What do Brazilian health professionals know about the frailty syndrome? A cross-sectional study.

BACKGROUND: The growing care demand for frail older adults and those at risk of frailty in primary health care (PHC) requires professionals trained in the subject to promote adequate care. This study aimed to analyze the self-reported, theoretical and practical knowledge of PHC professionals about the frailty syndrome. METHODS: This is an observational cross-sectional study with a sample of 485 Brazilian health professionals (bachelor's degree) working in PHC with older adults. An electronic questionnaire was used to collect data on professional characteristics and self-reported, theoretical and practical knowledge concerning frailty phenotype. Agreement analysis between types of knowledge and multivariate logistic regression were performed to show the factors associated with knowledge about frailty. RESULTS: Theoretical knowledge showed the worse result, with 87.5% of the professionals describing the syndrome incorrectly. Roughly half the professionals self-reported (52.6%) very little/no knowledge concerning the syndrome and demonstrated low practical knowledge (55.1%) when identifying clinical cases. There were misconceptions about the syndrome, like it is natural from the aging process (83.3%) and is synonymous with disability and comorbidity (51.2%). The majority of the professionals were unaware of instruments for assessing frailty (77.9%) and the phenotype criteria (68.2%). No agreement was observed between the types of knowledge. Professionals specialized in or who had taken training courses in older adult health were 6.1 and 2.7-fold more likely, respectively, to self-reported some knowledge on the frailty syndrome. CONCLUSIONS: PHC professionals presented little knowledge on the frailty syndrome. Most professionals were unaware of the frailty definition, its assessments for diagnosis and evidence for its treatment. The lack of knowledge on frailty could affect the care provided to older adults in primary care.

Physical Exercise for Frailty and Cardiovascular Diseases.

Cardiovascular diseases (CVD) and frailty syndrome are major problems for successful aging. These conditions share many biological aspects, symptoms and adverse effects. Aerobic capacity and muscle strength, that are important characteristics for independence in daily activity, are markedly reduced in older adults with CVD and frailty. There are evidence and recommendations of physical activity and exercises to prevent, treat and manage these conditions. However, the exact dose-response (type, intensity and duration) of exercises is still uncertain for these population. A good physical exercise program should consider the aging physiologic alterations, the vulnerability of the frail syndrome, and the functional-structural changes of CVD. Therefore, a multicomponent program with aerobic and strength training is desirable to improve these conditions. For long term results it is important to older adults with these conditions to change lifestyle and be more active during daily living to reduce sedentary behavior. Being frail with CVD it is not a contraindication for older adults to be engaged in physical activities.

Effectiveness of the Pilates method versus aerobic exercises in the treatment of older adults with chronic low back pain: a randomized controlled trial protocol.

BACKGROUND: Chronic low back pain is potentially disabling for older adults, and exercise is considered the best treatment. The Pilates method and aerobic exercises have been proven to be effective in pain and function improvement in patients with low back pain, but evidence in the treatment of older adults with low back pain is scarce. Therefore, the objective of this study is to investigate the effectiveness of the Pilates method compared to aerobic exercises in the treatment of older adults with chronic nonspecific low back pain. METHODS: This is a randomized controlled trial with blinded assessor, to be held in a physical therapy clinic in Sao Paulo, Brazil. Seventy four patients aged 65 to 85 years with chronic nonspecific pain will be randomized into Pilates Group (n = 37) with exercises based on the Pilates method and Aerobic Group (n = 37) with treadmill aerobic exercise. The primary outcomes will be pain intensity and general disability, assessed eight weeks after randomization. The secondary outcomes will be: pain intensity and general disability, assessed six months after randomization; and global perceived improvement, specific disability, dynamic balance, muscle strength (gluteus maximus, gluteus medius, and lateral hip rotators), and pressure pain threshold, assessed eight weeks and six months after randomization. Therapists and patients will not be blinded. DISCUSSION: This study has the potential to reduce pain and, consequently, improve balance and function of older adults with chronic low back pain with both therapies. However, Pilates may be more effective because the exercises are more targeted to the trunk stabilization muscles. The results of this study may provide valuable information on the effects of Pilates and aerobic exercise in older adults with chronic low back pain and contribute to a better selection of the treatment program according to the patient preference. TRIAL REGISTRATION: ClinicalTrials.gov NCT02729779 , April 6, 2016.

Virtual reality using games for improving physical functioning in older adults: a systematic review.

The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population. This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review. The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.

Research utilisation in older people care: Translation, cross-cultural adaptation and validation of instruments into Brazilian Portuguese.

AIMS: To translate and culturally validate the Estabrooks' Kinds of Research Utilization (RU) and the Conceptual Research Utilization Scale (CRU) into Brazilian Portuguese; and to describe the research use by health professionals working on Long Term Care Institutions (LTCI) for older people. BACKGROUND: Research utilisation ensures greater quality and effectiveness in the care provided by health professionals. However, there are no instruments to evaluate research utilisation in Latin America countries, like Brazil. MATERIALS & METHODS: A methodological cross-sectional questionnaire validity and descriptive study. The translation and adaptation of the instruments was performed in seven steps following psychometric guidelines. The instruments evaluate research utilisation by health professionals in clinical practice. The RU is composed of single-items of instrumental, persuasive, conceptual and overall forms; and the CRU the conceptual form through a 5-item scale. Professionals of technical level and graduated working in nine LTCI were evaluated from August to December 2018. Descriptive and inferential (reliability, correlation, internal consistency and structure of CRU) analyses were conducted. RESULTS: Sample composed of 117 professionals, 67.5% of healthcare aides and 32.5% of graduated health professionals. All forms of research utilisation showed high implementation in practice (about 75% of the time, or frequently). CRU internal consistency (α = 0.885) and structure were adequate. There were significant correlations between RU and CRU (from very low r = 0.187 to high r = 0.712). Intra-rater, inter-rater and alternate forms reliability ranged from moderate to substantial. CONCLUSIONS: The Brazilian versions of the RU and the CRU are valid, reliable and acceptable for evaluating research utilisation by professionals working on LTCI. It is of great relevance to introduce these instruments in low- and middle-income countries to have future data on how much older people care is influenced by the best evidence available. These instruments can be adapted to different healthcare settings and populations.

Mapping Research Conducted on Long-Term Care Facilities for Older People in Brazil: A Scoping Review.

This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, EMBASE, LILACS, and Google Scholar, within the timescale of 1999 to 2018, limited to English, Portuguese, or Spanish. The reference lists were hand searched for additional papers. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of evidence. Data were reported descriptively considering the study design, using content analysis: 327 studies were included (n = 159 quantitative non-randomized, n = 82 quantitative descriptive, n = 67 qualitative, n = 11 mixed methods, n = 6 randomized controlled trials, and n = 2 translation of assessment tools). Regardless of the study design, most were conducted in a single LTCF (45.8%), in urban locations (84.3%), and in non-profit settings (38.7%). The randomized trials and descriptive studies presented the lowest methodological quality based on the MMAT. This is the first review to provide an overview of research on LTCFs for older people in Brazil. It illustrates an excess of small-scale, predominantly qualitative papers, many of which are reported in ways that do not allow the quality of the work to be assured.

Sedentary behavior: barriers and facilitators among older adults after hip fracture surgery. A qualitative study.

OBJECTIVES: Understand the experience of older adults after hip fracture surgery considering barriers and facilitators related to sedentary behavior. METHODS: A qualitative study using a semi-structured interview with three men and eight women aged 60 years or older after hip fracture surgery. RESULTS: Five barriers emerged: physical complaints, lack of accessibility, fear of falling, demotivation and negative social representation of old age, and two facilitators: overcoming dependency and having a caregiver. CONCLUSION: Our results highlight that physical complaints commonly addressed by physical therapists on their interventions are not the only impediments to reduce sedentary behavior. Important individual and social barriers should not be neglected when physical therapists conduct interventions to reduce sedentary behavior to maximize functional recovery in older adults after hip fracture surgery. Future clinical trials are required to investigate the effectiveness of more comprehensive interventions to reduce sedentary behavior in this population.

Benefits of vestibular rehabilitation on patient-reported outcomes in older adults with vestibular disorders: a randomized clinical trial.

BACKGROUND: Chronic dizziness has a negative impact on emotional aspects, functional capacity, and quality of life of older people. OBJECTIVE: To compare the effects of the conventional Cawthorne & Cooksey and the multimodal Cawthorne & Cooksey protocols on patient-reported outcomes in older adults with vestibular disorders. METHODS: This is a single-blind, randomized controlled trial with three-months' follow-up. Older adults with chronic dizziness were randomly assigned to conventional or multimodal protocols. The protocols were performed in individual 50-minute sessions, twice weekly, for two months. The primary outcome was the Dizziness Handicap Inventory (DHI) and the secondary outcomes were the Visual Analogue Scale, the Vestibular Disorders Activities of Daily Living Scale, the Geriatric Depression Scale, and the Activities-specific Balance Confidence Scale. Outcomes were collected at baseline, post-treatment and three-month follow-up; and analyzed on an intention-to-treat approach. RESULTS: Eighty-two patients were randomized into the conventional (n = 40) or multimodal (n = 42) protocols. There was no between-group difference on DHI at post-treatment (Mean Difference (MD): -0.7; 95% CI: -9.2, 7.8) and at three-month follow-up (MD: -1.6; 95% CI: -9.5, 6.2). No between-group difference was found for the secondary outcomes. All patient-reported outcomes in the within-group analysis showed significant improvement between baseline and post-treatment, and changes were maintained between post-treatment and follow-up. Following treatment, 55% of patients in the conventional and 57% in the multimodal protocol reached DHI clinical improvement (decrease ≥18). CONCLUSIONS: The addition of multimodal exercises to the conventional Cawthorne & Cooksey protocol did not promote extra benefits on patient-reported outcomes in older adults with chronic dizziness. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry-ANZCTR (ACTRN12610000018011), the trial was registered January 7, 2010 and the first participant was enrolled April 15, 2010. URL of the registry: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=334985.

Usefulness, assessment and normative data of the Functional Reach Test in older adults: A systematic review and meta-analysis.

OBJECTIVE: To identify the evidence about the usefulness of the Functional Reach Test to evaluate balance and falls risk; to verify the Functional Reach Test assessment method and other variables that could interfere in its results; and to establish normative data for older adults. DATA SOURCES: Manual and electronic searches (MEDLINE, Embase, Web of Science, LILACS, CINAHL, AgeLine and PsycINFO) were conducted with no language restrictions and published since 1990. STUDY SELECTION: Observational studies about the Functional Reach Test in older adults with no specific health condition were selected. DATA EXTRACTION: Two independent reviewers extracted data from studies and a third reviewer provided consensus. The studies methodological quality was appraised using the Newcastle-Ottawa Scale. Studies were submitted to critical analysis and meta-analysis. RESULTS: 40 studies were selected (8 prospective and 32 cross-sectional). 33 studies used the Functional Reach to assess balance and 21 studies the falls risk. The meta-analysis of Functional Reach normative data was 26.6 cm [95%CI: 25.14; 28.06] for community-dwelling older adults (n = 21 studies) and was 15.4 cm [95%CI: 13.47; 17.42] for non-community older adults (n = 5 studies), with statistics differences between settings. Functional Reach Test performance was found to decrease with age. Sex and prospective history of falls did not influence the test results. Methodological quality analysis determined high to low risk of bias of the studies. CONCLUSION: This review revealed that the method of assessment and data of the Functional Reach Test varied greatly. Different values should be used for community- and non-community-dwelling older adults.

Frailty as a predictor of adverse outcomes in hospitalized older adults: A systematic review and meta-analysis.

Frailty syndrome is prevalent among hospitalized older adults as are the occurrence of adverse outcomes. This systematic review and meta-analysis investigated whether frailty in older adults at hospital admission predicts adverse outcomes. Manual (ProQuest, conferences annals and references) and electronic searches (PUBMED, EMBASE, Web of Science, Lilacs, CINAHL, PsycINFO and Google Scholar) were performed. We included prospective studies of hospitalized older adults. Primary outcomes were functional decline at hospital discharge and mortality after discharge. Other data were considered secondary outcomes. Methodological quality was evaluated by the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Twenty-eight papers were included, corresponding to 19 cohorts (5 cohorts for functional decline and 16 for mortality), with moderate to good methodological quality. Being frail [RR: 1.32 (95%CI: 1.04; 1.67)] and pre-frail [RR: 1.51 (95%CI: 1.05; 2.17)] are risk factors for functional decline compared with being nonfrail. Frail individuals had a relative risk for in-hospital mortality and mortality in medium- and long-term compared to nonfrail (in-hospital RR: 8.20, medium RR: 9.49 and long RR: 7.94) and pre-frail (in-hospital RR: 3.19, medium RR: 3.31 and long RR: 3.72). The overall mortality risk in frail individuals is 3.49 and 2.14 times compared to nonfrail and pre-frail, respectively. Length of hospital stay was higher for frail older adults (13.5 days) compared with pre-frail (10.5 days) and nonfrail (8.3 days). Therefore, being frail at hospital admission is a risk factor for in-hospital mortality, long hospital stay, functional decline at hospital discharge, and mortality in the medium- and long-term.

Physical activity in older people - Case studies of how to make change happen.

Enhancing physical activity (PA) is recognized as a powerful intervention for the prevention and treatment of chronic diseases and disability in older people. Furthermore, there is an agreement that increased PA in daily life is a key determinant of active and healthy ageing and should be recommended for frail and sedentary older people. Unfortunately, relatively few older people engage in regular PA or stay active in the long term. This article summarizes and discusses PA recommendations for older adults without focussing on specific diseases, presents the main barriers and facilitators for increasing PA levels, and considers the implementation of these recommendations on the basis of the existing evidence. Finally, we provide case studies of PA programmes for older people that were successfully implemented and highlight the current lessons learned.

Effects of Vestibular Rehabilitation on Balance Control in Older People with Chronic Dizziness: A Randomized Clinical Trial.

OBJECTIVE: The aim of this study was to compare the effects of vestibular rehabilitation protocols on balance control in elderly with dizziness. DESIGN: This is a randomized clinical trial with 3-mo follow-up period. The sample was composed of 82 older individuals with chronic dizziness from vestibular disorders. The control group was treated according to the Conventional Cawthorne & Cooksey protocol (n = 40), and the experimental group was submitted to a Multimodal Cawthorne & Cooksey protocol (n = 42). Measures included Dynamic Gait Index, fall history, hand grip strength, Time Up-and-Go Test, sit-to-stand test, multidirectional reach, and static balance tests. RESULTS: With the exception of history of falls, Forward Functional Reach, Unipedal Right and Left Leg Eyes Closed, and Sensorial Romberg Eyes Open, all outcomes improved after treatments. Such results persisted at follow-up period, with the exception of the Tandem Eyes Open and the Timed Up-and-Go manual. The between-group differences for Sensorial Romberg Eyes Closed (4.27 secs) and Unipedal Left Leg Eyes Open (4.08 secs) were significant after treatment, favoring the Multimodal protocol. CONCLUSIONS: Both protocols resulted in improvement on elderly's balance control, which was maintained during a short-term period. The multimodal protocol presented better performance on specific static balance tests.

[Agreement between observations on the functional capacity of home care elderly patients]. / Concordância de observações sobre a capacidade funcional de idosos em assistência domiciliar.

OBJECTIVE: To assess the agreement between measures of caregiver's perception and health provider's direct observation of performance in daily living activities among home care elderly patients. METHODS: Performance observations were carried out among 40 elderly patients and their respective caregivers were interviewed. During home visits, data on caregiver's perception were collected by an independent observer using the Functional Independence Measure (FIM) instrument. Health providers evaluated elderly patients on their functional capacity in six dimensions: self-care, sphincter control, mobility, walking, communication and social cognitive skills. RESULTS: Intraclass correlation coefficient (ICC) showed an excellent agreement in all dimensions and the highest total FIM score was 0.95. Only the dimensions self-care and mobility showed a bias error between measures (signal test: p<0.001). Bias errors were not found when Bland-Altman graphic was applied. CONCLUSIONS: The agreement between health provider's and caregiver's measures demonstrated a good interaction between program team and caregivers, which is of great importance on evaluating and treating elderly patients. The results also suggest that when a valid and reliable instrument such as FIM is used, there is a high reproducibility of measures, even for different types of evaluations.

Influence of sensory information on static balance in older patients with vestibular disorder.

INTRODUCTION: With aging, the sensory systems suffer an accumulation of degenerative, infectious and/or traumatic processes that may hinder the body balance maintenance. OBJECTIVE: To assess the influence of sensory information on static body balance of elderly individuals with vestibular disorders. METHODS: Cross-sectional study of elderly individuals with vestibular disorders. The Clinical Test of Sensory Interaction and Balance and posturography integrated with virtual reality (Balance Rehabilitation Unit) were used. Posturography parameters analyzed included center of pressure and velocity of body sway. RESULTS: 123 individuals with mean age of 73.11 were assessed. Worst performance was observed in the Clinical Test of Sensory Interaction and Balance condition of visual dome-unstable surface. Differences between conditions were: firm surface-open eyes/firm surface-closed eyes, unstable surface-open eyes/unstable surface-closed eyes (p<0.001), and unstable surface-closed eyes/unstable surface-visual dome. Considering center of pressure and velocity of body sway, significant differences were observed between the following conditions: firm surface-open eyes/firm surface-closed eyes: firm surface-saccadic stimulus/firm surface-vertical optokinetic stimulus; firm surface-optokinetic stimuli/firm surface-visual-vestibular interaction; and firm surface-visual-vestibular interaction/unstable surface. Worse performances were observed in conditions firm surface-closed eyes, firm surface-vertical optokinetic stimulus, F-visual-vestibular interaction, and unstable surface-closed eyes. There was a difference in the center of pressure between firm surface-closed eyes/firm surface-saccadic stimulus, with a worse performance in the condition of firm surface-closed eyes, and of velocity of body sway, between firm surface-saccadic stimulus/firm surface-horizontal optokinetic stimulus (p<0.001). CONCLUSION: Static body balance in elderly individuals with vestibular disorders is worse when the sensory conditions are more challenging, i.e. stable and unstable surfaces, visual stimuli, such as optokinetic and visual-vestibular interaction, and with the eyes closed.

Frailty and cardiovascular risk in community-dwelling elderly: a population-based study.

BACKGROUND: Evidence suggests a possible bidirectional connection between cardiovascular disease (CVD) and the frailty syndrome in older people. PURPOSE: To verify the relationship between CVD risk factors and the frailty syndrome in community-dwelling elderly. METHODS: This population-based study used data from the Fragilidade em Idosos Brasileiros (FIBRA) Network Study, a cross-sectional study designed to investigate frailty profiles among Brazilian older adults. Frailty status was defined as the presence of three or more out of five of the following criteria: unintentional weight loss, weakness, self-reported fatigue, slow walking speed, and low physical activity level. The ascertained CVD risk factors were self-reported and/or directly measured hypertension, diabetes mellitus, obesity, waist circumference measurement, and smoking. RESULTS: Of the 761 participants, 9.7% were characterized as frail, 48.0% as pre-frail, and 42.3% as non-frail. The most prevalent CVD risk factor was hypertension (84.4%) and the lowest one was smoking (10.4%). It was observed that among those participants with four or five risk factors there was a higher proportion of frail and pre-frail compared with non-frail (Fisher's exact test: P=0.005; P=0.021). Self-reported diabetes mellitus was more prevalent among frail and pre-frail participants when compared with non-frail participants (Fisher's exact test: P≤0.001; P≤0.001). There was little agreement between self-reported hypertension and hypertension identified by blood pressure measurement. CONCLUSION: Hypertension was highly prevalent among the total sample. In addition, frail and pre-frail older people corresponded to a substantial proportion of those with more CVD risk factors, especially diabetes mellitus, highlighting the need for preventive strategies in order to avoid the co-occurrence of CVD and frailty.

Avaliação do limite de estabilidade pelo Teste Alcance Funcional anterior em idosos / Assessment of the limits of stability through the forward Functional Reach Test in older adults

O Teste Alcance Funcional avalia o limite de estabilidade, isto é, o quanto o indivíduo pode se movimentar sem alterar sua base de sustentação. Objetivo: Avaliar idosos pelo Teste Alcance Funcional (AF) e verificar os fatores associados ao seu desempenho. Métodos: Pesquisa observacional de corte transversal com análise secundária de dados coletados em estudo prévio. Amostra de idosos da comunidade (≥ 65 anos), de Unidade de Saúde da Família, de ambos os sexos e com deambulação independente. Foram coletadas do banco as informações sociodemográficas, antropométricas, clínicas e de equilíbrio corporal (AF, Time Up and Go-TUG e Escala de Equilíbrio de Berg). O AF foi mensurado em uma única tentativa pelo deslocamento anterior do idoso, sendo classificado de forma numérica (cm) e categórica pela Berg. Foi realizada estatística descritiva e inferencial (testes de correlação e associação) Resultados: Foram avaliados 96 idosos com média de 74,8 anos, AF de 22,5±7,2 cm e 49% conseguiram alcançar à frente mais que 25 cm. Houve correlação entre o AF e variáveis sociodemográficas (idade), antropométricas (altura, peso e comprimento do pé), clínicas (força de preensão palmar e dor) e de equilíbrio (TUG e Berg). Idosos com faixa etária mais avançada, com doença endócrina, baixa acuidade visual, sedentários, com histórico de quedas, com queixas de dor e tontura apresentaram estatisticamente pior desempenho no AF. Conclusão: Idosos de Unidade de Saúde da Família apresentam AF levemente reduzido em relação à normalidade. Alguns fatores estão associados ao desempenho no AF e devem ser considerados na interpretação de seus resultados.

The Functional Reach assesses the limits of stability, that is, how far the individual can move without changing the base of support. Objective: To evaluate the Forward Functional Reach Test (FR) in older adults and to verify the factors associated with the test performance. Method: Observational cross-sectional study with secondary analysis of data from a previous study. Sample of community-dwelling older adults (≥ 65 years) from the Family Health Program, both sexes and independent for ambulation. Socio-demographic, anthropometric, clinical and balance control (FR, Time Up and Go-TUG and Berg Balance Scale) information were collected. The FR was measured in a single attempt by the anterior displacement of the subject classified numerically (cm) and categorically according to the Berg Balance Scale. Descriptive and inferential statistical analysis (correlation and association tests) were performed. Results: 96 older adults were evaluated with mean age of 74.8 years, FR of 22.5±7.2 cm and 49% achieved more than 25 cm. There was a correlation between FR and sociodemographic (age), anthropometric (height, weight and foot length), clinical (grip strength and pain) and balance (TUG and Berg Scale) data. Old people with more advanced age, with endocrine disease, low visual acuity, sedentary, with history of falls, with complaints of pain and dizziness presented statistically worse performance in FR. Conclusion: Older adults from the Family Health Program have a slightly reduced in FR compare to normative data from community-dwelling elderly. Some factors are associated with FR performance and should be considered when interpreting their results.

Brazilian version of the Vestibular Disorders Activities of Daily Living Scale (VADL).

UNLABELLED: The Vestibular Disorders Activities of Daily Living Scale (VADL) assesses the impact of dizziness and body imbalance on the everyday activities of patients with vestibulopathy. The scale encompasses 28 activities divided into three sub-scales (functional, ambulation and instrumental). OBJECTIVE: To translate and cross-culturally adapt the VADL to the Brazilian Portuguese language and verify its reliability. METHOD: Questionnaire translation methodological research. Eighty elderly subjects (age > 65 years) with chronic dizziness arising from vestibular disorders were enrolled, of which 40 participated in the pre-testing stage and 40 in reliability analysis. Concordance Correlation Coefficient (CCC) analysis was used to assess reliability. Internal consistency was estimated using Cronbach's alpha (α). RESULTS: Pre-test analysis revealed 15% of incomprehension on two activities; these items had to be adapted. The VADL-Brazil had similar levels of test-retest and inter-rater reliability for total score and presented substantial agreement (CCC = 0.79). Internal consistency was excellent for total score (α = 0.92), good for the functional (α = 0.89) and locomotion (α = 0.86) sub-scales, and poor for the instrumental subscale (α = 0.56). CONCLUSION: The Brazilian version of the VADL was proven adequate, with good levels of reliability and internal consistency. It might be thus considered as an alternative to assess the functional capacity of vestibulopathy patients.

Influence of history of smoking on the physical capacity of older people.

Among the elderly, smoking is related to death and it contributes to disability associated with chronic diseases. This study aims to verify the influence of a history of smoking on the physical capacity of elderly people, and its relationship with the gender. Elderly people beginning to practice physical activity reported questions about their smoking history and underwent a physical evaluation, consisted by hemodynamic data (blood pressure, heart rate and maximum oxygen consumption), body mass index (BMI), muscular strength, flexibility and balance. Mann-Whitney test and Spearman's test was used to data analysis. The sample consisted of 127 subjects, among whom 26.8% were ex-smokers. There were a higher number of nonsmoking women (p<0.001) than others, and women smoked fewer packets per day (p=0.047). Among the women, those ex-smokers were younger and more flexible in comparison with those nonsmokers (p<0.05). Among the men, the ex-smokers were older and walked more slowly than nonsmokers (p<0.05). There was a correlation between the BMI and duration of smoking time. Smoking cessation benefits the elderly, since the physical variables showed no long-term harm associated with the history of smoking when compared with those of elderly without this habit.

[The São Carlos Hospital School: assessment of its functioning by means of user satisfaction]. / O hospital-escola de São Carlos: análise do funcionamento por meio da satisfação dos usuários.

This research assessed the satisfaction of the users of São Carlos Hospital School in its first six months of functioning. A sample of 137 users was grouped according to the service used: hospital admittance, home care, emergency medical assistance, spontaneous emergency and shelter. Inferential statistics were realized by Chi-Square and Fischer Exact tests. The majority of users were women and aged 18 to 45 years-old. The users were "very satisfied" (46.2%) with attendance agility and with the team (52.6%). A number of 59.2% of the users were very satisfied with the hospital and 68.8% considered the service better than expected. Less "clarity concerning health" was reported for shelter regarding hospital admittance and home care (p<0.05). Users under hospital admittance presented greater satisfaction and better expectation compared to acceptance and emergency medical assistance (p<0.05). User profile characteristics as "skin color" and "health plan" presented statistical differences regarding general satisfaction. The study showed that the adoption of a humanized model of assistance in healthcare as the proposal of this Hospital resulted in user satisfaction.

Falls in the elderly of the Family Health Program.

This study aims to determine the factors that may be related to falls in the elderly assisted by the Family Health Program (FHP). Elderly individuals aged 60 years or over, who were assisted by the FHP primary care system (n=2209), responded to a sociodemographic and health questionnaire. Mental health was evaluated using the Geriatric Depression Scale (GDS) and quality of life was assessed by the Medical Outcome Study Short-Form Health Survey (SF-36). In order to verify which independent variables affected the occurrence of falls, logistic regression analysis was performed. 27.1% of the sample reported one fall during the previous year, and 8.7% were recurrent fallers over the same period. The factors considered in the final model for falls were: age over 80 years-old, female gender, the presence of more than eight associated diseases, need for hospitalization during the previous year and appointments outside the FHP routine, hearing complaints, GDS score over 11 points, and emotional problems SF-36 score between 25 and 74 points. The factors included in the final model for falls can be easily identified and properly overcome by FHP strategy. Patient falling history investigation should thus form part of the FHP team routine. This concern should be reinforced when it comes to women aged 80 years and over.