Functional, nutritional and social factors associated with mobility limitations in the elderly: a systematic review.

OBJECTIVE: To systematically review the prevalence and incidence of mobility limitations in the elderly people and their associated factors. MATERIALS AND METHODS: Articles in the electronic literature were searched via PubMed, Scopus,,Lilacs, SciELO, PAHO, MedCarib, Repidisca, Wholis, IBCES, PEDro, Medline and Bireme (2012-2016). The instrument STROBE was used to analyze the quality of the work and the PRISMA recommendation was used to structure the review. RESULTS: Nine studies were included. The prevalence of mobility limitations ranged from 58.1 to 93.2% and the incidence ranged from 23 to 53.7%. Studies provided evidence of association of mobility limitations in the elderly population with high BMI, low 25-hydroxy vitamin D, sarcopenia, fragility, chronic pain, functional dependence, advanced age in women, low hip flexion, sedentary lifestyle, and social support difficulties. CONCLUSIONS: Mobility limitations in the elderly had high prevalence and incidence, and there was evidence of association with nutritional, functional and social factors.

Effectiveness of intervention programs in primary care for the robust elderly.

OBJECTIVE: This study aimed to search the literature for intervention programs in primary care with a multiprofes-sional character, specifically directed at the robust elderly, and with viable and cost-effective interventions. MATERIALS AND METHODS: The search strategies were applied in Cochrane, Lilacs, Pubmed, Scopus, WHOLIS, Embase, Medcarib, SciELO, Web of Science, and PAHO databases. RESULTS: 3 665 articles were found and 32 remained for analysis, grouped into four categories: care management; multidisciplinary intervention; interventions on the basis of risk; and educational interventions with health professionals. CONCLUSION: Strategies such as domestic interventions can promote health and functionality of elderlies, as well as reduce mortality, use of the health system and costs. Besides that, the use of hard and light-hard technologies are important for risk prevention and care management for the elderly.There is a need to create programs for risk prevention and effective management of elderly care at the primary level.

Oral health care activities performed by caregivers for institutionalized elderly in Barcelona-Spain.

OBJECTIVES: To describe the frequency of brushing teeth and cleaning of dentures, performed by caregivers, for institutionalized elderly people. METHODS: A cross-sectional study in a sample of 196 caregivers of 31 health centers in Barcelona. The dependent variables were frequency of dental brushing and frequency of cleaning of dentures of the elderly by caregivers. The independent variables were characteristics of caregivers and institutions. We performed bivariate and multivariate descriptive analyses. Robust Poisson regression models were fitted to determine factors associated with the dependent variables and to assess the strength of the association. RESULTS: 83% of caregivers were women, 79% worked on more than one shift, 42% worked only out of necessity, 92% were trained to care for elderly persons, 67% were trained in oral hygiene care for the elderly, and 73% recognized the existence of institutional protocols on oral health among residents. The variables explaining the lower frequency of brushing teeth by caregivers for the elderly, adjusted for the workload, were: no training in the care of elderly persons (PRa 1.7 CI95%: 1.6-1.8), not fully agreeing with the importance of oral health care of the elderly (PRa 2.5 CI95%: 1.5-4.1) and not knowing of the existence of oral health protocols (PRa 1.8 CI95% 1.2-2.6). The variables that explain the lower frequency of cleaning dentures, adjusted for the workload, were lack of training in elderly care (PRa 1.7 CI95%: 1.3-1.9) and not knowing of the existence of protocols (PRa 3.7 CI95%: 1.6-8.7). CONCLUSION: The majority of caregivers perform activities of oral health care for the elderly at least once per day. The frequency of this care depends mainly on whether caregivers are trained to perform these activities, the importance given to oral health, the workload of caregivers and the existence of institutional protocols on oral health of institutionalized elderly persons.

Mobility Limitation in Older Adults Residing in Nursing Homes in Brazil Associated With Advanced Age and Poor Nutritional Status: An Observational Study.

BACKGROUND AND PURPOSE: Mobility is a basic human need, and its limitation compromises health status, especially in older adults from developing countries and residing in nursing homes. This study aims to determine the prevalence and factors associated with mobility limitation in older adults residing in nursing homes. METHODS: A cross-sectional study was conducted with 305 older adults (≥60 years) residing in 10 nursing homes in Northeast Brazil. Mobility limitation was evaluated using the "walking" item of the Barthel index. Sociodemographic/economic data concerning the participants and institutions, as well as conditions that could influence the mobility state of the older adults, were collected. The χ2 test and multiple logistic regression were performed using a significance level of 5%. RESULTS AND DISCUSSION: The prevalence of mobility limitation was 65.6% (95% confidence interval [CI], 59.6-70.4). Walking dependence was identified in 39.7% of the sample (26.9% wheelchair users and 12.8% bedridden), while 25.9% walked with assistance (16.7% with maximal assistance and 9.2% with minimal assistance). Mobility limitation was significantly associated with malnutrition/risk of malnutrition (1.86, 95% CI, 1.54-2.26, P < .001) and age ≥81 years (1.35, 95% CI, 1.12-1.63, P = .002). CONCLUSION: Mobility limitation has a high prevalence among older adults residing in nursing homes in Brazil, and is associated with advanced age and poor nutritional status. Health professionals should advocate for the maintenance of mobility and adequate nutritional support.

[Factors associated with the incidence and mortality from COVID-19 in the autonomous communities of Spain]. / Factores asociados a la incidencia y la mortalidad por COVID-19 en las comunidades autónomas.

OBJECTIVE: Analyze the evolution of the epidemic of COVID-19 after the alarm state and identify factors associated with the differences between the autonomous communities. METHOD: Ecological study that used epidemiological, demographic, environmental and variables on the structure of health services as explanatory variables. The analysis period was from March 15th (the start of the alarm state) until April 22nd, 2020. Incidence and mortality rates were the main response variables. The magnitude of the associations has been estimated using the Spearman correlation coefficient and multiple regression analysis. RESULTS: Incidence and mortality rates at the time of decree of alarm status are associated with current incidence, mortality and hospital demand rates. Higher mean temperatures are significantly associated with a lower current incidence of COVID-19 in the autonomous communities. Likewise, a higher proportion of older people in nursing homes is significantly associated with a higher current mortality in the autonomous communities. CONCLUSION: It is possible to predict the evolution of the epidemic through the analysis of incidence and mortality. Lower temperatures and the proportion of older people in residences are factors associated with a worse prognosis. These parameters must be considered in decisions about the timing and intensity of the implementation of containment measures. In this sense, strengthening epidemiological surveillance is essential to improve predictions.

Saliva as a possible tool for the SARS-CoV-2 detection: A review.

BACKGROUND: Salivary tests for the new coronavirus (SARS-CoV-2) diagnosis have been suggested as alternative methods for the nasopharyngeal and oropharyngeal tests. METHOD: Two reviewers independently performed a search in the following electronic databases: PubMed, Medline, Cochrane Library, Web of Science, Embase and Scopus to identify cross-sectional and cohort studies that used saliva samples for SARS-CoV-2 detection. The search strategy was: ("saliva") and ("SARS-CoV-2" or "coronavirus" or "COVID-1"). RESULTS: A total of 363 studies were identified and 39 were selected for review. Salivary samples for SARS-CoV-2 detection was as consistent and sensitive as the nasopharyngeal swabs in most studies, having been effective in detecting asymptomatic infections previously tested negative in nasopharyngeal samples. Viral nucleic acids found in saliva obtained from the duct of the salivary gland may indicate infection in that gland. Live viruses could be detected in saliva by viral culture. CONCLUSIONS: Salivary samples show great potential in SARS-CoV-2 detection and may be recommended as a simple and non-invasive alternative.

Screening for Voice Disorders in Older Adults (RAVI)-Part III: Cutoff Score and Clinical Consistency.

AIM: The aim of the study was to determine the cutoff score and clinical consistency of "Screening for Voice Disorders in Older Adults" (RAVI-Rastreamento de Alterações Vocais em Idosos). STUDY DESIGN: This is a prospective, nonrandomized, cross-sectional diagnostic study. METHODS: A sample of 301 subjects, including both sexes, aged 60 and more, and all of whom were living in either a community or an institution, was studied. To determine which subjects had or did not have voice problems, we used a composite reference standard (auditory-perceptual analysis of sustained vowel phonation, auditory-perceptual analysis of connected speech, and vocal self-assessment). The best cutoff score was identified using the receiver operating characteristic (ROC) curve analysis. The clinical consistency indicators were co-positivity, co-negativity, positive and negative predictive values, positive and negative likelihood ratio, and test efficiency. The significance level was 5%. RESULTS: The area under the ROC curve was 0.763 (95% confidence interval: 0.706-0.821), and the best cutoff score for determining which older adults had or did not have a voice disorder was 2. All clinical consistency indicators were satisfactory: co-positivity (79%), co-negativity (60%), predictive positive value (51%), negative predictive value (84%), positive likelihood ratio (2.01), negative likelihood ratio (0.34), and test efficiency (69%). CONCLUSIONS: RAVI has satisfactory indicators of clinical consistency and is able to determine which older adults have voice disorders by a cutoff score of 2. The use of RAVI as a screening tool is recommended to help determine the prevalence of voice disorders in older adults.

Functional, nutritional and social factors associated with mobility limitations in the elderly: a systematic review / Factores funcionales, nutricionales y sociales asociados con las limitaciones de la movilidad en los ancianos: revisión sistemática

Abstract: Objective: To systematically review the prevalence and incidence of mobility limitations in the elderly people and their associated factors. Materials and methods: Articles in the electronic literature were searched via PubMed, Scopus, Lilacs, SciELO, PAHO, MedCarib, Repidisca, Wholis, IBCES, PEDro, Medline and Bireme (2012-2016). The instrument STROBE was used to analyze the quality of the work and the PRISMA recommendation was used to structure the review. Results: Nine studies were included. The prevalence of mobility limitations ranged from 58.1 to 93.2% and the incidence ranged from 23 to 53.7%. Studies provided evidence of association of mobility limitations in the elderly population with high BMI, low 25-hydroxy vitamin D, sarcopenia, fragility, chronic pain, functional dependence, advanced age in women, low hip flexion, sedentary lifestyle, and social support difficulties. Conclusion: Mobility limitations in the elderly had high prevalence and incidence, and there was evidence of association with nutritional, functional and social factors.

Resumen: Objetivo: Revisar sistemáticamente la prevalencia e incidencia de las limitaciones de movilidad en los ancianos y sus factores asociados. Material y métodos: Se realizaron búsquedas de artículos en la literatura electrónica a través de PubMed, Scopus, Lilacs, SciELO, PAHO, MedCarib, Repidisca, Wholis, IBCES, PEDro, Medline y Bireme (2012-2016). El instrumento STROBE fue utilizado para analizar la calidad del trabajo y la recomendación de PRISMA para estructurar la revisión. Resultados: Se incluyeron nueve estudios. La prevalencia de limitaciones de movilidad varió de 58.1 a 93.2% y la incidencia de 23 a 53.7%. Los estudios aportaron evidencia de asociación de limitaciones de movilidad en los ancianos con alto IMC, 25-hidroxivitamina D baja, sarcopenia, fragilidad, dolor crónico, dependencia funcional, edad avanzada de las mujeres, flexión de cadera baja, sedentarismo y dificultades de apoyo social. Conclusiones: Las limitaciones de movilidad en los ancianos presentan alta prevalencia e incidencia, y hay evidencia de asociación con factores nutricionales, funcionales y sociales.

Vector electronystagmography analysis in elderly individuals with dizziness complaint.

Introduction Vector electronystagmography is widely used to evaluate vestibular function; however, elderly patients may show changes not due to vestibular disorders. Aim This study aims to characterize vector electronystagmography tests in the elderly participants in a service station of the Brazilian public health system, the Unified Health System (SUS) in the city of Natal, who presented with dizziness. Methods A cross-sectional and clinical study to characterize the vector electronystagmography in 10 members of an elderly SUS referral center located in the city of Natal with dizziness. Results Of 10 patients interviewed, 9 were women, and just 1 was a man. All complained of dizziness in the last year, and most of them had more than one type of dizziness. The main differential diagnosis was benign paroxysmal positional vertigo. Regarding vector electronystagmography, we found 20% of patients with semispontaneous nystagmus in at least one direction and changes in saccades latency in 100% of patients, with 20% in relation to the accuracy of pendular tracking changes at the frequency of 0.2 Hz, 10% at 0.4 Hz, and 80% at 0.8 Hz, and 10% change in optokinetic gain. No patient had altered caloric test. Conclusion Vector electronystagmography alterations in the elderly do not always indicate disease.