Frailty Screening: Inflammatory Markers Assessment and Identification of Adverse Health Factors in Hospitalized Older Adults.

BACKGROUND AND PURPOSE: The detection of older individuals who are most vulnerable to adverse health effects (AHE) may be useful for practitioners in managing health care resources. The purpose of this study was to analyze the prevalence and identify AHE after hospital discharge (HD). METHODS: This cohort study included 135 hospitalized older individuals. Fragility was assessed by changes in the plasma concentrations of C-reactive protein and / or leukocytes. RESULTS: Fragile individuals had a higher risk of rehospitalization, consumption of drugs, functional impairment and mortality within 30 days post-HD, and higher risk of functional disability at 180 days post-HD. CONCLUSION: More than one-third of hospitalized older individuals are fragile and require more attention in the first 30 days because of the associated AHE.

Barriers to the involvement of the elderly in public services to promote physical activity.

The aim of this study was to examine the sociodemographic, health and behavioural characteristics related to non-participation of elderly people in activities offered by the program PROETI Health of Uberaba, Minas Gerais state. Observational study, case-control design with pairing 1:1 and sample composed of 220 elderly 60-80 years. Binary Logistic Regression was used to identify the sociodemographic, health and behavioral factors associated with non-engagement of non-users to the program. After hierarchical analysis, the non-engagement of the elderly in the program activities was associated with depressive symptoms, insufficient physical activity in the domain of leisure and reduced self-efficacy for performing moderate or vigorous physical activity. The characteristics identified in this study should receive priority attention in the formulation of community programs targeted at promoting physical activity for elderly people.

Barriers to the involvement of the elderly in public services to promote physical activity / Barreiras no engajamento de idosos em serviços públicos de promoção de atividade física

The aim of this study was to examine the sociodemographic, health and behavioural characteristics related to non-participation of elderly people in activities offered by the program PROETI Health of Uberaba, Minas Gerais state. Observational study, case-control design with pairing 1:1 and sample composed of 220 elderly 60-80 years. Binary Logistic Regression was used to identify the sociodemographic, health and behavioral factors associated with non-engagement of non-users to the program. After hierarchical analysis, the non-engagement of the elderly in the program activities was associated with depressive symptoms, insufficient physical activity in the domain of leisure and reduced self-efficacy for performing moderate or vigorous physical activity. The characteristics identified in this study should receive priority attention in the formulation of community programs targeted at promoting physical activity for elderly people.

O objetivo deste estudo foi analisar as características sociodemográficas, de saúde e comportamentais relacionadas a não participação das idosas nas atividades oferecidas pelo programa Proeti Saúde de Uberaba, Minas Gerais. Estudo observacional, do tipo caso controle, com pareamento 1:1, tendo amostra sido composta por 220 idosas de 60 a 80 anos. A Regressão Logística Binária foi utilizada para a identificação dos fatores sociodemográficos, de saúde e comportamentais associados ao não engajamento das não usuárias ao programa. Após análise hierarquizada o não engajamento das idosas às atividades do programa mostrou-se associada à sintomatologia depressiva, prática insuficiente de atividade física no domínio do lazer e autoeficácia reduzida para a realização de atividade física moderada ou vigorosa. As características identificadas neste estudo devem receber atenção prioritária na formulação de programas comunitários direcionados à promoção de atividade física às pessoas idosas.

Cardiac autonomic modulation in non-frail, pre-frail and frail elderly women: a pilot study.

Frailty has been defined as a geriatric syndrome that results in high vulnerability to health adverse outcomes. This increased vulnerability state results from dysregulation of multiple physiological systems and its complex interactions. Thus, assessment of physiological systems integrity and of its dynamic interactions seems to be useful in the context of frailty management. Heart rate variability (HRV) analysis provides information about autonomic nervous system (ANS) function, which is responsible to control several physiologic functions. This study investigated the cardiac autonomic modulation by HRV analysis in community-dwelling elderly women classified as non-frail, pre-frail and frail. Twenty-three elderly women were assigned to the following groups: non-frail (n = 8), pre-frail (n = 8) and frail (n = 7). HRV assessment was performed through linear and non-linear analysis of cardiac interval variability. It was observed a higher sympathetic and lower parasympathetic modulation in frail when compared with non-frail and pre-frail groups (p < 0.05) as indicated by frequency domain indices. Additionally, frail group had a decreased 2LV % pattern (that reflects parasympathetic modulation) in the symbolic analysis in comparison with non-frail group. These findings suggest that frail elderly women present an autonomic imbalance characterized by a shift towards sympathetic predominance. Thus, monitoring ANS function in the context of frailty management may be an important strategy to prevention, diagnosis and treatment of this syndrome and its consequences.

Análise de grupos de pesquisa em atividade física e envelhecimento no Brasil / Analyses of research groups in physical activity and aging in Brazil

Atividade física regular tem sido recomendada pelos estudiosos da área do envelhecimento devido aos seus benefícios à saúde.O objetivo desse estudo foi analisar e caracterizar os Grupos de Pesquisa em Atividade Física e Envelhecimento no Brasil, de acordo com a distribuição geográfica. Realizou-se busca sistemática no Diretório de Grupos de Pesquisa do Conselho Nacional de Desenvolvimento Científico e Tecnológico sobre a temática: Atividade Física e Envelhecimento. Os Grupos de Pesquisa em Atividade Física e Envelhecimento certificados estão distribuídos entre as regiões Sudeste (n=8), Sul (n=6) e Nordeste (n=4). Artigos publicados em periódicos representam 69,7% (n=639) da produção científica da região Sudeste, 65,0% (n=39) da região Sul e 64,9% (n=126) da região Nordeste. Observou-se um gradativo aumento no número de Grupos de Pesquisa em Atividade Física e Envelhecimento no Brasil, porém estes grupos ainda não estão distribuídos por todo país.

Regular physical activity has been recommended by experts in the field of aging because of its health benefits. The aim of this study was to analyze and characterize the research groups in physical activity and aging in Brazil, according to geographical distribution. A systematic search was conducted in the directory of research groups of the National Council for Scientific and Technological Development about the issue: “physical activity and aging”. The research groups in physical activity and aging in Brazil certificates are distributed in three regions of Brazil: Southeast (n = 8), South (n = 6) and Northeast (n = 4). Articles published in journals represent 69.7% (n = 639) of the scientific production of the Southeast region, 65.0% (n = 39) of the South region and 64.9% (n = 126) of the Northeast region. There was a gradual increase in the number of research groups in physical activity and aging in Brazil, but these groups are not distributed throughout the country.

Physical activity as a predictor of absence of frailty in the elderly.

OBJECTIVE: To analyze physical activity in different domains (work, transportation, housework, and leisure) as a predictor of the absence of frailty. METHODS: An epidemiological cross-sectional study with a random sample of 622 individuals aged > 60 years was carried out in Uberaba, MG, Brazil. Receiver operating characteristic (ROC) curves were generated and compared with physical activity in different domains and the absence of frailty. Cutoffs points of physical activity (minutes/week) were established to predict the absence of frailty. A confidence interval of 95% was established in order to find the largest areas under the ROC curves for work, transportation, household, and leisure. The total physical activity and its domains were assessed by the international physical activity questionnaire. The index of frailty (unintentional weight loss, functional limitation to chair rise, handgrip strength, physical activity, and exhaustion) was based on the study by Fried; the participants were dichotomously classified as not frail and frail. RESULTS: The prevalence of frailty was 19.7% (men) and 20% (women). Physical activity of moderate or vigorous intensity accumulated in different domains for 145 minutes/week for women and 140 minutes/week for men or 85 minutes/week for women and 112.5 minutes/week for men for activities in the leisure domain showed the best cutoff to predict the absence of frailty. CONCLUSION: The practice of physical activity, especially in leisure time or accumulated in different domains, contributes to the prevention of frailty in the elderly.

Atividade física como preditor da ausência de fragilidade em idosos / Physical activity as a predictor of absence of frailty in the elderly

OBJETIVO: Analisar a atividade física em diferentes domínios (trabalho, transporte, tarefas domésticas e lazer) como preditor de ausência de fragilidade. MÉTODOS: Estudo epidemiológico de corte transversal com uma amostra probabilística de 622 indivíduos com idade > 60 anos foi realizado em Uberaba, MG. Foram construídas curvas receiver operating characteristic (ROC) e comparadas com a atividade física em diferentes domínios e ausência de fragilidade. Pontos de corte de atividade física (minutos/semana) foram estabelecidos para prever a ausência de fragilidade. Um intervalo de confiança de 95% foi considerado para encontrar as maiores áreas sob as curvas ROC para os domínios trabalho, transporte, tarefas domésticas e lazer. A atividade física total e seus domínios foram avaliados pelo Questionário Internacional de Atividade Física. O índice de fragilidade (perda de peso não intencional, limitação funcional para levantar da cadeira, força de preensão manual, atividade física habitual e exaustão) foi realizado com base no estudo de Fried, sendo os participantes classificados dicotomicamente em não frágil e frágil. RESULTADOS: A prevalência de fragilidade foi de 19,7% (homens) e 20% (mulheres). A atividade física de intensidade moderada ou vigorosa acumulada em diferentes domínios durante 145 minutos/semana para mulheres e 140 minutos/semana para o homem ou ainda, 85 minutos/semana para mulheres e 112,5 minutos/semana para o homem de atividades no domínio do tempo de lazer apresentaram o melhor ponto de corte para predizer a ausência de fragilidade. CONCLUSÃO: Praticar atividade física, especialmente no tempo de lazer ou acumulada em diferentes domínios, contribui para a prevenção da fragilidade em idosos.

OBJECTIVE: To analyze physical activity in different domains (work, transportation, housework, and leisure) as a predictor of the absence of frailty. METHODS: An epidemiological cross-sectional study with a random sample of 622 individuals aged > 60 years was carried out in Uberaba, MG, Brazil. Receiver operating characteristic (ROC) curves were generated and compared with physical activity in different domains and the absence of frailty. Cutoffs points of physical activity (minutes/week) were established to predict the absence of frailty. A confidence interval of 95% was established in order to find the largest areas under the ROC curves for work, transportation, household, and leisure. The total physical activity and its domains were assessed by the international physical activity questionnaire. The index of frailty (unintentional weight loss, functional limitation to chair rise, handgrip strength, physical activity, and exhaustion) was based on the study by Fried; the participants were dichotomously classified as not frail and frail. RESULTS: The prevalence of frailty was 19.7% (men) and 20% (women). Physical activity of moderate or vigorous intensity accumulated in different domains for 145 minutes/week for women and 140 minutes/week for men or 85 minutes/week for women and 112.5 minutes/week for men for activities in the leisure domain showed the best cutoff to predict the absence of frailty. CONCLUSION: The practice of physical activity, especially in leisure time or accumulated in different domains, contributes to the prevention of frailty in the elderly.

Factores asociados al riesgo de desnutrición en mujeres mayoresen comunidades de bajos ingresos / Factors associated to risk of malnutrition amongst elderly women in low-income communities

Objective: The present study aimed to identify the prevalence and the factors associated with the risk ofmalnutrition in elderly women.Methods: The study deals with a cross-sectional design, with a sample of 222 women in the age group from 60to 96 years of age. An interview was carried out containing socio-demographic variables, clinical conditions, and behavioral aspects. The statistical analysis was accomplished via calculation of the respective prevalence ratios (PR) in the Poisson regression, p<0.05. Results: A prevalence of 33.8% (n=75) of women, considered with a malnutrition risk or undernourished, which started from the hierarchical multivariate analysis, was identified. A significant association with the age group ranging from 70 to 79 years of age (PR=2.1; CI 95%: 1.3-6.7), low education level (PR=3.1; CI 95%: 1.0-11,6), living with otherpeople (PR=2.0; CI 95%: 1.0-4.6), the presence of depressive symptomatology (PR=2.1; CI 95%: 1.0-7.1), absenceof administration of medication (PR=3.0; CI 95%: 1.1-7.6), having had some food privation along their lives (PR=3.1; CI 95%: 1.3-9.6), and with less than 75% of the time of physical activity in their leisure time (PR=2.0; CI 95%: 1.0-4.7) were found.Conclusion: There is a high percentage of elderly women in situation of malnutrition risk, and the associatedfactors to the condition suggests a complex causal net in the determination of the nutritional state.

[Functional incapacity among low-income elderly women]. / Incapacidade funcional em mulheres idosas de baixa renda.

The scope of this study was to analyze the relationship between socio-demographic and health-related aspects and functional incapacity among low-income elderly women. This cross-sectional study involved a representative sample of 222 women with mean age of 70 years (± 7.27), in community groups in the city of Jequié, in the State of Bahia, Brazil. Anthropometric measurements were taken and interviews staged to examine the socio-demographic, physical and behavioral health variables. The statistical analysis was accomplished with a level of significance of p<0.05, with calculation of the respective odds ratio in the binary logistic regression, for analysis of hierarchically-grouped factors. The prevalence of functional incapacity was 46.8% and, by using hierarchical multivariate analysis, a significant association was detected with increased age, insufficient schooling, hospitalization, lack of physical exercise throughout life and alterations in the cognitive function. The characteristics identified that associated limitations in instrumental activities in daily life suggest a complex causal network in the determination of functional incapacity in low-income elderly women.

Incapacidade funcional em mulheres idosas de baixa renda / Functional incapacity among low-income elderly women

O propósito deste estudo foi o de analisar a relação dos aspectos sociodemográficos e referentes às condições de saúde com a incapacidade funcional em mulheres idosas de baixa renda. O estudo teve delineamento transversal, com uma amostra representativa de 222 mulheres, com média de 70 anos (± 7,27), pertencentes a grupos de convivência no município de Jequié, Bahia. Foram realizadas medidas antropométricas e a aplicação de uma entrevista contemplando as variáveis: sociodemográficas, saúde física e comportamental. A análise estatística foi realizada com nível de significância p<0,05, com cálculo da respectiva razão de chances na regressão logística binária, para análise de fatores hierarquicamente agrupados. A prevalência de incapacidade funcional foi de 46,8 por cento, nos quais a partir de análise multivariada hierarquizada verificaram-se associação significativa com o aumento da idade, baixo nível de educação, hospitalização, ausência de práticas de atividades físicas ao longo da vida e alterações na função cognitiva. As características identificadas que associaram as limitações em atividades instrumentais da vida diária sugerem uma complexa rede causal na determinação da capacidade funcional em mulheres idosas de baixa renda.

The scope of this study was to analyze the relationship between socio-demographic and health-related aspects and functional incapacity among low-income elderly women. This cross-sectional study involved a representative sample of 222 women with mean age of 70 years (± 7.27), in community groups in the city of Jequié, in the State of Bahia, Brazil. Anthropometric measurements were taken and interviews staged to examine the socio-demographic, physical and behavioral health variables. The statistical analysis was accomplished with a level of significance of p<0.05, with calculation of the respective odds ratio in the binary logistic regression, for analysis of hierarchically-grouped factors. The prevalence of functional incapacity was 46.8 percent and, by using hierarchical multivariate analysis, a significant association was detected with increased age, insufficient schooling, hospitalization, lack of physical exercise throughout life and alterations in the cognitive function. The characteristics identified that associated limitations in instrumental activities in daily life suggest a complex causal network in the determination of functional incapacity in low-income elderly women.

Atividade física e aspectos Sociodemográficos de Mulheres Idosas / Physical activity and sociodemographic characteristics of elderly women

Este estudo objetivou avaliar a associação entre nível de atividade física e a condição sociodemográfica de mulheres idosas. Trata-se de um inquérito com delineamento transversal com amostragem probabilística, incluindo 265 idosas da cidade de Jequié, região nordeste do Brasil, em 2005. As características sociodemográficas (faixa etária, estadocivil, moradia, escolaridade e renda familiar) e de Atividade Física (AF) foram coletadas. Utilizaram-se os procedimentos da estatística descritiva, medidas de associação e análise não paramétricas, p<0,05. A maior concentração de mulheres ocorreu na faixa etária entre 65 e 69 anos; há uma predominância de mulheres viúvas, arranjo familiar classificado comomultigeracional, baixo nível de escolaridade e econômico. O maior dispêndio total em minutos por semana em atividades moderadas e vigorosas ocorre em atividades domésticas, seguida do meio de transporte, de lazer/recreação e de trabalho. A prevalência de idosas mais ativas fisicamente foi de 64,5%. O nível de AF foi inversamente associado com: faixa etária, classe econômica e renda familiar. Os resultados obtidos sugerem ações que estimulem a prática em AF de lazer em grupos etários mais velhos, e tanto de condições econômicas mais favoráveis como menos providos financeiramente.

The purpose of this investigation was to analyze the relationship between physical activity levels and sociodemographic conditions of elderly women. This was a cross-sectional study of a probabilistic sample of 265 elderly women in 2005 in the city of Jequié, located in Brazil?s Northeastern region. Sociodemographic characteristics (age, marital status, housing, Educational status and family income) and Physical Activity (PA) were recorded. Descriptive statistics, measures of association and non-parametric analyses were used, p<0.05. The greatest concentration of women was in the 65 to 69 year age group; widowed women, family arrangements classified as multigenerational and low educational and economic levels were dominant. The number of minutes per week spent performing moderate and vigorous activities was greatest for domestic activities, followed by other activities as transport, leisure/recreation and work. The prevalence of more physically active elderly women was 64.5%. Level of PA was inversely related to: age group, economic class and family income. The results suggest a need for actions to stimulate PA as leisure among older age groups, both those in more privileged economic classes and those less well-off financially.

Caracterización del nivel de aptitud funcional de mujeres mayores residentes en comunidades de bajos ingresos / Characterizing the level of functional fitness of female senior-citizens residing in low-income communities

Objetivo Desarrollar una tabla descriptiva con el nivel de desempeño en parámetros de aptitud funcional en mujeres de 60 a 92 años, residentes en comunidades de bajos ingresos. Métodos La muestra se conformó con 222 mujeres de 16 grupos de convivencia para personas mayores en el municipio de Jequié, Bahia (IC=95 por ciento), Brasil. Se analizaron los parámetros de aptitud funcional (fuerza, resistencia aeróbica, flexibilidad, agilidad/equilibrio dinámico y el índice de masa corporal como estimación de la composición corporal), correspondientes a tres grupos etarios. Para el análisis de los datos se utilizaron procedimientos de estadística descriptiva (media, desviación media y distribución de percentiles) y análisis de varianza comparando las tres franjas etarias, categorizadas de acuerdo con los parámetros de aptitud funcional, por intermedio del test de Kruskal Wallis, con p<0.05. Resultados Se observaron diferencias entre los grupos de edad en cuanto a la aptitud funcional, excepto para la composición corporal. Sin embargo, en comparación con otros estudios que enfocaron la temática, se constató que los cambios ocurridos en el desempeño físico, al avanzar la edad cronológica, ocurren de manera más lenta. Conclusiones Los resultados alcanzados proveen una escala normativa específica a ser utilizada en poblaciones con características similares, la cual puede servir como parámetro para la elaboración de programas más efectivos en el mantenimiento de la aptitud funcional de personas mayores, residentes en comunidades de bajos ingresos.

Objective Developing a descriptive table regarding functional fitness parameters for women aged 62 to 92 residing in low-income communities. Methods The samples consisted of 222 women divided into 16 senior-citizen social groups in Jequié, Bahia, (95 percentCI) Brazil. Functional fitness parameters (force, aerobic resistance, flexibility, agility, dynamic equilibrium and body mass index for evaluating body composition) were analysed in women divided into three age-groups. Descriptive statistics (mean, standard deviation and percent distribution) were used for data analysis and analysing variance by comparing the three age-groups classified in accordance with functional fitness parameters (Kruskal Wallis test, p<0.05). Results There was an expressed standard decline in the age-groups' ability classified in relation to the functional fitness parameters being evaluated (except for body composition). However, compared to other studies dealing with the subject, changes occurring in physical performance happened more gradually with advanced age. Conclusions The results achieved provide a specific normative scale which may be used on populations having similar characteristics in such a way that they can be used as a parameter for preparing more effective programmes for maintaining the functional fitness of senior-citizens living in low-income communities.

Fatores associados às limitações funcionais em idosas de baixa renda / Factors associated to functional limitations in elderly of low income

OBJETIVO: Analisar a relação dos aspectos sociodemográficos e referentes às condições de saúde com as limitações funcionais em mulheres idosas de baixa renda do Nordeste brasileiro. MÉTODOS: Estudo com delineamento transversal, tendo uma amostra representativa de 208 mulheres, com média de 70 anos (± 7,1) pertencentes a grupos de convivência e que eram residentes na zona urbana do município de Jequié/Bahia. Foi realizada uma bateria de testes físicos, coletadas medidas antropométricas e a aplicação de uma entrevista contendo questões relativas às variáveis sociodemográficas, condições clínicas, saúde percebida, condições físicas e comportamentais. A análise estatística foi realizada com nível de significância p<0,05, com cálculo da respectiva razão de chances mediante regressão logística binária, para análise de fatores hierarquicamente agrupados. RESULTADOS: Encontrou-se uma prevalência de 56 por cento de mulheres consideradas com limitações funcionais do tipo moderada ou grave, nos quais a partir de análise multivariada hierarquizada, verificou-se associação significativa com a faixa etária superior a 80 anos (p=0,02), condições de viuvez (p=0,04), presença de hipertensão arterial (p=0,001), e inatividade física no lazer (p=0,03). CONCLUSÃO: As características identificadas que se associaram às limitações funcionais sugerem uma complexa rede causal na determinação da condição funcional em mulheres idosas. No entanto, ações direcionadas ao incentivo da prática de atividades físicas no lazer podem contribuir para uma vida com mais qualidade a estas pessoas.

OBJECTIVE: To analyze the relationship of the partner-demographic and relevant aspects to the conditions of health, with the functional limitations in elderly women of low income in the Brazilian Northeast. METHODS: This cross-sectional study involved a representative sample of 208 women with mean age of 70 years (± 7.1), belonging to coexistence groups and that were resident in the urban zone of the municipal district of Jequié / Bahia. A battery of physical tests was conducted, anthropometric measurements were collected and an interview was made concerning subjects related to partner-demographic variables, clinical conditions and apparent health, physical conditions and behavior. The statistical analysis was carried out with a level of significance of p<0.05. Calculation was made of the respective odds ratio by regression binary logistics for analysis of hierarchically clustered factors. RESULTS: Prevalence of functional limitations of the moderate or serious type was 56 percent. After hierarchical multivariate analysis, significant association was verified with the older age group of 80 years (p=0.02) , conditions of widowhood (p=0.04), presence of arterial hypertension (p=0.001), and physical inactivity at leisure (p=0.03). CONCLUSION: The characteristics identified, associated to functional limitations suggest a complex causal network in the determination of the functional condition of elderly women. However, actions addressed to incentivate practice of physical activities at leisure can contribute to the quality of life of these women.

[Characterizing the level of functional fitness of female senior-citizens residing in low-income communities]. / Caracterización del nivel de aptitud funcional de mujeres mayores residentes en comunidades de bajos ingresos.

OBJECTIVE: Developing a descriptive table regarding functional fitness parameters for women aged 62 to 92 residing in low-income communities. METHODS: The samples consisted of 222 women divided into 16 senior-citizen social groups in Jequié, Bahia, (95 %CI) Brazil. Functional fitness parameters (force, aerobic resistance, flexibility, agility, dynamic equilibrium and body mass index for evaluating body composition) were analysed in women divided into three age-groups. Descriptive statistics (mean, standard deviation and percent distribution) were used for data analysis and analysing variance by comparing the three age-groups classified in accordance with functional fitness parameters (Kruskal Wallis test, p<0.05). RESULTS: There was an expressed standard decline in the age-groups' ability classified in relation to the functional fitness parameters being evaluated (except for body composition). However, compared to other studies dealing with the subject, changes occurring in physical performance happened more gradually with advanced age. CONCLUSIONS: The results achieved provide a specific normative scale which may be used on populations having similar characteristics in such a way that they can be used as a parameter for preparing more effective programmes for maintaining the functional fitness of senior-citizens living in low-income communities.