Development and validation of predictive model for long-term hospitalization, readmission, and in-hospital death of patients over 60 years old.

OBJECTIVE: To develop and validate a high-risk predictive model that identifies, at least, one common adverse event in older population: early readmission (up to 30 days after discharge), long hospital stays (10 days or more) or in-hospital deaths. METHODS: This was a retrospective cohort study including patients aged 60 years or older (n=340) admitted at a 630-beds tertiary hospital, located in the city of São Paulo, Brazil. A predictive model of high-risk indication was developed by analyzing logistical regression models. This model prognostic capacity was assessed by measuring accuracy, sensitivity, specificity, and positive and negative predictive values. Areas under the receiver operating characteristic curve with 95% confidence intervals were also obtained to assess the discriminatory power of the model. Internal validation of the prognostic model was performed in a separate sample (n=168). RESULTS: Statistically significant predictors were identified, such as current Barthel Index, number of medications in use, presence of diabetes mellitus, difficulty chewing or swallowing, extensive surgery, and dementia. The study observed discrimination model acceptance in the construction sample 0.77 (95% confidence interval: 0.71-0.83) and good calibration. The characteristics of the validation samples were similar, and the receiver operating characteristic curve area was 0.687 (95% confidence interval: 0.598-0.776). We could assess an older patient's adverse health events during hospitalization after admission. CONCLUSION: A predictive model with acceptable discrimination was obtained, with satisfactory results for early readmission (30 days), long hospital stays (10 days), or in-hospital death.

FGF23 levels as a marker of physical performance and falls in community-dwelling very old individuals

ABSTRACT Objective: The fibroblast growth factor 23 (FGF23) has been related to biological aging, but data in elderly individuals are scant. We determined the profile of serum FGF23 levels in a population of very-old individuals and studied their correlations with parameters of bone metabolism and health markers, as functional performance. Materials and methods: This cross-sectional study was performed on 182 community dwellers aged ≥ 80 years. Serum levels of FGF23, PTH, calcium, albumin, phosphorus, creatinine, bone markers, and bone mineral density data were analyzed. Physical performance was evaluated with the stationary march (Step), Flamingo, and functional reach tests, along with questionnaires to assess falls and fractures in the previous year, energy expenditure (MET), and the Charlson index (CI). Physical activity was evaluated with the International Physical Activity Questionnaire (IPAQ). Results: Most participants (75%) had FGF23 levels between 30-120 RU/mL (range: 6.0-3,170.0 RU/mL). FGF23 levels correlated with estimated glomerular filtration rate (eGFR; r = -0.335; p = 0.001) and PTH (r = 0.318; p < 0.0001). Individuals with FGF23 in the highest tertile had more falls in the previous year (p = 0.032), worse performance in the Flamingo (p = 0.009) and Step (p < 0.001) tests, worse CI (p = 0.009) and a trend toward sedentary lifestyle (p = 0.056). On multiple regression, FGF23 tertiles remained significant, independently of eGFR, for falls in the previous year, performance in the Flamingo and stationary march tests, lean mass index, and IPAQ classification. Conclusion: In a population of very elderly individuals, FGF23 levels were inversely associated with neuromuscular and functional performances. Higher concentrations were related to more falls, lower muscle strength and aerobic capacity, and poorer balance, regardless of renal function, suggesting a potentially deleterious role of high FGF23 concentrations in musculoskeletal health.

Development and validation of predictive model for long-term hospitalization, readmission, and in-hospital death of patients over 60 years old

ABSTRACT Objective To develop and validate a high-risk predictive model that identifies, at least, one common adverse event in older population: early readmission (up to 30 days after discharge), long hospital stays (10 days or more) or in-hospital deaths. Methods This was a retrospective cohort study including patients aged 60 years or older (n=340) admitted at a 630-beds tertiary hospital, located in the city of São Paulo, Brazil. A predictive model of high-risk indication was developed by analyzing logistical regression models. This model prognostic capacity was assessed by measuring accuracy, sensitivity, specificity, and positive and negative predictive values. Areas under the receiver operating characteristic curve with 95% confidence intervals were also obtained to assess the discriminatory power of the model. Internal validation of the prognostic model was performed in a separate sample (n=168). Results Statistically significant predictors were identified, such as current Barthel Index, number of medications in use, presence of diabetes mellitus, difficulty chewing or swallowing, extensive surgery, and dementia. The study observed discrimination model acceptance in the construction sample 0.77 (95% confidence interval: 0.71-0.83) and good calibration. The characteristics of the validation samples were similar, and the receiver operating characteristic curve area was 0.687 (95% confidence interval: 0.598-0.776). We could assess an older patient's adverse health events during hospitalization after admission. Conclusion A predictive model with acceptable discrimination was obtained, with satisfactory results for early readmission (30 days), long hospital stays (10 days), or in-hospital death.

Association between baseline Mini-Mental State Examination score and dementia incidence in a cohort of oldest old.

BACKGROUND: The Brazilian population has aged rapidly. The oldest old, defined as persons aged 80 years or older, is the fastest growing segment of the Brazilian population. Several instruments have been used to assess the cognitive performance of the older people and predict dementia. One of the most commonly used is the Mini-Mental State Examination (MMSE). OBJECTIVE: The aim of this study was to investigate the relationship between baseline MMSE score and the incidence of dementia in a Brazilian cohort of independent oldest old. METHODS: Sociodemographic data and serial cognitive assessment of 248 older adults were analyzed. RESULTS: Mean follow-up time of subjects was 4.0(±1.9) years, 71.4% were women, and mean MMSE score at entry was 25(±3.5). Mean MMSE scores at baseline were significantly higher (p=0.001) in the cognitively intact group than in those who developed dementia. The logistic regression showed that for a one point increase in MMSE score at baseline there was a 10% reduction in the probability of dementia. CONCLUSIONS: In the Brazilian scenario of a rapidly growing population of oldest old, the extensive use of the MMSE gives rise to the need not only to determine its effectiveness for screening dementia, but also to interpret its score in terms of future conversion to dementia.

Association between baseline Mini-Mental State Examination score and dementia incidence in a cohort of oldest old / Associação entre a pontuação inicial do Miniexame do Estado Mental e a incidência de demência em uma coorte de longevos

ABSTRACT Background: The Brazilian population has aged rapidly. The oldest old, defined as persons aged 80 years or older, is the fastest growing segment of the Brazilian population. Several instruments have been used to assess the cognitive performance of the older people and predict dementia. One of the most commonly used is the Mini-Mental State Examination (MMSE). Objective: The aim of this study was to investigate the relationship between baseline MMSE score and the incidence of dementia in a Brazilian cohort of independent oldest old. Methods: Sociodemographic data and serial cognitive assessment of 248 older adults were analyzed. Results: Mean follow-up time of subjects was 4.0(±1.9) years, 71.4% were women, and mean MMSE score at entry was 25(±3.5). Mean MMSE scores at baseline were significantly higher (p=0.001) in the cognitively intact group than in those who developed dementia. The logistic regression showed that for a one point increase in MMSE score at baseline there was a 10% reduction in the probability of dementia. Conclusions: In the Brazilian scenario of a rapidly growing population of oldest old, the extensive use of the MMSE gives rise to the need not only to determine its effectiveness for screening dementia, but also to interpret its score in terms of future conversion to dementia.

RESUMO Antecedentes: A população brasileira envelheceu rapidamente. Os longevos, definidos como pessoas com 80 anos ou mais, são o segmento da população brasileira que mais cresce. Diversos instrumentos têm sido usados para avaliar o desempenho cognitivo de idosos e para predizer demência. Um dos instrumentos mais utilizados é o Miniexame do Estado Mental (MEEM). Objetivo: Nosso objetivo foi investigar a relação entre a pontuação inicial do MEEM e a incidência de demência em uma coorte brasileira de idosos longevos independentes. Métodos: Foram avaliados dados de 248 idosos por meio de um questionário sociodemográfico e de avaliações cognitivas seriadas. Resultados: O tempo médio de acompanhamento dos participantes foi de 4,0 (±1,9) anos. Eram mulheres 71,4% deles e a pontuação média do MEEM na entrada foi de 25 (±3,5) pontos. As pontuações médias do MEEM no início do estudo foram significativamente maiores (p=0,001) no grupo cognitivamente intacto do que naqueles que desenvolveram demência. A regressão logística mostrou que, para cada ponto a mais na pontuação do MEEM no início do estudo, houve redução de 10% na probabilidade de desenvolver demência. Conclusões: No cenário brasileiro de rápido crescimento da população de idosos longevos, o uso da ferramenta cognitiva mais amplamente utilizada cria a necessidade de determinar não apenas sua eficácia no rastreamento da demência, mas também de interpretar seu escore considerando-se a futura conversão para demência.

Associação da Composição Corporal com Rigidez Arterial em Longevos / Association of Body Composition with Arterial Stiffness in Long-lived People

Resumo Fundamento Pouco se conhece sobre a relação entre sarcopenia e hemodinâmica central em idosos longevos. Objetivo Estudar a relação da rigidez arterial com a composição corporal em idosos longevos. Métodos A composição corporal foi avaliada por meio da absortometria de Raio X de dupla energia (DEXA) e dos parâmetros de circulação central (PCC) obtidos por método oscilométrico não invasivo, com o Mobil-O-Graph 24h PWA Monitor®. Os parâmetros centrais avaliados foram: velocidade da onda de pulso (VOP), augmentation index (AIx), índice de amplificação da pressão de pulso (iAPP) e pressão de pulso central (PPc). Estes foram correlacionados com massa magra total (MM) e apendicular (MA), percentual de gordura corporal e índice de Baumgartner (IB). Aceitou-se nível de significância de 5%. Resultados Participaram 124 longevos, com idade média de 87,1 anos (DP±4,3 anos), sendo 74,2% mulheres e 57,3% brancos. Houve correlação inversa do AIx com as variáveis MM (r = - 0,391, p < 0,001), MA (r= -0,378, p< 0,001) e IB (r = -0,258, p 0,004). A PPc apresentou associação inversa com MM (r= -0,268, p =0,003), MA (r=-0,288, p= 0,001) e IB (r= -0,265, p = 0,003). Houve relação direta apenas entre AIx e percentual de gordura corporal (r= 0,197, p= 0,029). Conclusão Em idosos longevos, o percentual de gordura corporal se associa diretamente com a rigidez arterial e tem associação inversa com a quantidade de MM. Esses achados podem estar associados ao maior risco cardiovascular.

Abstract Background Arterial stiffness, obesity and sarcopenia correlate with each other and with cardiac outcomes in younger adults. However, there is little evidence of the association between body composition and markers of central arteries stiffness in long-lived people. Objective To evaluate the relationship between arterial stiffness and body composition in functionally independent long-lived individuals. Methods This is a cross-sectional analysis of the association between markers of arterial stiffness and body composition among participants in a longitudinal cohort of elderly individuals aged 80 years or older who were functionally independent and lived in the community . Body composition measurements were performed using dual energy X-ray absorptiometry (DEXA) and central circulation parameters (CCP) obtained by a non-invasive oscillometric method through the Mobil-O-Graph 24h PWA Monitor® device. The central parameters evaluated were: pulse wave velocity (PWV), augmentation Index (AIx), pulse pressure amplification index (PPAi) and central pulse pressure (cPP). These were correlated to total lean mass (LM) and appendicular lean mass (aLM), body fat percentage, and Baumgartner's Index (BI). The level of significance was set at 5% for all tests. Results Data from 124 elderly people with a mean age of 87.1 years (SD ± 4.3 years) were analyzed, with 74.2% of women and 57.3% of white. There was a statistically significant inverse correlation of AIx with LM (r = -0.391, p <0.001), aLM (r = -0.378, p <0.001), and BI (r = -0.258, p = 0.004). Also, cPP had an inversely proportional association with LM (r = -0.268, p = 0.003), aLM (r = -0.288, p = 0.001), and BI (r = -0.265, p = 0.003). When assessing the relationship between fat mass and CCP, a statistically significant direct relationship was observed only between AIx and body fat percentage (r = 0.197, p = 0.029). Conclusion In long-lived people, body fat percentage is directly associated with arterial stiffness and inversely associated with the amount of LM. These findings may be associated with increased cardiovascular risk.

Association between fibroblast growth factor 23 and functional capacity among independent elderly individuals.

OBJECTIVE: To examine the association of between serum fibroblast growth factor 23 and the functional capacity among independent individuals, aged 80 or older. METHODS: The functional capacity of 144 elderly was assessed by Instrumental Activities of Daily Living, cognitive tests, handgrip strength and the timed ability to rise from a chair and sit down five times. Fibroblast growth factor 23 was measured using an ELISA assay. RESULTS: Participants in the lowest fibroblast growth factor 23 tertile had the highest mean±standard deviation estimated glomerular filtration rate, the highest mean hemoglobin level, the lowest average number of diseases and the lowest number of medications used. In participants with the estimated glomerular filtration rate >45mL/minute/1.73m2, mean fibroblast growth factor 23 level was higher in those with 25(OH) vitamin D <20ng/mL than in those with 25(OH) vitamin D ≥20ng/mL (75.6RU/mL±42.8 versus 68.5RU/mL±41.7; p<0.001). There was an increase in the mean serum cystatin C (from 1.3mg/mL±0.3 to 1.5mg/mL±0.3 to 1.7mg/mL±0.4) as function of higher fibroblast growth factor 23 tertile (p<0.001). Fibroblast growth factor 23 levels were not significantly associated with capacity in physical or cognitive tests. CONCLUSION: In independent community-dwelling elderly, aged ≥80 years, fibroblast growth factor 23 was associated with aged-related comorbidities and renal function but not with functional capacity.

Association between fibroblast growth factor 23 and functional capacity among independent elderly individuals / Associação entre fator de crescimento de fibroblastos 23 e capacidade funcional em idosos independentes

ABSTRACT Objective To examine the association of between serum fibroblast growth factor 23 and the functional capacity among independent individuals, aged 80 or older. Methods The functional capacity of 144 elderly was assessed by Instrumental Activities of Daily Living, cognitive tests, handgrip strength and the timed ability to rise from a chair and sit down five times. Fibroblast growth factor 23 was measured using an ELISA assay. Results Participants in the lowest fibroblast growth factor 23 tertile had the highest mean±standard deviation estimated glomerular filtration rate, the highest mean hemoglobin level, the lowest average number of diseases and the lowest number of medications used. In participants with the estimated glomerular filtration rate >45mL/minute/1.73m2, mean fibroblast growth factor 23 level was higher in those with 25(OH) vitamin D <20ng/mL than in those with 25(OH) vitamin D ≥20ng/mL (75.6RU/mL±42.8 versus 68.5RU/mL±41.7; p<0.001). There was an increase in the mean serum cystatin C (from 1.3mg/mL±0.3 to 1.5mg/mL±0.3 to 1.7mg/mL±0.4) as function of higher fibroblast growth factor 23 tertile (p<0.001). Fibroblast growth factor 23 levels were not significantly associated with capacity in physical or cognitive tests. Conclusion In independent community-dwelling elderly, aged ≥80 years, fibroblast growth factor 23 was associated with aged-related comorbidities and renal function but not with functional capacity.

RESUMO Objetivo Examinar a associação entre o fator de crescimento de fibroblastos 23 sérico e a capacidade funcional em indivíduos independentes, com 80 anos ou mais. Métodos A capacidade funcional de 144 idosos foi avaliada por meio de Atividades Instrumentais da Vida Diária, testes cognitivos, força de preensão manual e capacidade de levantar de uma cadeira e sentar cinco vezes. O fator de crescimento de fibroblastos 23 foi medido pelo teste ELISA. Resultados Os participantes no tercil mais baixo de fator de crescimento de fibroblastos 23 tiveram a maior média±desvio-padrão da taxa de filtração glomerular estimada, concentração média de hemoglobina mais alta, menor número médio de doenças e menor número de medicamentos utilizados. Em participantes com taxa de filtração glomerular estimada >45mL/minuto/1,73m2, o nível médio do fator de crescimento de fibroblastos 23 foi maior naqueles com 25(OH) vitamina D <20ng/mL do que naqueles com 25(OH) vitamina D ≥20ng/mL (75,6RU/mL±42,8 versus 68,5RU/mL±41,7; p<0,001). Houve aumento na cistatina C sérica média (de 1,3mg/mL±0,3 a 1,5mg/mL±0,3 a 1,7mg/mL±0,4) em função do tercil de fator de crescimento 23 de fibroblastos mais alto (p<0,001). Os níveis de fator de crescimento de fibroblastos 23 não foram significativamente associados à capacidade em testes físicos ou cognitivos. Conclusão Em idosos independentes residentes na comunidade ≥80 anos, o fator de crescimento de fibroblastos 23 foi associado a comorbidades relacionadas à idade e à função renal, mas não à capacidade funcional.

Functional capacity, renal function and vitamin D in community-dwelling oldest old.

PURPOSE: The aim of this study was to evaluate the association between the decline in estimated glomerular filtration rate (eGFR) and serum 25(OH)D with the physical and mental functional capacity of elderly individuals aged 80 years or older. METHODS: We evaluated the functional capacity in its multidomain aspects: Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), Mental State Mini-Exam (MMSE), Verbal Fluency Test (VF), handgrip strength and time to sit and rise from a chair five times, combined creatinine and cystatin C-based eGFR and 25(OH)D levels in 205 independent asymptomatic and community-dwelling elderly subjects in a cross-sectional study. RESULTS: Every 1 year of life, there was reduction of about 10% chance of adequate performance in functional capacity. Each 1 ml/min/m2 in eGFR was associated with 2% better chance of adequate performance in the IADL. We found no association between eGFR and cognition. Serum 25(OH)D between 15.00 and 22.29 ng/ml increased the chance of better performance in VF, IADL, handgrip strength and sit and rise from the chair compared to the lower level of serum vitamin D. CONCLUSIONS: Decreased renal function associated with age compromises the ability to perform activities for independent life in the community, but we did not observe influence in specific domains of cognition and physical performance. Low serum level of 25(OH)D appears to be a marker of greater risk of functional decline than eGFR measurement in independent oldest old dwelling in the community.

Depression and cancer were independently associated with quality of life in Brazilian older people.

OBJECTIVE: To analyse the factors associated with low health-related quality of life (HRQoL) in older people living in Brazil. METHODS: In this cross-sectional study of the Jewish community residing in Sao Paulo, Brazil, we extensively evaluated the characteristics - including clinical, functional and sociodemographic - of 496 older people. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), while the Geriatric Depression Scale (GDS) was used to measure depressive symptoms. RESULTS: After adjusting for potential confounders, we found that GDS score (ß = -0.07; P = 0.04) and cancer (ß = -0.47; P = 0.05) were associated with a low WHOQOL-BREF score. CONCLUSION: Depressive symptoms and cancer were independently associated with low HRQoL among older people living in Brazil.

Association between respiratory capacity, quality of life and cognitive function in elderly individuals / Associação entre capacidade respiratória, qualidade de vida e cognição em idosos

ABSTRACT Objective To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. Methods The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve <80% and >60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. Results Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). Conclusion Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men.

RESUMO Objetivo Investigar a associação entre capacidade respiratória, qualidade de vida e função cognitiva em idosos. Métodos A amostra incluiu 386 idosos (232 mulheres). A capacidade respiratória foi avaliada pela pressão expiratória máxima obtida no pico de fluxo expiratório. Com base nos resultados máximos de fluxo expiratório, os indivíduos foram classificados de acordo com o valor previsto para sexo, idade e estatura em capacidade respiratória normal (curva de fluxo expiratório de pico inferior a 80% e superior a 60%) ou capacidade respiratória reduzida (curva de fluxo expiratório de pico menor que 60%). O questionário World Health Organization Quality of Life e o Miniexame do Estado Mental foram utilizados para avaliar a qualidade de vida e a função cognitiva, respectivamente. Resultados Em comparação com mulheres idosas com capacidade respiratória normal, as pessoas com capacidade respiratória reduzida apresentaram escores mais baixos para o Miniexame do Estado Mental (p=0,048) e qualidade de vida (p=0,040). Nos homens, não foram observadas diferenças (p>0,05). Conclusão Capacidade respiratória reduzida foi associada à pior qualidade de vida e à função cognitiva em mulheres idosas. Essas associações não foram observadas em idosos do sexo masculino.

Genes related to maintenance of autophagy and successful aging / Genes relacionados à manutenção da autofagia e envelhecimento bem-sucedido

ABSTRACT Considering aging as a phenomenon in which there is a decline in essential processes for cell survival, we investigated the autophagic and proteasome pathways in three different groups: young, older and oldest old male adults. The expression profile of autophagic pathway-related genes was carried out in peripheral blood, and the proteasome quantification was performed in plasma. No significant changes were found in plasma proteasome concentrations or in correlations between proteasome concentrations and ages. However, some autophagy- and/or apoptosis-related genes were differentially expressed. In addition, the network and enrichment analysis showed an interaction between four of the five differentially expressed genes and an association of these genes with the transcriptional process. Considering that the oldest old individuals maintained both the expression of genes linked to the autophagic machinery, and the proteasome levels, when compared with the older group, we concluded that these factors could be considered crucial for successful aging.

RESUMO Considerando o envelhecimento como um fenômeno em que há um declínio nos processos essenciais a sobrevivência celular, investigamos as vias autofágica e proteassômica em três grupos: jovens, idosos e longevos. O perfil de expressão dos genes relacionados à via autofágica foi analisado em sangue periférico, e a quantificação do proteassoma realizada em plasma. Não foram encontradas alterações significativas nas concentrações plasmáticas de proteassoma ou na correlação entre as concentrações de proteassoma e as idades. No entanto, alguns genes relacionados a autofagia e / ou apoptose foram expressos diferencialmente. Além disso, as análises de rede e de enriquecimento mostraram uma interação entre quatro dos cinco genes diferencialmente expressos e a associação desses ao processo transcricional. Considerando que os indivíduos longevos mantiveram tanto a expressão de genes ligados à maquinaria autofágica, quanto os níveis de proteassoma quando comparados aos idosos, concluímos que esses fatores poderiam ser considerados cruciais para o envelhecimento bem-sucedido.

Pain-induced depression in the elderly: Validation of psychometric properties of the Brazilian version of the "Geriatric Emotional Assessment of Pain" - GEAP-b / Depressão dor-induzida em idosos: validação das propriedades psicométricas da versão brasileira do "Geriatric Emotional Assessment of Pain" - GEAP-b

Summary Objective: In order to introduce an instrument within our midst that allows a comprehensive clinical evaluation of pain-induced depression in the elderly, we proposed the translation, cross-cultural adaptation into Brazilian Portuguese, and study of the psychometric properties of the "Geriatric Psychosocial Assessment of Pain-induced Depression" (GEAP) scale. This instrument was especially developed for the screening of depression associated with chronic pain in the elderly. Method: We performed translation and cross-cultural adaptation of the GEAP scale, whose psychometric properties were analyzed in a sample of 48 elderly individuals. Sociodemographic data and information related to chronic pain were ascertained, as well as those related to depression. The GEAP-b scale was applied at three different times on the same day by two different interviewers (I1 and I2), and after 15 days by one of those interviewers (I3). Results: The GEAP-b proved to be an easy-to-apply instrument with a high internal consistency value, according to the Cronbach's alpha coefficient (0.835). The reproducibility of the instrument was optimal, achieving intraclass correlations of 98.5 and 92% for interobserver and intraobserver, respectively. There was "considerable" agreement (between 0.419 and 1.0) for each GEAP-b item, except for item 19, according to the kappa statistic. As for the validity of the GEAP-b criterion, positive and statistically significant correlations were obtained for pain, according to GPM-p (r=49.5%, p<0.001), and depression, according to GDS (r=59%, p<0.001), both values being considered regular (between 40-60%). Conclusion: The GEAP-b scale has proven to be reliable and valid in the screening of pain-related depression in the elderly.

Resumo Objetivo: A fim de se introduzir no nosso meio um instrumento que permitisse uma avaliação clínica abrangente da depressão dor-induzida em idosos, propôs-se a tradução, adaptação transcultural para o Brasil e estudo das propriedades psicométricas do "Geriatric Psychosocial Assessment of Pain-induced Depression" (GEAP). Esse instrumento foi desenvolvido especialmente para rastreio da depressão associada à dor em idosos. Método: Foram realizadas tradução e adaptação transcultural do GEAP, cujas propriedades psicométricas foram analisadas em uma amostra de 48 idosos. Foram apurados dados sociodemográficos e relacionados a dor crônica, além de depressão. O GEAP-b foi aplicado em três momentos distintos, em um mesmo dia por dois entrevistadores diferentes (E1 e E2), e após 15 dias por um daqueles entrevistadores (E3). Resultados: O instrumento GEAP-b mostrou-se ser de fácil aplicação e alto valor de consistência interna, de acordo com o coeficiente alfa de Cronbach (0,835). Teve reprodutibilidade ótima, segundo as correlações intraclasses: valores de 98,5 e 92%, interobservador e intraobservador, respectivamente. As concordâncias para cada item do GEAP-b foram "consideráveis" (entre 0,419 e 1,0), excetuando-se a concordância para o item 19, segundo a estatística kappa. Para a validade de critério do GEAP-b, correlações positivas e estatisticamente significativas foram obtidas para a dor, segundo o GPM-p (r=49,5%; p<0,001), e para a depressão, segundo o GDS (r=59%; p<0,001), com ambos os valores considerados regulares (entre 40 e 60%). Conclusão: O GEAP-b demonstrou ser confiável e válido no rastreio da depressão associada à dor em idosos.

Ultrasonographic assessment of thyroid volume in oldest-old individuals

ABSTRACT Objective The aim of this study was to describe the relationship between thyroid volume and age, gender, anthropometric characteristics, and echogenicity in oldest-old subjects in an iodine-sufficient area. Subjects and methods The study included 81 independent elderly individuals aged ≥ 80 years (65 [80.2%] women). We determined these individuals' anthropometric characteristics, body mass index (BMI), and lean body mass, as well as thyroid volume and echogenicity by ultrasonography. Results We observed that octogenarians and nonagenarians had different profiles of thyroid echogenicity. The volume of the thyroid was smaller in nonagenarians than octogenarians (p = 0.012, r = 0.176), and subjects aged 80-89 years had more often hypoechoic glands than those aged ≥ 90 years (p = 0.01 versus 0.602). Conclusion The identification of ultrasonographic differences in oldest-old individuals will contribute to establishing preclinical markers, such as echogenicity, to identify individuals at risk of developing autoimmune thyroid disease. Future prospective studies should identify if 80-89-year-old individuals with hypoechoic glands progress to hypothyroidism, and if the absence of changes in echogenicity (i.e. a normal thyroid parenchyma) would have a positive impact on longevity among nonagenarians.

Anxiety disorder in elderly persons with chronic pain: frequency and associations / Transtorno de ansiedade em idosos com dor crônica: frequência e associações

Abstract Objectives: to evaluate the frequency of anxiety disorders in older elderly persons with chronic pain and identify associated factors. Method: a descriptive, analytical and cross section study of the "Projeto Longevos" ("Long-Lived Elderly Persons Project") was carried out, featuring elderly persons living in the community who were aged 80 or over. Older elderly persons with chronic pain were selected, and data regarding their sociodemographic characteristics and factors related to pain was gathered, especially with regard to the multidimensional nature of pain, according to the "Geriatric Pain Measure-p" (GPM-p). Self-perception of health was also recorded and functionality assessments were carried out, along with the screenings for depression and anxiety disorders, according to the Geriatric Depression Scale and the State-Trait Anxiety Inventory, respectively. Associations were analyzed by Pearson correlation, the ANOVA Test and Tukey multiple comparisons. Results: the sample was composed of 41 elderly persons with a mean age of 85.7 years, most of whom were female, white, widowed and had a low education. A high prevalence of anxiety disorders was observed, being 53.6% and 68.3%, respectively, for trait and state anxiety. A significant, but not high, correlation was found between the anxiety trait and chronic pain according to the GPM-p (r=31.5%; p=0.048), and there was a significant and high correlation between the same type of anxiety and depression (r=61.3%; p<0.001). Conclusion: anxiety disorders were very prevalent in older elderly persons with chronic pain, and these correlated significantly with pain and depression, which could justify the need for varied multidisciplinary therapeutic measures against the persistent pain conditions of the elderly. AU

Resumo Objetivos: avaliar a frequência de transtornos de ansiedade em idosos longevos com dor crônica e verificar as suas associações. Método: estudo descritivo, analítico e de corte transversal do "Projeto Longevos", do qual participam idosos da comunidade com 80 anos de idade ou mais. Selecionados os longevos com dor crônica dos quais se apuraram as características sociodemográficas e os aspectos referentes à dor, principalmente aqueles relacionados às suas multidimensões, segundo o Geriatric Pain Measure-p (GPM-p). Foram realizadas avaliações de funcionalidade e autopercepção de saúde, e os rastreios dos transtornos de depressão e ansiedade, segundo a Escala de Depressão Geriátrica e o Inventário de Ansiedade Traço-Estado, respectivamente. As associações foram analisadas segundo a correlação de Pearson, o teste de Anova e o Teste de comparações múltiplas de Tukey. Resultados: amostra constituída por 41 idosos com média de idade de 85,7 anos, sendo a maioria do sexo feminino, branca, viúva e de baixa escolaridade. Observadas altas prevalências de transtornos de ansiedade, 53,6% e 68,3%, respectivamente, traço e estado de ansiedade. Foi observada correlação significativa, mas não alta, da ansiedade-traço com a dor crônica segundo o GPM-p (r=31,5%; p=0,048) e correlação significativa e alta desse mesmo tipo de ansiedade com a depressão (r=61,3%; p<0,001). Conclusão: os transtornos de ansiedade foram muito prevalentes nos longevos com dor crônica, e esses se correlacionaram significativamente com a dor e a depressão, o que poderia justificar a necessidade de medidas terapêuticas multidisciplinares e diferentes nos quadros álgicos persistentes de idosos.AU

Health-related quality of life in Brazilian community-dwelling and institutionalized elderly: Comparison between genders / Qualidade de vida relacionada à saúde em idosos brasileiros residentes em comunidade e institucionalizados: comparação entre gêneros

SUMMARY Objective To compare the health-related quality of life (HRQL) indicators between institutionalized and community-dwelling elderly men and women. Method This was a cross-sectional study with a sample of 496 elderly men and women, surveyed by researchers at a private hospital that attends institutionalized and community-dwelling elderly. HRQL (World Health Organization Quality of Life), daily living activities (Katz questionnaire), and instrumental daily living activities (Lawton questionnaire), mini-mental state examination, handgrip strength test, and function capacity (timed up and go test) were obtained. Results Institutionalized men presented higher scores in physical and psychological domains of HRQL compared to elderly men living alone (p<0.05). Among women, the scores in all domains (physical, psychological, relationship, and environment) were similar between institutionalized and community-dwelling individuals. Conclusion Institutionalized elderly men reported better scores in physical and psychological domains of HRQL compared to their community-dwelling pairs, while both institutionalized and community-dwelling elderly women presented similar HRQL.

RESUMO Objetivo comparar os indicadores de qualidade de saúde de vida (QV) entre idosos homens e mulheres institucionalizados e aqueles que vivem na comunidade sozinhos ou com a família. Método estudo transversal com amostra composta por 496 idosos homens e mulheres, entrevistados por pesquisadores em um hospital privado que atende idosos institucionalizados e da comunidade. Os indicadores de QV (World Health Organization Quality of Life), atividades da vida diária (Katz questionnaire), atividades instrumentais da vida diária (Lawton questionnaire), exame do estado mental (mini-mental), teste de força de preensão manual (Handgrip) e capacidade funcional (Timed up to go) foram obtidos. Resultados homens institucionalizados apresentaram maiores escores de QV no domínio físico e psicológico em relação aos idosos que vivem na comunidade sozinhos (p<0,05). Nas mulheres, os escores em todos os domínios de QV (físico, psicológico, relações sociais e ambientais) foram semelhantes entre as idosas institucionalizadas e as residentes na comunidade, que vivem sozinhas ou com a família. Conclusão homens idosos institucionalizados relataram melhores escores de QV nos domínios físico e psicológico em comparação com pares que vivem na comunidade, enquanto, em mulheres, resultados similares foram observados nas idosas institucionalizadas e da comunidade.

Peak expiratory flow mediates the relationship between handgrip strength and timed up and go performance in elderly women, but not men

OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (p<0.01). After adjustment for PEF, the relationship between handgrip strength and TUG performance remained significant. In women, handgrip strength was also associated with both PEF and TUG performance (p<0.01). However, after adjustment for PEF, the relationship between handgrip strength and TUG performance was no longer significant. CONCLUSION: Mobility in the elderly is sex dependent. In particular, PEF mediates the relationship between handgrip strength and TUG performance in women, but not in men.

Course of functional status in elderly patients after coronary artery bypass surgery: 6-month follow up.

AIM: To determine longitudinal changes in functional status using three functional assessment scales in elderly patients undergoing coronary artery bypass grafting. METHODS: This was a prospective observational cohort study of 73 patients aged ≥60 years undergoing elective coronary artery bypass grafting. Patients were assessed for functional status before admission, at hospital discharge, and at 1 and 6 months after discharge using the Functional Independence Measure, Katz Activities of Daily Living scale, and Lawton Instrumental Activities of Daily Living scale. Data were stratified by age (≥70 years and <70 years) and complications (with and without) for analysis. RESULTS: In patients aged ≥70 years (n = 38), Functional Independence Measure scores ranged from 121.30 ± 6.42 (pre-admission) to 112.10 ± 17.10 (1 month) and 117.80 ± 13.50 (6 months), Katz scores from 5.88 ± 0.32 (pre-admission) to 5.45 ± 1.04 (1 month) and 5.83 ± 0.65 (6 months), and Lawton scores from 25.40 ± 3.30 (pre-admission) to 20.05 ± 4.93 (1 month) and 24.50 ± 4.10 (6 months; P < 0.001 for all). No significant changes were found in scale scores over time between groups with (n = 34) and without (n = 39) complications. When groups aged ≥70 years (n = 38) and <70 (n = 35) were compared, Functional Independence Measure scores showed a difference toward recovery over time in older patients (discharge - pre-admission, P = 0.010; 1 month - pre-admission, P = 0.0004; and 6 months - pre-admission, P = 0.079). CONCLUSIONS: The Functional Independence Measure was able to detect significant functional loss over a 6-month period in elderly patients undergoing coronary artery bypass grafting, suggesting that this scale is a promising tool for the assessment of functional recovery over time after cardiac surgery, especially in patients aged older than 70 years. Geriatr Gerontol Int 2015; ●●: ●●-●●.

Abnormal phenotypic distribution of regulatory and effector T cells in octogenarian and nonagenarian women.

INTRODUCTION: aging is associated with several immunologic changes. Regulatory (Treg) and effector T cells are involved in the pathogenesis of infectious, neoplastic, and autoimmune diseases. Little is known about the effects of aging on the frequency and function of these T cell subpopulations. METHODS: peripheral blood mononuclear cells (PBMC) were obtained from 26 young (under 44 years old) and 18 elderly (above 80 years old) healthy women. T cell subpopulations were analyzed by flow cytometry. RESULTS: elderly individuals had lower frequency of several activated effector T cell phenotypes as compared with young individuals: CD3+CD4+CD25+ (3.82±1.93 versus 9.53±4.49; p<0.0001); CD3+CD4+CD25+CD127+(2.39±1.19 versus 7.26±3.84; p<0.0001); CD3+CD4+CD25+ (0.41±0.22 versus 1.86±0.85, p<0.0001); and CD3+CD4+CD25highCD127+(0.06±0.038 versus 0.94±0.64, p<0.0001). Treg (CD3+CD4+CD25+CD127øFoxp3+) presented lower frequency in elderly individuals as compared to young adults (0.34±0.18 versus 0.76±0.48; p=0.0004) and its frequency was inversely correlated with age in the whole group (r=-0.439; p=0.013). The elderly group showed higher frequency of two undefined CD25øFoxp3+ phenotypes: CD3+CD4+CD25øFoxp3+(15.05±7.34 versus 1.65±1.71; p<0.0001) and CD3+CD4+CD25øCD127øFoxp3+(13.0±5.52 versus 3.51±2.87; p<0.0001). CONCLUSIONS: the altered proportion of different T cell subsets herein documented in healthy elderly women may be relevant to the understanding of the immunologic behavior and disease susceptibility patterns observed in geriatric patients.

Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level / Dor crônica em idosos longevos: prevalência, características, mensurações e correlação com nível sérico de vitamina D

ABSTRACTBACKGROUND AND OBJECTIVES:Chronic pain considerably worsens quality of life of the elderly, giving relevance to studies addressing it in such individuals, especially those long-lived. Recently, vitamin D deficiency, very prevalent among the elderly, has been correlated to chronic pain. This study aimed at estimating the prevalence of chronic pain among community long-lived elderly with functional independence, at evaluating its characteristics and at correlating this pain to serum vitamin D levels.METHODS:Cross-sectional study of the “Long-Lived Project”, with elderly aged 80 years or above, of both genders, with functional independence. Socio-demographic data were collected, referred chronic pains were measured and serum vitamin D levels were obtained.RESULTS:We have evaluated 330 participants of the “Long-Lived Project” and pain prevalence was 20.9%, especially nociceptive, continuous, moderate to severe and lumbar pain. Among pain intensity measurement tools, faces and verbal numeric scales were preferred. There has been high prevalence of vitamin D deficiency among long-lived elderly with chronic pain (87%); deficiency and insufficiency levels were 49 and 38%, respectively, however such levels were not significantly correlated to chronic pain.CONCLUSION:There has been high prevalence of chronic pain among the elderly. Moderate to severe and low back pain were the most frequent. There has been high prevalence of vitamin D deficiency among studied long-lived elderly; however there has been no significant correlation between low serum vitamin D levels and chronic pain.

RESUMOJUSTIFICATIVA E OBJETIVOS:A dor crônica diminui consideravelmente a qualidade de vida dos idosos, dando relevância aos estudos que a abordam nesses indivíduos, sobretudo nos longevos. Recentemente, a hipovitaminose D, muito prevalente entre idosos, tem sido relacionada à dor crônica. O objetivo deste estudo foi estimar a prevalência de dor crônica entre os longevos da comunidade com independência funcional, avaliar suas características e correlacionar essa dor com os níveis séricos de vitamina D.MÉTODOS:Estudo transversal do “Projeto Longevos”, com idosos de 80 anos ou mais, de ambos os gêneros, com independência funcional. Foram apurados os dados sócio-demográficos, avaliadas e mensuradas as dores crônicas apresentadas e obtidos os níveis séricos da vitamina D.RESULTADOS:Foram avaliados 330 participantes do “Projeto Longevos”, e encontrada prevalência de 20,9% de dor crônica, sendo essa principalmente do tipo nociceptiva, contínua, de intensidade moderada a intensa, de localização lombar. Dentre os instrumentos de mensuração da intensidade dolorosa, os preferidos foram as escalas de faces e numérica verbal. Observou-se alta prevalência de hipovitaminose D nos longevos com dor crônica (87%); níveis de deficiência e insuficiência em 49 e 38%, respectivamente, porém tais níveis não se correlacionaram significativamente com a presença de dor crônica.CONCLUSÃO:A prevalência de dor crônica entre os longevos foi alta. Intensidade moderada e intensa e localização lombar foram as mais frequentes. Houve alta prevalência de hipovitaminose D entre os longevos estudados, porém não se observou correlação significativa entre baixos níveis séricos de vitamina D e dor crônica.