervention to improve physical activity in adults. We also aimed to describe the participants' perception regarding the protocol and the use of the app for physical activity qualitatively. METHODS: We conducted a feasibility 24-week/two-stage SMART in which 18 insufficiently active participants (<10,000 steps/day) were first randomized to group 1 (smartphone app only), group 2 (smartphone app + tailored messages), and a control group (usual routine during the protocol). Participants were motivated to increase their step count by at least 2000 steps/day each week. Based on the 12-week intermediate outcome, responders continued the intervention and nonresponders were rerandomized to subsequent treatment, including a new group 3 (smartphone app + tailored messages + gamification) in which they were instructed to form groups to use several game elements available in the chosen app (Pacer). We considered responders as those with any positive slope in the linear relationship between weeks and steps per day at the end of the first stage of the intervention. We compared the accelerometer-based steps per day before and after the intervention, as well as the slopes of the app-based steps per day between the first and second stages of the intervention. RESULTS: Twelve participants, including five controls, finished the intervention. We identified two responders in group 1. We did not observe relevant changes in the steps per day either throughout the intervention or compared with the control group. However, the rerandomization of five nonresponders led to a change in the slope of the steps per day (median -198 steps/day [IQR -279 to -103] to 20 steps/day [IQR -204 to 145]; P=.08). Finally, in three participants from group 2, we observed an increase in the number of steps per day up to the sixth week, followed by an inflection to baseline values or even lower (ie, a quadratic relationship). The qualitative analysis showed that participants' reports could be classified into the following: (1) difficulty in managing the app and technology or problems with the device, (2) suitable response to the app, and (3) difficulties to achieve the goals. CONCLUSIONS: The SMART design was feasible and changed the behavior of steps per day after rerandomization. Rerandomization should be implemented earlier to take advantage of tailored messages. Additionally, difficulties with technology and realistic and individualized goals should be considered in interventions for physical activity using smartphones. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-8xtc9c; http://www.ensaiosclinicos.gov.br/rg/RBR-8xtc9c/.

Frailty, depression, and quality of life: a study with elderly caregivers.

OBJECTIVE: to analyze the relationship between frailty, depressive symptoms, and quality of life of elderly caregivers of other elderly living in high social vulnerability. METHODS: a descriptive, correlational and cross-sectional study conducted with 40 elderly caregivers. A questionnaire to characterize elderly caregivers, the Fried frailty phenotype, the Geriatric Depression Scale (to screen depressive symptoms) and the Short-Form 6 Dimension (to assess quality of life) were used. For data analysis, Student's t-test, ANOVA, Pearson's χ2 and Fisher's exact test were used. RESULTS: most were pre-frail (52.5%) and had no evidence of depressive symptoms (57.5%). They presented, on average, a score of 0.76 (±0.1) in relation to quality of life. Statistical significance was observed between the average scores of quality of life with depressive symptoms (p=0.012) and frailty level (p=0.004). CONCLUSION: frail elderly caregivers with depressive symptoms had a worse perception of quality of life.

Factors associated with depressive symptoms in older adults in context of social vulnerability.

OBJECTIVE: To identify factors associated with depressive symptoms in the elderly inserted in a context of high social vulnerability. METHODS: A cross-sectional study was carried out with 302 elderly people enrolled in Primary Care. We used a sociodemographic questionnaire, Geriatric Depression Scale, Mini Nutritional Assessment, Shor-form-6D Quality of Life Questionnaire and Medical Outcome Study Scale. For data analysis, a logistic regression was performed considering two groups, with and without depressive symptoms. RESULTS: A good perception of the quality of life (OR: 0.21) and receiving emotional support (OR: 0.98) were presented as protective factors for depression, have risks of malnutrition (OR: 4.87), belong to the female sex OR: 1.88) and living alone (OR: 2.34), indicated a predictor factor for depression. CONCLUSION: Quality of life and social support were identified as protective factors for depressive symptoms while being at risk of malnutrition, living alone, reporting pain and being female are predictors.

Vitamin D Deficient Older Adults Are More Prone to Have Metabolic Syndrome, but Not to a Greater Number of Metabolic Syndrome Parameters.

This study investigated the relationship between metabolic parameters and low serum 25-hydroxyvitamin D (25(OH)D) levels in older adults (n = 265). They were assessed for anthropometrics and metabolic measurements, including 25(OH)D, insulin, glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and other inflammatory markers. Vitamin D deficiency was defined as a 25(OH)D level below 50 nmol/L. Comparisons between groups were performed using Wilcoxon-Mann-Whitney or Pearson's Chi-squared test. A multivariate adjusted Poisson regression was used to model the number of metabolic parameters as a function of a set of explanatory variables. Subjects with 25(OH)D deficiency were predominantly females and presented higher body weight, body mass index, waist circumference, triglycerides and Tumor Necrosis Factor-α (TNF-α), and higher insulin resistance. Metabolic syndrome was also more prevalent among 25(OH)D-deficient subjects. In those without metabolic syndrome, 25(OH)D deficiency was related only to obesity and higher insulin resistance. Female sex, hypertension, higher waist circumference and higher levels of hemoglobin A1C (%), HDL-C, and TG were significantly associated with an increased number of metabolic syndrome parameters after adjusting for covariates, but 25(OH)D was not. The fact that serum 25(OH)D concentration was inversely associated with metabolic syndrome and insulin resistance not only reaffirms the relevance to consider serum 25(OH)D concentration as an influencing factor for insulin resistance, but also the need to actively screen for hypovitaminosis D in all patients with this condition.

Frailty, depression, and quality of life: a study with elderly caregivers / Fragilidad, depresión y calidad de vida: un estudio con cuidadores ancianos / Fragilidade, depressão e qualidade de vida: um estudo com idosos cuidadores

ABSTRACT Objective: to analyze the relationship between frailty, depressive symptoms, and quality of life of elderly caregivers of other elderly living in high social vulnerability. Methods: a descriptive, correlational and cross-sectional study conducted with 40 elderly caregivers. A questionnaire to characterize elderly caregivers, the Fried frailty phenotype, the Geriatric Depression Scale (to screen depressive symptoms) and the Short-Form 6 Dimension (to assess quality of life) were used. For data analysis, Student's t-test, ANOVA, Pearson's χ2 and Fisher's exact test were used. Results: most were pre-frail (52.5%) and had no evidence of depressive symptoms (57.5%). They presented, on average, a score of 0.76 (±0.1) in relation to quality of life. Statistical significance was observed between the average scores of quality of life with depressive symptoms (p=0.012) and frailty level (p=0.004). Conclusion: frail elderly caregivers with depressive symptoms had a worse perception of quality of life.

RESUMEN Objetivo: analizar la relación entre fragilidad, síntomas depresivos y calidad de vida de cuidadores ancianos de otras personas ancianas insertadas en un contexto de alta vulnerabilidad social. Métodos: estudio descriptivo, correlacional y transversal, realizado con 40 cuidadores ancianos. Se utilizó un cuestionario para caracterizar al cuidador anciano, el fenotipo de fragilidad de Fried, la Escala de Depresión Geriátrica (seguimiento de los síntomas depresivos) y el cuestionario Short-Form 6 Dimensions (evaluación de la calidad de vida). En el análisis de datos, se utilizaron la prueba t de Student, ANOVA, χ2 de Pearson y la prueba exacta de Fisher. Resultados: la mayoría de los cuidadores ancianos eran pre-frágiles (52.5%) y sin evidencia de síntomas depresivos (57.5%). Presentaron, en promedio, una puntuación de 0.76 (± 0.1) en relación con la calidad de vida. Se observó significación estadística entre los puntajes promedio de calidad de vida con síntomas depresivos (p=0.012) y nivel de fragilidad (p=0.004). Conclusión: los cuidadores ancianos frágiles con síntomas depresivos tenían una peor percepción de la calidad de vida.

RESUMO Objetivo: analisar a relação entre fragilidade, sintomas depressivos e qualidade de vida de idosos cuidadores de outros idosos inseridos em contexto de alta vulnerabilidade social. Métodos: estudo descritivo, correlacional e transversal, realizado com 40 idosos cuidadores. Foram aplicados: questionário para caracterização do idoso cuidador, fenótipo de fragilidade de Fried, Escala de Depressão Geriátrica (rastrear sintomas depressivos) e Questionário Short-Form 6 Dimensions (avaliar qualidade de vida). Na análise dos dados, utilizou-se Teste t de Student, ANOVA, χ2 de Pearson e Exato de Fisher. Resultados: a maioria dos idosos cuidadores estavam pré-frágeis (52,5%) e sem indícios de sintomas depressivos (57,5%). Apresentaram, em média, um escore de 0,76 (±0,1) em relação à qualidade de vida. Observou-se significância estatística entre os escores médios de qualidade de vida com sintomas depressivos (p=0,012) e nível de fragilidade (p=0,004). Conclusão: idosos cuidadores frágeis e com sintomas depressivos apresentaram pior percepção sobre a qualidade de vida.

Factors associated with depressive symptoms in older adults in context of social vulnerability / Factores Asociados a los síntomas depresivos en ancianos en contexto de alta vulnerabilidad social / Fatores associados a sintomas depressivos em idosos inseridos em contexto de vulnerabilidade social

ABSTRACT Objective: To identify factors associated with depressive symptoms in the elderly inserted in a context of high social vulnerability. Methods: A cross-sectional study was carried out with 302 elderly people enrolled in Primary Care. We used a sociodemographic questionnaire, Geriatric Depression Scale, Mini Nutritional Assessment, Shor-form-6D Quality of Life Questionnaire and Medical Outcome Study Scale. For data analysis, a logistic regression was performed considering two groups, with and without depressive symptoms. Results: A good perception of the quality of life (OR: 0.21) and receiving emotional support (OR: 0.98) were presented as protective factors for depression, have risks of malnutrition (OR: 4.87), belong to the female sex OR: 1.88) and living alone (OR: 2.34), indicated a predictor factor for depression. Conclusion: Quality of life and social support were identified as protective factors for depressive symptoms while being at risk of malnutrition, living alone, reporting pain and being female are predictors.

RESUMEN Objetivo: Identificar factores asociados a los síntomas depresivos en ancianos insertados en contexto de alta vulnerabilidad social. Métodos: Estudio transversal realizado con 302 ancianos de comunidad registrados en Unidades de Salud de la Familia. Se utilizó cuestionario sociodemográfico, Escala de Depresión Geriátrica, Mini Evaluación Nutricional, Cuestionario de Calidad de Vida Shor-form-6D y Escala de Medical Outcome Study. Para el análisis de datos ha sido realizada regresión logística considerando dos equipos, con y sin síntomas depresivos. Resultados: Una buena percepción de la calidad de vida (OR: 0,21) y recibir apoyo emocional (OR: 0,98) se presentaron como factores protectores a la depresión, tener riesgos de desnutrición (OR: 4,87), pertenecer al sexo femenino (OR: 4,87) OR: 1,88) y vivir solo (OR: 2,34), indicaron factor indicador para la depresión. Conclusión: La calidad de vida y el apoyo social han sido identificados como factores protectores para los síntomas depresivos en cuanto estar bajo el riesgo de desnutrición, vivir solo, relatar el dolor y ser del sexo femenino son factores indicadores

RESUMO Objetivo: Identificar fatores associados a sintomas depressivos em idosos inseridos em contexto de alta vulnerabilidade social. Métodos: Estudo transversal realizado com 302 idosos de comunidade cadastrados em Unidades de Saúde da Família. Utilizou-se questionário sociodemográfico, Escala de Depressão Geriátrica, Mini Avaliação Nutricional, Questionário de Qualidade de Vida Short-Form-6D e Escala de Medical Outcome Study. Para análise de dados foi realizada regressão logística, considerando dois grupos, com e sem sintomas depressivos. Resultados: Uma boa percepção da qualidade de vida (OR: 0,21) e receber apoio emocional (OR: 0,98) se apresentaram enquanto fatores protetores à depressão; e ter riscos de desnutrição (OR: 4,87), pertencer ao sexo feminino (OR: 1,88) e morar só (OR: 2,34) indicaram fator preditor para a depressão. Conclusão: Qualidade de vida e suporte social foram identificados como fatores protetores para sintomas depressivos, enquanto estar sob risco de desnutrição, morar sozinho, relatar dor e ser do sexo feminino são fatores preditores.

Barreiras para prática de atividade física entre mulheres atendidas na Atenção Básica de Saúde / Barriers for physical activity in Primary Health Care / Barreras a la actividad física en mujeres atendidas en Atención Primaria de Salud

Resumo O objetivo do estudo foi comparar as barreiras para atividade física (AF) entre mulheres participantes e não participantes de um programa de exercícios físicos (EF) da Atenção Básica de Saúde (AB). Estudo transversal realizado em áreas de abrangência em unidades de saúde da AB que ofereciam programa de EF. Foram selecionadas 222 mulheres participantes e não participantes dos programas, avaliadas em relação a características sociodemográficas, AF e barreiras. Foram feitas análises descritivas e de comparação dos dados. As barreiras mais reportadas pelo grupo de mulheres não participantes foram: falta de companhia (40,9%), falta de energia (38,7%), sentir-se muito cansada ou desmotivada (38,2%). Os grupos de não participantes e de idosos apresentaram maior proporção de barreiras para AF.

Abstract The objective of the study was to compare the barriers to physical activity (PA) between women participants and nonparticipants of an exercise program in Primary Health Care. Cross-sectional study carried out in areas covered by health centers that offered an exercise program. Twenty-two participants and non-participants of the programs were selected and evaluated in relation to sociodemographic characteristics, PA and barriers. Descriptive and comparative data analyzes were performed. The most reported barriers for women non-participants were lack of company (40.9%), lack of energy (38.7%), feeling very tired or unmotivated (38.2%). The non-participants and the elderly had a higher proportion of barriers to PA.

Resumen El objetivo del estudio fue comparar las barreras a la actividad física (AF) entre mujeres participantes y no participantes de un programa de ejercicio físico (EF) en Atención Primaria de Salud. Se trata de un estudio transversal en las áreas de cobertura de las unidades de salud que ofrecen programa de EF. Se seleccionó a 222 participantes y no participantes de los programas evaluados en función de algunas características sociodemográficas, AF y barreras. Se realizó la comparación descriptiva y de los análisis de datos. Las barreras más comunicadas por el grupo de mujeres no participantes fueron: falta de compañía (40,9%), falta de energía (38,7%) y sentirse muy cansada o desmotivada (38,2%). Las no participantes y las mujeres de edad avanzada mostraron mayor proporción de las barreras a la AF.

Adherence, Adhesion, and Dropout Reasons of a Physical Activity Program in a High Social Vulnerability Context.

BACKGROUND: One of the most important health determinants is social vulnerability, which can interfere in the practice of physical activity (PA). This study aimed at analyzing adherence to a PA program in a high social vulnerability context. METHODS: A longitudinal study with a 6-month intervention period was conducted. The program offered monitored walks associated with behavioral change educational campaigns. Sociodemographic characteristics, occupation, PA level, noncommunicable chronic diseases, participants' frequency of participation in the program, and intervention dropout reasons were evaluated. Descriptive and survival analyses were accomplished. RESULTS: Among the 106 participants, 88.0% were female and 21.7% were older adults. The most mentioned participation reasons were health improvement (23.0%), weight loss (19.0%), disease control (17.0%), and social living (12%). The mean frequency of participation in the program was 27.4%. Dropout rate was 52.7%. The main reported reasons for dropping out were work hours (27.8%), health problems (25.9%), personal reasons (22.2%), and lack of time (11.1%). Factors associated with remaining in the program were being older adults and presenting body mass index <25 kg/m2. CONCLUSIONS: Results showed that in a high social vulnerability context, adherence to PA programs is low, and adult-life-related commitments and high levels of obesity are factors associated with lower adherence.

Prevalence of Physical Inactivity and Associated Factors Among Older Caregivers of Older Adults.

OBJECTIVE: The aim of this study is to analyze the prevalence of physical inactivity (PI) and associated factors in older caregivers of older adults. METHOD: A cross-sectional study was conducted including 312 older caregivers. Sociodemographic, clinical, and care-related characteristics were considered the independent variables for the determination of associated factors with PI in the logistic regression model. RESULTS: The prevalence of PI was 75.3% (95% confidence interval [CI] = [70.1%, 80.0%]). The following factors were associated with PI: being female (odds ratio [OR] = 2.8, 95% CI = [1.3, 5.9]), being older than 75 years of age (OR = 7.1, 95% CI = [2.2, 22.9]), not having a marital life (OR = 4.2, 95% CI = [1.1, 15.8]), being prefrail (OR = 6.2, 95% CI = [1.7, 21.9]), and being frail (OR = 14.8, 95% CI = [3.8, 57.7]). DISCUSSION: The prevalence of PI was high and associated with the female sex, an advanced age, and not being married. Specific public policies considering these results should be created for older caregivers.

Efetividade de duas intervenções com diferentes volumes de exercícios físicos na qualidade de vida em mulheres usuárias da Atenção Básica de Saúde / Effectiveness of two primary health care-based interventions with different physical exercise volumes on quality of life in women

O objetivo do estudo foi comparar o efeito de duas intervenções oferecidas na Atenção Básica à Saúde com diferentes volumes de exercício físico na qualidade de vida de mulheres. O estudo foi realizado em três Unidades de Saúde da Atenção Básica de Saúde da cidade de Rio Claro-SP. Participaram 50 mulheres (56,36 ± 10,26 anos), divididas em dois grupos, de acordo com a abrangência de território das Unidades de Saúde: G1 - 25 mulheres e duas sessões por semana de exercícios físicos com duração de 60 minutos cada (120 min/sem) e; G2 - composto por 25 mulheres e três sessões por semana de exercícios físicos com duração de 90 minutos cada (270 min/sem). As intervenções tiveram duração de 12 meses. A qualidade de vida foi avaliada por meio do questionário WHO-QOL-BREF em dois momentos (pré e pós intervenção). Os efeitos do tempo, da intervenção e da interação (tempo x intervenção) foram analisadas pelo teste Two-way mixed ANOVA, tendo-se rea-lizado as comparações post-hoc com o teste de Bonferroni. Na comparação intra-grupos os escores dos domínios psicológico, social, qualidade de vida geral foram superiores após as intervenções para ambos os grupos (p < 0,05). Houve melhora no domínio ambiente somente para o G2 (p < 0,001). Não houve efeito na interação entre os grupos.As intervenções oferecidas, independente do volume não modificaram os escores do domínio físico. As intervenções de exercícios físicos foram efetivas em melhorar aspectos da qualidade de vida geral dos usuários do Sistema Único de Saúde

The objective of this study was to evaluate the effect and the comparison of interventions offered in Primary Health Care with different volumes of physical exercise on the quality of life in women. The study was carried out in three Health Units of the Primary Health Care of Rio Claro, Sao Paulo State. Fifty women (56.36 ± 10.26 years) were divided into two groups, G1 (two sessions per week of physical exercises lasting 60 minutes) and G2 (three sessions per week of physical exercises lasting 90 minutes). The interventions lasted for 12 months. The quality of life was assessed through the WHOQOL-BREF questionnaire in two moments (pre and post intervention). The effects of time, intervention and interaction (time x intervention) were analyzed by the Two-way mixed ANOVA test, and the post-hoc comparisons with the Bonferroni test were performed. In the intra-group comparison, the scores of the psychological, social domains and the gen-eral quality of life were higher after the interventions for both groups (p < 0.05). There was improvement in the environment domain only for G2 (p < 0.001). Statistical analysis showed no effect of interaction and between groups. The interventions offered, regardless of the volume of physical exercise, did not modify the physical domain scores. Both interventions offered in Primary Health Care, regardless of the volume of physical exercise were effective in improving aspects of the general quality of life in the Public Health System ́s users