Equilíbrio postural e fatores associados ao risco de quedas em idosos com diabetes mellitus tipo 2 / Postural balance and associated factors with the fall risk assessed in older adults with type 2 diabetes mellitus

Resumo Objetivo Identificar os fatores clínico-funcionais associados ao risco de quedas, avaliado pelo Mini-BESTest, em idosos com diabetes mellitus tipo 2 (DM2). Método Trata-se de um estudo transversal. Um total de 145 idosos com idade =60 anos foram avaliados por meio das variáveis sociodemográficas (sexo, faixa etária, estado civil, nível de educação e percepção geral da saúde, audição e visão) Mini-BESTest, Mini-Mental State Examination (MMSE), Escala de Depressão Geriátrica (GDS-15) e o teste Timed Up and Go (TUG) (dupla tarefa). Foi utilizado um modelo de regressão logística múltipla. Resultados O domínio de orientação sensorial apresentou a pontuação média mais elevada, seguido pelos domínios estabilidade na marcha, ajustes posturais antecipatórios e respostas posturais. Os fatores associados ao risco de quedas em idosos foram: percepção visual ruim/muito ruim OR 3.40 (1,50-7,72); presença de doenças respiratórias OR 8.00 (1,32-48,46); sensação de tontura OR 2.53 (1,10-5,80); e tempo do teste Timed Up and Go (TUG) (dupla tarefa) igual ou superior a 13,5 segundos OR 3.31 (1,03-10,64). Conclusão Os idosos deste estudo apresentaram um equilíbrio postural comprometido, principalmente no domínio das respostas posturais. O conhecimento dos fatores associados ao risco de quedas em idosos com DM2 permite uma orientação mais eficaz na avaliação, prevenção e intervenção, visando minimizar a ocorrência de quedas e preservar ou otimizar o equilíbrio postural. Diversos fatores influenciaram esse resultado, tais como sobrepeso, baixa atividade física e nível educacional, várias comorbidades, polifarmácia, diagnóstico de DM2 por mais de dez anos, percepção negativa da saúde geral e da visão, e sintomas depressivos.

Abstract Objective Identify clinical-functional factors associated to the risk of falls, assessed by Mini-BESTest in older adults with type 2 diabetes mellitus (T2DM). Method This cross-sectional study. A total of 145 older adults aged ≥60 years were evaluated through sociodemographic variables (sex, age group, married, education level, general health status hearing and vision), Mini-BESTest, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and dual-task Timed Up and Go Test (TUG) Multiple logistic regression model was used. Results The sensory orientation domain presented the highest average score, followed by the gait stability, anticipatory postural adjustments and postural responses domains. Factors associated to the risk of falls in older adults are: poor/very poor visual perception OR 3.40 (1.50-7.72); have respiratory diseases OR 8.00 (1.32-48.46); feeling dizzy OR 2.53 (1.10-5.80); and TUGT (dual task) time equal to or greater than 13.5 seconds OR 3.31 (1.03-10.64). Conclusion Older adults in this study presented impaired postural balance, mainly in the postural responses domain. The knowledge of the factors associated with the risk of falls in older adults with T2DM allows for better guidance in prevention, assessment and intervention, in order to minimize the occurrence of falls and maintain or optimize postural balance. Several factors influenced this outcome, such as overweight, low physical activity and education, several comorbidities, polypharmacy, T2DM diagnosis for more than ten years, negative perception of general health and vision, and depressive symptoms.

Como direcionar a formação do fisioterapeuta em Gerontologia no Brasil diante do envelhecimento populacional? / How to direct the training of physiotherapists in Gerontology in Brazil in the face of population aging?

O rápido envelhecimento populacional brasileiro mudou nosso cenário de saúde, o que exige que o profissional fisioterapeuta esteja preparado para lidar com as especificidades desta população. A Associação Brasileira de Fisioterapia em Gerontologia (ABRAFIGE), que tem a missão de fortalecer a especialidade e promover assistência qualificada em Fisioterapia em Gerontologia, propõe uma relação das competências fundamentais para formação no ensino nos cursos de graduação em Fisioterapia e de pósgraduação lato sensu em Fisioterapia em Gerontologia. Essa iniciativa visa auxiliar os gestores das Instituições de Ensino Superior das diversas regiões brasileiras no planejamento de tais cursos de forma a melhorar a qualidade da formação dos fisioterapeutas nessa área.

The rapid aging of the Brazilian population has changed the health scenario. Such a change requires physiotherapists to be prepared to deal with the specificities of this population. The Associação Brasileira de Fisioterapia em Gerontologia - ABRAFIGE (Brazilian Association of Physical Therapy in Gerontology), which has the mission of strengthening the specialty and the purpose of promoting qualified assistance in physical therapy in gerontology, proposes fundamental skills for training in teaching in undergraduate and graduate courses in physical therapy in gerontology. This initiative aims to assist administrators at higher education institutions in different regions of Brazil in the planning of such courses to improve the quality of the education of physiotherapists in this field.

Prevalence risk of sarcopenia in older Brazilian adults during the pandemic: A cross-sectional analysis of the Remobilize Study

ABSTRACT BACKGROUND: Social distancing has led to lifestyle changes among older adults during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES: This study aimed to estimate the prevalence risk of sarcopenia (RS) and investigate its associated factors during the COVID-19 pandemic in older Brazilian adults. DESIGN AND SETTING: Cross-sectional observational analysis of baseline data as part of the Remobilize Study. METHODS: Participants in the study were older adults (≥ 60 years), excluding those who were bedridden or institutionalized. The data collected consisted of answers about the RS (SARC-F), functional status, walking, sedentary behavior (SB), pain, comorbidity, and life space mobility. RESULTS: A total of 1,482 older adults (70 ± 8.14 years, 74% women) participated in the study, and an RS prevalence of 17.1% was found. (95% confidence interval [CI] 15.25-19.15%). The adjusted multivariate model showed a significant association between RS and functional limitation (odds ratio [OR]: 19.05; CI 13.00-28.32), comorbidity (OR: 5.11; CI 3.44-7.81), pain (OR: 4.56; CI 3.33-6.28), total walking (OR: 0.99; CI 0.99-1.00), SB of 8-10 hours (OR: 1.85; CI 1.15-2.93), and SB of > 10 hours (OR: 3.93; CI 2.48-6.22). RS was associated with mobility during the pandemic (OR: 0.97; CI 0.96-0.98). P < 0.05. CONCLUSIONS: During the pandemic, the prevalence of RS in older Brazilians was estimated at 17.1%. Moderate to severe functional limitation, comorbidities, presence of pain, walking, longer SB period, and reduced life space mobility significantly contributed to RS in older adults during the pandemic.

Dual visual impairment and contrast sensitivity among community-dwelling older adults: a cross-sectional study from the PrevQuedas Brazil trial / Duplo déficit visual e sensibilidade ao contraste em idosos da comunidade: estudo transversal do PrevQuedas Brasil

OBJECTIVE: To investigate the importance of improving visual assessment for community-dwelling older adult fallers. METHODS: Cross-sectional study with eligible older adults (> 60 years old) living in the community and who suffered at least one fall in the last 12 months from the PrevQuedas Brasil clinical trial. Sociodemographic data, information on previous falls, physical and functional assessment (BOMFAQ and FES-I) were collected. We evaluated impairments in visual acuity and contrast sensitivity using the Snellen E chart and low-contrast visual acuity tests, respectively. Dual visual impairment refers to the presence of both impairments. For statistical analysis we compared the participants in relation to the number of falls (single fallers or recurrent fallers) using Chi-square or Fisher's exact test and the significance level was <0.05 for all analyses. RESULTS: Visual acuity, low contrast sensitivity, and dual visual impairment were associated with recurrent falls (OR 1.85); visual impairment was more prevalent among the oldest old. Approximately 90% of the participants reported using glasses, and 63.80% used multifocal lenses. Dual impairment was identified in 143 (20.30%) participants. In multivariate logistic regression, the predictive variables for recurrent falls were low contrast sensitivity (95%CI 1.15­2.47), dual visual impairment (95%CI 1.16­2.83), and self-perceived fall risk (95%CI 1.16­2.46) which was measured using the Falls Efficacy Scale-International. CONCLUSION: Older adults with dual visual impairment are more likely to suffer recurrent falls. Low contrast sensitivity is crucial for fall risk assessment

OBJETIVO: Este estudo investiga a importância de avaliar a visão de idosos caidores na comunidade. METODOLOGIA: Estudo transversal com idosos elegíveis (> 60 anos) residentes na comunidade e que sofreram pelo menos uma queda nos últimos 12 meses do ensaio clínico PrevQuedas Brasil. Foram coletados dados sociodemográficos, informações sobre quedas pregressas, exames físicos e funcionais (BOMFAQ e FES-I). Avaliamos os comprometimentos da acuidade visual e da sensibilidade ao contraste por meio da Tabela E de Snellen e testes de acuidade visual de baixo contraste, respectivamente. O duplo déficit visual refere-se à presença de ambas as deficiências. Para análise estatística comparamos os idosos com relação ao número de quedas (caidores únicos ou caidores recorrentes) usando Qui-quadrado ou Teste exato de Fisher e o nível de significância foi <0.05 para todas as análises. RESULTADOS: Baixa acuidade visual, baixa sensibilidade ao contraste e duplo déficit visual foram associados a quedas recorrentes com odds ratio ­ OR 1,85, frequentemente mais prevalente entre os idosos longevos. Cerca de 90,00% dos idosos relataram usar óculos e 63,80% usavam lentes multifocais. O duplo déficit visual foi identificado em 143 (20,30%) participantes. Nos modelos de regressão logística multivariados, verificamos que as variáveis preditoras para queda recorrente foram a baixa sensibilidade ao contraste (intervalo de confiança ­ IC95% 1,15­2,47), duplo déficit (IC95% 1,16­2,83) e a autopercepção do risco de cair (IC95% 1,16­2,46) medido pela Falls Efficacy Scale-International. CONCLUSÃO: Idosos com baixa sensibilidade ao contraste e duplo déficit visual têm maiores chances de sofrerem múltiplas quedas quando comparados com idosos que possuem apenas baixa acuidade visual. Assim, a baixa sensibilidade ao contraste é essencial na avaliação do risco de quedas dos idosos

Progressive Resistance Training Program Characteristics in Rehabilitation Programs Following Hip Fracture: A Meta-Analysis and Meta-Regression.

Introduction: Older adults often experience incomplete recovery after a hip fracture. Rehabilitation programs with progressive resistance training are associated with improved functional recovery. This systematic review and meta-analysis with meta-regression a) evaluated resistance training characteristics reported in hip fracture rehabilitation programs, b) performed meta-analysis of resistance training impact on strength (primary outcome), gait and physical activity (secondary outcomes), and c) explored resistance training program characteristics associated with improved outcomes using meta-regression. Materials and Methods: Medline, EMBASE, CINAHLPLUS, and Web of Science Core Collection databases were searched (January2000-February2021). Randomized controlled trials including progressive resistance training rehabilitation programs after hip fracture surgery in adults ≥50 years old were included. Meta-analyses and exploratory meta-regression were performed. Results: Meta-analysis showed significant increases in strength (10 trials-728 participants; Standardized Mean Difference (SMD) [95%CI]; .40 [.02, .78]) immediately following program completion in intervention relative to control participants. Meta-analysis on 5 trials (n = 384) with extended follow up found no significant group differences (SMD = .47 [-.28, 1.23]) in strength. Center-based relative to home-based programs were associated with significantly greater improvements in strength (P < .05) as were programs where resistance training intensity was prescribed using one-repetition maximum relative to other exercise prescription methods (P < .05). In gait meta-analysis (n = 10 trials-704 participants), gait speed in intervention participants immediately after the program was significantly higher than control (SMD = .42 [.08, .76]) but this finding was not maintained in extended follow-up (n = 5 trials-240 participants; SMD = .6 [-.26, .38]). Higher resistance training intensity was associated with significant improvements in gait speed (P < .05). No meta-analysis was performed for the 3 heterogeneous studies reporting physical activity. Discussion: Progressive resistance training improved muscle strength and gait speed after hip fracture surgery in adults ≥50years old immediately after the program ended, but the longer-term impact may be more limited. Conclusions: Higher resistance training intensity and center-based programs may be associated with more improvement, but require further research.

Discontinuation of Health Interventions Among Brazilian Older Adults During the Covid-19 Pandemic: REMOBILIZE Study.

The objective of this study was to analyze changes in access to health interventions during the pandemic among Brazilian older adults and to investigate the factors associated with social and health inequalities. We conducted an online survey with Brazilian adults aged 60 + years between May and June 2020. A multidimensional questionnaire was used to investigate access to health interventions during the pandemic and associated factors. Of 1482 participants, 56.5% reported health care before the pandemic, and 36.4% discontinued it during the pandemic. The discontinuation rate was 64.4% (95% CI 61.1-67.6). Participants with higher educational level (nine or more years of education: OR 0.34; 95% CI 0.17-0.70) and higher income (eight or more times the minimum wage: OR 0.54; 95% CI 0.36-0.81) were associated with less probability of discontinuation. Presenting multimorbidity (OR: 1.42; 95% CI 1.06-1.90) and polypharmacy (OR: 0.61; 95% CI 0.46-0.81) were associated with discontinuity in health interventions. Our study showed that structural health inequities in access to health care shaped the rates of discontinuation in health care interventions during the COVID-19 pandemic. Strategic actions should be set up to actively monitor socially vulnerable older adults and strengthen community-based services to mitigate the discontinuation of health care interventions.

Domains of Balance Training Delivered in Rehabilitation Programs Following Hip Fracture Surgery in Older Adults: A Systematic Review.

BACKGROUND AND PURPOSE: The aim of this systematic review was to assess the domains and characteristics of balance training (BT) interventions delivered in rehabilitation programs following hip fracture to identify potential treatment gaps. METHODS: Manual and electronic searches (Web of Science, Medline, EMBASE, CINAHL, and ProQuest) were conducted. We selected randomized controlled trials with older adults following hip fracture surgery that included either specific BT or gait, mobility, or transfer training. Two independent reviewers extracted data and rated the methodological quality using the Physiotherapy Evidence Database scale. A third reviewer provided consensus. Extracted BT data included balance domain, progression, frequency, duration, intensity, level of supervision, setting, and rehabilitation phase. RESULTS AND DISCUSSION: We included 17 trials from 19 studies; 11 studies were rated as moderate to high methodological quality, but only 8 were considered to have high-quality BT components. Half of the interventions included only one balance domain, with stability during movement being the most commonly included domain. The primary balance progression utilized was reducing hand support. Dual task, anticipatory postural adjustment, reactive strategies, and perceptual training domains were rarely included. Balance training duration and intensity were poorly described. Although most programs were home-based with minimal levels of supervision, a few extended beyond postacute phase of rehabilitation. CONCLUSION: Further consideration should be given to include more challenging BT domains with planned progressions to maximize patient recovery through hip fracture rehabilitation programs.

Mobilisation and physiotherapy intervention following hip fracture: snapshot survey across six countries from the Fragility Fracture Network Physiotherapy Group.

PURPOSE: Hip fracture guidelines recommend early mobilisation, multidisciplinary care, physiotherapy and fall prevention interventions. This study documents mobilisation practices and physiotherapy interventions provided post-hip fracture in six countries. MATERIALS AND METHODS: Physiotherapists from orthopaedic wards in Denmark, Australia, Spain, Brazil, Norway and Ireland provided information regarding mobilisation and physiotherapy for 10 consecutive hip fracture patients (>60 years), between 2014 and 2018. RESULTS: Physiotherapists (n = 107) entered data on 426 patients. Two-thirds of patients (283, 66%) attempted standing 0-1 days after surgery (range: 0% of patients in Spain to 92% in Norway). Fewer patients (199, 47%) attempted walking on day 0-1 (range: 0% Spain/Brazil to 69% Norway). Physiotherapy to mobilise every weekday was provided to 356 patients (84%, range: 60% Ireland to 100% Spain). On weekends, physiotherapy to mobilise was limited (175, 40%, range: 0% Spain to 81% Brazil) but 298 patients (70%) mobilised with non-physiotherapy staff (range: 0% Spain to 96% Denmark/Ireland). Physiotherapy treatments included mobility, gait training, and range-of-motion exercises. Referral to fall prevention interventions was low (93, 22%, range: 0% Spain to 76% Ireland). CONCLUSION: Stronger compliance with guideline recommendations on early mobilising, weekend mobilising and referral to fall prevention interventions post hip-fracture is needed in some countries.Implications for rehabilitation This study provides a snapshot of mobilisation and physiotherapy practice for hip fracture patients in six countries. The results suggest a need to improve systems and approaches in some countries to enhance compliance with recommendations specifically relating to: • early attempts at standing and walking post-surgery. • opportunities to mobilise on weekends (with physiotherapist and/or other staff). • broader range of multidisciplinary care e.g., geriatric review, occupational therapy and nutrition advice. • use of standardised tests by physiotherapists post-surgery. • referral to fall prevention interventions.

Precisão da medida de mobilidade no espaço de vida para discriminar fragilidade e sarcopenia em idosos / Accuracy of the life-space mobility measure for discriminating frailty and sarcopenia in older people

Resumo Objetivo Identificar o perfil de mobilidade nos espaços de vida em idosos que vivem na comunidade e estabelecer a precisão dos pontos de corte desse instrumento para discriminar entre níveis de fragilidade, fragilidade em marcha e de risco de sarcopenia. Método Estudo observacional e metodológico com 391 participantes com 72 anos e mais (80,4±4,6), que responderam ao Life Space Assessment (LSA) e a medidas de rastreio de fragilidade e risco de sarcopenia usando respectivamente o fenótipo de fragilidade e o SARC-F. Os pontos de corte para fragilidade e risco de sarcopenia foram determinados por meio da Curva ROC (Receiver Operating Characteristic) com intervalos de confiança de 95%. Resultados A média da pontuação no LSA foi 53,6±21,8. Os pontos de corte de melhor acurácia diagnóstica foram ≤54 pontos para fragilidade em marcha (AUC= 0,645 95%; p<0,001) e ≤60 pontos para risco de sarcopenia (AUC= 0,651 95%; p<0,001). Conclusão A capacidade de idosos de se deslocar nos vários níveis de espaços de vida, avaliado pelo LSA demonstrou ser uma ferramenta viável que pode contribuir no rastreio de fragilidade em marcha e de risco de sarcopenia e, com isso, prevenir desfechos negativos.

Abstract Objective To identify the profile of a sample of older people recruited at home based on a measure of life-space mobility and to establish the accuracy of the cut-off points of this instrument for discriminating between levels of frailty, frailty in walking speed and risk of sarcopenia. Method An observational methodological study of 391 participants aged ≥72 (80.4±4.6) years, who answered the Life-Space Assessment (LSA) and underwent frailty and risk of sarcopenia screening using the frailty phenotype and SARC-F measures, respectively, was performed. The cut-off points for frailty and risk of sarcopenia were determined using ROC (​​Receiver Operating Characteristic) curves and their respective 95% confidence intervals. Results Mean total LSA score was 53.6±21.8. The cut-off points with the best diagnostic accuracy for total LSA were ≤54 points for frailty in walking speed (AUC=0.645 95%; p<0.001) and ≤60 points for risk of sarcopenia (AUC=0.651 95%; p<0.001). Conclusion The ability of older people to move around life-space levels, as assessed by the LSA, proved a promising tool to screen for frailty in walking speed and risk of sarcopenia, thus contributing to the prevention of adverse outcomes.

Defining, reporting, and monitoring near-falls in older adults: a scoping review protocol / Definição, registro e monitoramento de quase-quedas em idosos: protocolo de revisão de escopo

INTRODUCTION: In addition to traditional risk factors for falls (e.g., reduced muscle strength, polypharmacy, and poor vision), researchers have been investigating whether other factors, such as near-falls, can be identified to allow early intervention and prevention. A near-fall can be defined as a slip, trip, or loss of balance that would result in a fall if adequate recovery mechanisms were not activated. Despite the increasing interest in near-falls, there is no consensus about the definition, reporting methods, and contributing factors. OBJECTIVE: To identify how near-falls among older adults have been defined, reported, and monitored in the scientific literature. METHODS: Indexed literature published in English, Spanish, and Portuguese will be considered and retrieved from 10 databases, until August 31st, 2020. Two authors will independently screen titles, abstracts, and full texts against the eligibility criteria, and disagreements will be resolved by a third reviewer. This review will consider studies with different designs that have included older adults (aged 60 years and over), recruited participants from different settings, and had an explicit definition and/or reporting of near-falls. A customized form will be used to extract data from the included studies. The results will be presented in tabular form, accompanied by a narrative summary. This protocol is registered at https://osf.io/txnv4. EXPECTED RESULTS AND RELEVANCE: Depending on the results, a conceptual framework for nearfall reporting, contributing factors, and a possible prodrome of falls will also be presented. It is expected that the present study will help professionals identify and manage near-falls in different settings.

INTRODUÇÃO: Além dos fatores de risco tradicionais para quedas (por exemplo, força muscular reduzida, polifarmácia e visão deficiente), pesquisadores têm investigado se outros fatores, como quase-quedas, podem ser identificados para permitir a intervenção e prevenção precoces. Uma quase-queda pode ser definida como um escorregão, um tropeço ou a perda de equilíbrio que resultaria em uma queda se os mecanismos de recuperação adequados não fossem ativados. Apesar do crescente interesse em quase-quedas, não há consenso sobre a definição, os métodos de registro e os fatores contribuintes. OBJETIVO: Identificar como as quase-quedas em idosos têm sido definidas, registradas e monitoradas na literatura científica. MÉTODOS: Será considerada a literatura indexada publicada em inglês, espanhol e português e extraída de 10 bases de dados, até 31 de agosto de 2020. Dois autores irão verificar os títulos, os resumos e os textos completos de forma independente de acordo com os critérios de elegibilidade, e as divergências serão resolvidas por um terceiro revisor. Nesta revisão, serão considerados estudos com diferentes desenhos que incluam idosos (com 60 anos ou mais), que tenham recrutado os participantes em diferentes ambientes e que tenham uma definição explícita e/ou registro de quase-quedas. Um formulário personalizado será utilizado para extrair os dados dos estudos incluídos. Os resultados serão apresentados em forma de tabela, acompanhados de um resumo narrativo. Este protocolo está registrado em https:// osf.io/txnv4. RESULTADOS ESPERADOS E RELEVÂNCIA: Dependendo dos resultados, também será apresentada uma matriz conceitual para o registro de quase-quedas, fatores contribuintes e um possível pródromo de quedas. Espera-se que o presente estudo ajude os profissionais na identificação e no gerenciamento de quase-quedas em diferentes cenários.

Multidimensional investigation of chronic pain experience and physical functioning following hip fracture surgery: clinical implications.

INTRODUCTION: Older adults experience significant chronic pain after hip fracture, resulting in decreased physical functioning. However, pain investigation in this population is mostly limited to self-reported pain intensity. Detailed pain assessment may identify intervention targets other than pain relief. The aim of this study is to investigate multiple dimensions of pain experience (intensity, sensory, affective, evaluative and miscellaneous dimensions) and to correlate them to lower limb functionality and limitations in daily living activities. METHODS: We conducted a cross-sectional study of 50 older adults (77.1 ± 8.1 years old) who underwent hip fracture surgery in the past 4 months. We used the Numeric Rating Scale (NRS), the McGill Pain Questionnaire (MPQ) and an algometer to assess pain intensity, pain quality and pressure pain threshold, respectively. Lower limb functionality and limitation in basic (activities of daily living (ADL)) and instrumental activities of daily living (IADL) were assessed using the Short Physical Performance Battery (SPPB) and the Brazilian OARS Multidimensional Functional Assessment Questionnaire. RESULTS: Participants described pain as brief, momentary and transient, especially during weight-bearing activities. Although the pain intensity measured by the NRS was reported as moderate to severe (7.5 ± 1.6 points), it was not correlated with physical functioning. However, we observed a moderate negative correlation between pressure pain threshold, ADL and IADL disability (r = -0.41, p < 0.01). Among pain qualities, the sensory category was moderately negatively correlated to SPPB (r = -0.41, p < 0.01), and the evaluative category was moderately correlated to ADL and IADL disability (r = 0.43, p < 0.01). CONCLUSION: Pain can be present 4 months after hip fracture surgery, particularly during weight-bearing activities, and it is associated with poor lower limb functionality, as well as ADL and IADL disability. Older adults may benefit from pain assessments that go beyond pain intensity measurements after hip fracture, as this helps clinicians optimise pain management and overall functional recovery.

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.

Utilitarian walking and walking as exercise among community-dwelling older adults: what factors influence it? / Caminhada utilitária e caminhada como exercício para os idosos: quais fatores podem influenciar?

Abstract Objective : to investigate the association between utilitarian walking and walking as exercise, and socio-demographic, clinical and functional covariates related to these walking types. Methods : a cross-sectional exploratory study was conducted with 148 older adults (aged 60 and over). Walking frequency and duration was assessed using the IPEQ-W (Incidental and Planned Exercise Questionnaire - Version W). Socio-demographic, clinical conditions, level of disability and mobility were also assessed. Types of walking were compared among the variables using the Mann-Whitney test and non-parametric Spearman rho correlations were used to investigate the association between the types of walking and the variables. Results : the participants performed a mean of 1.1 (±2.1) h/week of walking as exercise and 2.2 (±2.3) h/week of utilitarian walking. Older adults who had diabetes (p=0.015) did fewer h/week of walking as exercise. Participants who were older (p=0.014), reported poor self-rated health (p<0.001), poor disability levels (p<0.001), hypertension (p=0.048), strokes (p<0.001), heart disease (p=0.026), urinary incontinence (p<0.001), dizziness (p=0.008), or sleep disorders (p=0.042) spent fewer hours performing utilitarian walking. Correlations between the covariates and types of walking varied from very weak to weak. Conclusion : chronic diseases and unfavorable health conditions decreased walking time. Utilitarian walking was the most frequent type of walking performed by the older adults. Health care professionals and public policy managers should use utilitarian walking as a way of increasing levels of physical activity and to promote healthy aging.

Resumo Objetivo : Investigar a associação entre a caminhada utilitária, a caminhada como exercício e variáveis sociodemográficas, clínicas e funcionais associadas a esses tipos de caminhada. Métodos : Foi conduzido um estudo transversal exploratório, com 148 idosos (com 60 anos de idade ou mais). A frequência e duração da caminhada foi avaliada por meio do IPEQ-W (Incidental and Planned Exercise Questionnaire - Version W). Dados sociodemográficos, condições clínicas, nível de funcionalidade e mobilidade também foram avaliados. O teste de Mann-Whitney foi utilizado para comparar os tipos de caminhada com as variáveis e o teste de correlação de Spearman rho foi utilizado para analisar a associação entre os tipos de caminhada e as variáveis. Resultados : Participantes realizaram em média 1,1 (±2,1) h/semana de caminhada como exercício e 2,2 (±2,3) h/semana de caminhada utilitária. Participantes mais velhos (p=0,014), com pior percepção de saúde (p<0,001), com pior funcionalidade (p<0,001), que relataram hipertensão (p=0,048), AVE (p<0,001), doença do coração (p=0,026), incontinência urinária (p<0,001), tontura (p=0,008), problemas para dormir (p=0,042) e polifarmácia (p=0,019) fizeram menos horas de caminhada utilitária. A correlação entre as covariáveis e os tipos de caminhadas variou de muito fraca a fraca. Conclusão : Doenças crônicas e condições desfavoráveis de saúde diminuem o tempo de caminhada. A caminhada utilitária é a mais comumente realizada pelos idosos. Profissionais de saúde e gestores de políticas públicas devem usar a caminhada utilitária como uma forma de aumentar o nível de atividade física e promover o envelhecimento saudável.

Whodas 2. 0 - BO: normative data for the assessment of disability in older adults / Whodas 2. 0 - BO: dados normativos para avaliação de incapacidade em idosos

ABSTRACT OBJECTIVE: To examine the normative data of WHODAS 2.0-BO for older Brazilians (World Health Disability Assessment Schedule - Brazilian version for older people) and its distribution according to sex, age, health, subjective health perception, performance in a mobility test and presence of chronic diseases and depression. METHODS: Cross-sectional study, with 350 participants with 60 years of age or older, men and women, patients of a geriatric specialized center for medical consultations or rehabilitation. The older adults were evaluated using a semi-structured questionnaire containing demographic and clinical data (WHODAS 2.0-BO) and the geriatric depression scale (GDS), having been subsequently subjected to a mobility test (Timed Up and Go). The data were analyzed via their distribution in percentiles of the population and via analysis of variance. RESULTS: Two-hundred and sixty-six (76%) participants were women, and the average age was 71.8 (DP = 6.7) years old. The average score in WHODAS 2.0-BO was 4.3 (DP = 5.2) points, the highest value found having corresponded to 33 points. The average time for the Timed Up and Go test was 10.0 (SD = 3.2) seconds. About 30% of the older adults did not report any difficulties in the tasks evaluated by WHODAS 2.0-BO and half of the sample scored up to two points. CONCLUSIONS: A score corresponding to 12 points in the 90 percentile on a scale from zero to 40 was observed, which suggests severe disability. The score in WHODAS 2.0-BO increased with the advance in age, as well as in the presence of comorbidities, negative health perception, depression, high blood pressure, visual and hearing impairment and mobility impairment.

RESUMO OBJETIVO: Examinar os dados de normatização do WHODAS 2.0-BO para idosos brasileiros (World Health Disability Assessment Schedule - Brazilian version for older people) e sua distribuição de acordo com sexo, idade, percepção subjetiva de saúde, desempenho em teste de mobilidade e presença de doenças crônicas e depressão. MÉTODOS: Estudo transversal, com 350 participantes com 60 anos ou mais, homens e mulheres, atendidos em um centro de referência secundário para consultas médicas ou de reabilitação. Os idosos foram avaliados por meio de um questionário semiestruturado, contendo dados sociodemográficos e clínicos, o WHODAS 2.0-BO e a escala de depressão geriátrica (EDG), e submetidos a um teste mobilidade, o Timed Up and Go. Os dados foram analisados por sua distribuição em percentis na população e por análise de variância. RESULTADOS: Duzentos e sessenta e seis (76%) participantes eram mulheres, a idade média foi de 71,8 (DP = 6,7) anos. O escore médio do WHODAS 2.0-BO foi de 4,3 (DP = 5,2) pontos, sendo o maior valor encontrado 33 pontos. O tempo para o Timed up and Go foi de 10,0 (DP = 3,2) segundos. Cerca de 30% dos idosos não relataram nenhuma dificuldade nas tarefas avaliadas pelo WHODAS 2.0-BO e metade da amostra alcançou até dois pontos. CONCLUSÕES: Observou-se um escore de 12 pontos no percentil 90 em uma escala de zero a 40, o que sugere incapacidade grave. O escore do WHODAS 2.0-BO aumentou com o avançar da idade, bem como na presença de comorbidades, de percepção subjetiva de saúde ruim, de depressão, de hipertensão arterial, de dificuldade para enxergar e escutar e de alteração da mobilidade.

Characteristics of falls in elderly persons residing in the community: a population-based study / Características das quedas em idosos que vivem na comunidade: estudo de base populacional

Abstract Object: to examine the characteristics to the last fall of Brazilian elderly persons who experienced falls in 2008 and 2009, and to identify if there is a relationship with sociodemographic characteristics, physical health, comorbidities, clinical conditions and the circumstances of the falls. Methods: a cross-sectional, population based study was carried out with participants aged 65 and older from Barueri in the state of São Paulo and Cuiabá in the state of Mato Grosso, Brazil. Households were enrolled within each census region according to population density and the number of elderly persons living in each region. A multidimensional questionnaire composed of sociodemographic factors and data regarding falls was used. Associations were analyzed using contingency tables, and Fisher's Exact or Pearson's Chi-square test was used. Results: 774 elderly people were included in the study, 299 of whom reported falling in the previous year. Of these, 176 (58.9%) had fallen once and 123 (41.1%) reported having fallen twice or more. Among fallers the mean age was 72.53 (±6.12) years and 214 (71.6%) were female. About 107 (35.8%) of the elderly reported having fallen forwards, 79 (26.4%) fell to the side and 42(14%) fell backwards. Regarding the circumstances of the falls, 107 (35.8%) reported having lost their balance, 79 (26.4%) said they had stumbled and 42 (14%) said they had slipped. There was an association between the mechanism and circumstances of the falls and having fallen once or twice or more. There was an association between the circumstances of falls and the number of medications taken. Conclusion: The characteristics of falls were different among elderly persons who had fallen once or twice or more, which may guide health professionals, the elderly and their families in relation to specific fall prevention strategies. AU

Resumo Objetivo: Explorar as características da última queda em idosos brasileiros que caíram em 2008 e 2009 e identificar se há relação com as características sociodemográficas, de saúde física, comorbidades, condições clínicas e com as circunstâncias de quedas. Método: Estudo transversal, de base populacional, com idosos de 65 anos de idade ou mais, de Barueri, SP e Cuiabá, MT, Brasil. Foi utilizado um inquérito multidimensional contendo dados sociodemográficos, de saúde física e mental e de quedas. As associações foram analisadas por meio de tabelas de contingência e foi usado o teste Exato de Fisher ou de qui-quadrado de Pearson. Resultados: 774 idosos foram incluídos no estudo e destes, 299 (38,6%) relataram queda no último ano, sendo que 176 (58,9%) caíram uma vez e 123 (41,1%) relataram ter caído duas vezes ou mais. Entre os caidores, a idade média foi de 72,5 (±6,1) Cerca de 107 (35,8%) dos idosos relataram ter caído para frente,79 (26,4%) para os lados e 42 (14%) para trás. Quanto às circunstâncias, 107 (35,8%) idosos relataram ter perdido o equilíbrio, 79 (26,4%) referiram ter tropeçado e 42 (14%) ter escorregado. Houve associação entre o mecanismo e as circunstâncias das quedas e ter caído uma vez ou duas vezes ou mais. Houve associação entre as circunstâncias das quedas e o número de medicações. Conclusão: As características das quedas são diferentes para os idosos que caíram uma ou duas ou mais vezes, o que pode nortear os profissionais de saúde, idosos e seus familiares em relação a estratégias específicas para prevenção de quedas. AU

Microwave diathermy and transcutaneous electrical nerve stimulation effects in primary dysmenorrhea: clinical trial protocol.

The aim of this study will be to analyze the effects of microwave diathermy (MWD) and transcutaneous electrical nerve stimulation (TENS) on primary dysmenorrhea. Eighty eight women, age range 18-44 years, with no previous pregnancy, no practice physical activities, a BMI of ≤29.9 kg/m2, a regular menstrual cycle and a diagnosis of primary dysmenorrhea, with menstrual pain ranging from mild to severe, will be selected. The participants will be randomized into four groups: MWD and TENS, MWD and placebo TENS, placebo MWD and TENS, and placebo MWD and placebo TENS. Pain will be measured using the visual numeric scale and the McGill Pain Questionnaire; the pressure pain threshold using a digital algometer and conditioned pain modulation using the cold pressor test. Brazilian Clinical Trials Registry (RBR-5QKCK4. Registered on 16 March 2016).

Prevalence of obesity, sarcopenic obesity and associated factors: A FIBRA Network study / Prevalência da obesidade, obesidade sarcopênica e fatores associados: um estudo da Rede FIBRA

Abstract Introduction: Sarcopenic obesity in older adults may lead to an inability to use muscles efficiently and has been associated with functional deficits and disabilities. Objective: To identify the prevalence of obesity and sarcopenic obesity (SO) among community-dwelling older adults, and to characterize associated sociodemographics, health conditions and functional performance. Methods: Study data are from the FIBRA Network database of the Federal University of Minas Gerais. There were 1,373 older adult participants, subdivided into three groups: 1) non-obese; 2) non-sarcopenic obese; and 3) sarcopenic obese (SO). The latter is defined as a BMI ≥30 kg/m2 and weak palmar grip strength (PGS). Results: The overall prevalence of obesity and SO among older adults was 25.85% and 4.44%, respectively, with levels of frailty and pre-frailty among at 36.1% and 59%, respectively. Gait speed (GS) was lower in the SO group as well, compared to the other groups. An average increase in GS of 0.1 m/sec reduced the likelihood of SO by 85.1%, in average. Sarcopenic obese older adults were 14.2 times more likely to be pre-fragile and 112.9 times more likely to be fragile than the other groups. Conclusion: The prevalence of obesity found in this study was higher than that in the general population, but similar to national statistics for the sample's mean age and gender. SO was directly associated with frailty in advanced and instrumental activities of daily living as well as gait speed and significantly increased the likelihood of being pre-frail and frail. GS may be an extremely useful tool for monitoring the progress of SO in older adults.

Resumo Introdução: A obesidade sarcopênica é uma condição de saúde que em idosos, pode resultar na incapacidade de utilizar os músculos de forma eficiente e tem sido associada a déficits funcionais e incapacidades. Objetivo: Identificar a prevalência da obesidade e obesidade sarcopênica (OS) e os fatores sociodemográficos, condições de saúde e medidas de desempenho funcional, associadas à OS em idosos comunitários. Métodos: Recorte do banco de dados do polo UFMG da Rede FIBRA. Participaram do estudo 1373 idosos divididos em três grupos 1) Não obesos; 2) Obesos não sarcopênicos; 3) Obesos sarcopênicos. OS foi definida por IMC ≥30 kg/m2 e baixa força de preensão palmar (FPP). Resultados: A prevalência de obesidade foi 25,85% e de OS foi 4,44%. Entre os obesos sarcopênicos a prevalência de fragilidade foi 36,1% e 59% de pré-frágilidade. A velocidade de marcha (VM) no grupo obeso sarcopênico, foi menor quando comparada aos outros grupos. Um aumento médio de 0,1m/seg na VM reduziu em média 85,1% a chance de se ter OS na amostra. Ser obeso sarcopênico aumentou em 14,2 vezes a chance de ser pré-frágil e 112,9 vezes a chance de ser frágil. Conclusão: A prevalência de obesidade foi maior que as taxas gerais, porém semelhante aos dados nacionais para a média de idade e sexo da amostra. OS se associou ao perfil de fragilidade, às atividades instrumentais e avançadas de vida diária e à velocidade de marcha. OS aumentou expressivamente a chance de o idoso ser pré-frágil e frágil e a VM pode ser uma ferramenta útil de acompanhamento da progressão da OS.

Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study / Fatores relacionados à sonolência diurna excessiva em idosos da comunidade: um estudo exploratório

Excessive daytime sleepiness (EDS) imposes a wide range of adverse health-related outcomes in older people, such as disability, which impair everyday activities and may increase the risk of fall. Few studies have explored EDS in Brazilian older people living in the community who are typically cared in primary health services. This study aims to investigate the prevalence of EDS and its sociodemographic, physical and mental health correlates among community-dwelling older adults. This is an exploratory, population-based study derived from Frailty in Brazilian Older Adults (FIBRA) study including adults aged 65 years and older. Participants with a score ≥ 11 points on the Epworth Sleepiness Scale were considered as having excessive daytime sleepiness. A structured, multidimensional questionnaire was used to investigate sociodemographic, physical and mental health, and self-rated health variables. The sample was composed of 776 older adults, of whom 21% (n = 162) presented excessive daytime sleepiness. Multivariate regression analysis revealed that EDS is associated with obesity (OR = 1.50; 95%CI 1.02 - 2.20), urinary incontinence (OR = 1.53; 95%CI 1.01 - 2.31), poor self-rated health (OR = 1.54; 95%CI 1.06 - 2.24), and depression symptoms (OR = 1.49; 95%CI 1.00 - 2.20). Our results suggest that healthcare professionals should identify older adults with EDS and implement intervention strategies to minimize the negative impact of the co-occurrence of this condition with obesity, depression and urinary incontinence over health and quality of life.

A Sonolência Diurna Excessiva (SDE) está relacionada a vários efeitos adversos na saúde de pessoas idosas, como a incapacidade funcional, que compromete as atividades do cotidiano e aumenta o risco de quedas. Poucos estudos têm explorado a SDE em idosos brasileiros que vivem na comunidade, que são tipicamente cuidados em serviços de atenção primária em saúde. Este estudo tem como objetivo investigar a prevalência da SDE e sua correlação com dados sociodemográficos, físicos e sobre a saúde mental de idosos que vivem na comunidade. Este é um estudo exploratório de base populacional, derivado da Rede de Estudos de Fragilidade de Idosos Brasileiros (FIBRA) com idosos com de 65 anos ou mais. Participantes com um escore ≥ 11 pontos na Escala de Sonolência de Epworth foram considerados como tendo SDE. Um questionário estruturado, multidimensional foi usado para investigar as variáveis sociodemográficas, físicas, saúde mental, e qualidade de vida. A amostra foi composta por 776 idosos, dos quais 21% (n = 162) apresentavam SDE. A análise de regressão múltipla revelou que a SDE está associada à obesidade (OR = 1.50; IC95% 1.02 - 2.20), incontinência urinária (OR = 1.53; IC95% 1.01 - 2.31), má qualidade de vida (OR = 1.54; IC95% 1.06 - 2.24) e sintomas depressivos (OR = 1.49; IC95% 1.00 - 2.20). Nossos resultados sugerem que profissionais da saúde devem identificar os idosos com SDE e implementar intervenções para minimizar o impacto negativo da coocorrência dessas condições com obesidade, depressão e incontinência urinária sobre a saúde e qualidade de vida.

Association among measures of mobility-related disability and self-perceived fatigue among older people: a population-based study

Objective: To investigate the relationship between self-perceived fatigue with different physical functioning tests and functional performance scales used for evaluating mobility-related disability among community-dwelling older persons. Method: This is a cross-sectional, population-based study. The sample was composed of older persons with 65 years of age or more living in Cuiabá, MT, and Barueri, SP, Brazil. The data for this study is from the FIBRA Network Study. The presence of self-perceived fatigue was assessed using self-reports based on the Center for Epidemiologic Studies-Depression Scale. The Lawton instrumental activities of daily living scale (IADL) and the advanced activities of daily living scale (AADL) were used to assess performance and participation restriction. The following physical functioning tests were used: five-step test (FST), the Short Physical Performance Battery (SPPB), and usual gait speed (UGS). Three models of logistic regression analysis were conducted, and a significance level of α<0.05 was adopted. Results: The sample was composed of 776 older adults with a mean age (SD) of 71.9 (5.9) years, of whom the majority were women (74%). The prevalence of self-perceived fatigue within the participants was 20%. After adjusting for covariates, SPPB, UGS, IADL, and AADL remained associated with self-perceived fatigue in the final multivariate regression model. Conclusion: Our results suggest that there is an association between self-perceived fatigue and lower extremity function, usual gait speed and activity limitation and participation restriction in older adults. Further cohort studies are needed to investigate which physical performance measure may be able to predict the negative impact of fatigue in older adults. .

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.