Problemas del equilibrio y de la marcha relacionados con la fragilidad en mujeres adultas mayores físicamente activas / Balance and gait problems related to frailty in physically active older women

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Correction: Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

[This corrects the article DOI: 10.1371/journal.pone.0194967.].

Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

BACKGROUND: Despite the number of studies that have tried to demonstrate that there is an association between previous falls and the fear of falling, the relationship between these two variables remains a matter of controversy. OBJECTIVES: Our objective was to investigate whether the fear of falling is a cause of falls, a consequence, or both in community-dwelling adults aged ≥ 75 years old. METHODS: A descriptive, longitudinal, prospective study was performed. A total of 640 individuals were interviewed between 2009 and 2011. Sociodemographic data, health status, history of falls and fear of falling were assessed at baseline and at 24 months. RESULTS: The prevalence of falls at baseline was 25% as opposed to 35.2% at 24 months. The prevalence of the fear of falling was 41.5% at baseline. Logistic regression analysis showed a significant association between a history of falls and the fear of falling. Other factors associated with the fear of falling were female gender, comorbidity, depressive symptoms, and disability. In total, 41.7% of the subjects who had reported a fear of falling at baseline had suffered at least one fall 24 months later. Unadjusted Cox regression analysis revealed that the fear of falling was a risk factor for falls. According to the final model adjusted for other covariates, the only reliable predictor was female gender. The Cox model stratified by gender failed to show a crude association between fear of falling and falls. CONCLUSION: A previous history of falls in the previous year was a good predictor of the fear of falling; but the fear of falling was a predictor of falls during follow-up only in the unadjusted model, pointing to strong gender turns out as an effect modifier of the association of FOF and subsequent falls. Nursing staff working in elderly care should not only routinely assess patients' previous history of falls, but also evaluate their fear of falling and its associated factors.

Differences in fitness level between women aged 60 and over participating in three different supervised exercise programs and a sedentary group.

The aim of this study was to compare fitness levels in women aged 60 and over participating in a supervised exercise program (involving tai chi, recreational gymnastics, and/or aquatic fitness) with those in a sedentary group. An observational, descriptive, cross-sectional study was performed on a total of 171 women aged from 60 to 92 who attended public community clubs for older adults. The instruments used included the Senior Fitness Test, the Tinetti Balance Assessment Tool, the Katz Index, and the Lawton & Brody Activities of Daily Living Scale. Significant differences in fitness levels were observed when we compared the exercise groups with the sedentary group. Women with better fitness levels had a lower risk of suffering falls and greater autonomy in performing activities of daily living and instrumental activities of daily living. Agility and gait control were found to be independently associated with exercise groups.

El ejercicio físico y su efectividad sobre la condición física en personas mayores frágiles. Revisión sistemática de ensayos clínicos aleatorizados / Effectiveness of physical exercise on fitness in frail older adults: a systematic review of randomised trials

El ejercicio físico es una actividad clave en la intervención de la fragilidad, por lo que mantener una buena condición física es parte esencial para la prevención o mejora de la misma. El objetivo de esta revisión fue examinar los beneficios del ejercicio físico sobre la condición física en personas mayores frágiles. Se realizó una extensa búsqueda bibliográfica de las bases de datos electrónicas, incluyendo ensayos clínicos aleatorizados (ECA) de los últimos 15años. La calidad metodológica se obtuvo mediante la escala PEDro. Fueron incluidos 10 artículos, obteniéndose una muestra de 1.130 sujetos. La puntuación en la escala PEDro osciló entre 5 y 8/10. El entrenamiento multicomponente de la condición física, al parecer, es la mejor estrategia para mejorar la condición física. Son necesarios más estudios para clarificar cuáles deben ser las características más adecuadas de estos programas de ejercicios, al mismo tiempo que incrementar la evidencia científica a nivel hospitalario y de institucionalización (AU)

Performing exercise to maintain a good physical condition is crucial to improve and prevent frailty in older adults. The aim of this review was to assess the beneficial effects of physical exercise on fitness in frail older adults. A thorough literature search of randomised clinical trials (RCT) in the last 15 years was performed on different electronic databases. The methodological assessment of studies was obtained using the PEDro scale. Ten RCT were included, providing a final sample of 1,130 individuals. Scores on the PEDro scale ranged from 5 to 8/10. Multicomponent training programs seem to be the best strategy to improve fitness outcomes. Further studies should be performed in order to optimise the design of supervised exercise programs, and further research is needed in hospital and institutionalised settings (AU)

[Effectiveness of physical exercise on fitness in frail older adults: A systematic review of randomised trials]. / El ejercicio físico y su efectividad sobre la condición física en personas mayores frágiles. Revisión sistemática de ensayos clínicos aleatorizados.

Performing exercise to maintain a good physical condition is crucial to improve and prevent frailty in older adults. The aim of this review was to assess the beneficial effects of physical exercise on fitness in frail older adults. A thorough literature search of randomised clinical trials (RCT) in the last 15 years was performed on different electronic databases. The methodological assessment of studies was obtained using the PEDro scale. Ten RCT were included, providing a final sample of 1,130 individuals. Scores on the PEDro scale ranged from 5 to 8/10. Multicomponent training programs seem to be the best strategy to improve fitness outcomes. Further studies should be performed in order to optimise the design of supervised exercise programs, and further research is needed in hospital and institutionalised settings.

Respuesta: Malnutrición: un dominio más de la fragilidad clínica / Reply: Malnutrition: Another domain of frailty

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La fragilidad como predictora de mortalidad en una cohorte de edad avanzada / Frailty as a predictor of mortality in a cohort of people aged 75 years and older

Objetivo. Determinar la asociación entre los estados de fragilidad de las personas mayores y la mortalidad en la ciudad de Lleida durante el período 2009-2012. Método. Estudio longitudinal prospectivo realizado con sujetos que viven en la ciudad de Lleida de 75 años o más de edad con tarjeta sanitaria y residentes en viviendas familiares. La fase transversal se realizó entre los años 2009 y 2010, y la fase longitudinal a los 2 años (mediana 25 meses). Resultados. La supervivencia fue peor para los frágiles frente a los prefrágiles y los no frágiles (log rank = 10,56; p = 0,005). Además de la fragilidad (hazard ratio [HR] = 4,95; intervalo de confianza del 95% [IC95%]: 1,71-14,31), la edad también fue significativa (HR = 2,87; IC95%: 1,02-8,26). Conclusión. En una cohorte prospectiva de mayores de 75 años que viven en su propio domicilio en la ciudad de Lleida, el mayor nivel de fragilidad está asociado con un mayor riesgo de muerte a los 2 años (AU)

Objective. To determine the association between frailty in older persons and mortality in the city of Lleida (Spain) between 2009 and 2012. Methods. We conducted a prospective longitudinal study based on persons living in the city of Lleida aged 75 years and older, covered by the public health system and living in single-family households. The cross-sectional study was performed between 2009 and 2010 and longitudinal study was carried out 3 years later (median 25 months). Results. Survival was lower in frail individuals than in pre-frail and non-frail individuals (log rank = 10.56; p = 0.005). In addition to frailty (HR = 4.95; 95%CI: 1.71-14.31). Age was also a significant predictor (HR = 2.87; 95%CI: 1.02-8.26). Conclusion. A higher level of frailty was associated with an increased risk of death at 2 years in a prospective cohort of elderly persons older than 75 years living in their own homes in the city of Lleida (AU)

Asociación entre el Mini Nutritional Assessment y el índice de fragilidad de Fried en las personas mayores que viven en la comunidad / Association between Mini Nutritional Assessment and the Fried frailty index in older people living in the community

Fundamento y objetivo: Valorar la asociación entre el Mini Nutritional Assessment (MNA) y el índice de fragilidad de Fried en las personas mayores que viven en la comunidad. Material y método: Estudio transversal en individuos de 75 años o más, residentes en la comunidad. Como variables se incluyeron el estado nutricional medido a través del MNA y su forma abreviada, el Mini Nutritional Assessment Short Form (MNA-SF), y el índice de fragilidad a través de los criterios de Fried. Resultados: La muestra fue de 640 individuos, con media (DE) de edad de 81,3 (5,0) años; el 39,7% eran varones. Según el MNA-SF, el 76,9% de los individuos estaban bien nutridos, el 19,8% en riesgo de desnutrición y el 1,9% desnutridos, mientras que según el MNA, dichos porcentajes fueron del 78,1, 19,6 y 2,3%, respectivamente. Según los criterios de Fried, el 43,4% eran no frágiles, el 47%, prefrágiles, y el 9,6%, frágiles. La mayor proporción de sujetos frágiles se encontraban en riesgo de desnutrición. La puntuación del MNA y del MNA-SF en los sujetos frágiles fue significativamente menor que en los prefrágiles y no frágiles. A medida que aumentaba la puntuación de los componentes del MNA, aumentaba el índice de fragilidad. Así mismo, existía una asociación significativa entre los 5 criterios de fragilidad y las categorías del MNA y el MNA-SF. El área bajo la curva ROC para el MNA-SF fue de 0,75, mientras que para el MNA fue de 0,80. Conclusiones: Los resultados presentados ponen de manifiesto la clara asociación entre el MNA y los criterios de Fried. También evidencian que la categoría del MNA «riesgo de desnutrición» es la que está más fuertemente asociada al índice de fragilidad (AU)

Background and objective: To assess the association between Mini Nutritional Assessment (MNA) and the Fried frailty index in older people living in the community. Material and method: Cross-sectional study of individuals aged 75 and over living in the community. Variables: nutritional status measured by Mini Nutritional Assessment Short Form (MNA-SF) and MNA, and frailty measured by Fried’s frailty criteria. Results: The sample consisted of 640 individuals with a mean age of 81.3 5.0 years; 39.7% were men. According to the MNA-SF, 76.9% of patients were well nourished, 19.8% were at risk of malnutrition and 1.9% were malnourished, while percentages were 78.1, 19.6 and 2.3%, respectively, according to the MNA. According to Fried criteria, 43.4% were not frail, 47% were pre-frail and 9.6% were frail. The largest proportion of frail subjects were at risk of malnutrition. The higher the score of MNA components, the higher was the frailty index. Likewise, there was a significant association between the 5 frailty criteria and the categories of MNA and MNA-SF. The area under the ROC curve for the MNA-SF was 0.75 while for the MNA it was 0.80. Conclusions: The results presented show a clear association between Mini Nutritional Assessment and Fried’s criteria. They also suggest that the «nutritional risk» MNA category is the one most strongly associated with the Fried’s frailty index (AU)

[Frailty as a predictor of mortality in a cohort of people aged 75 years and older]. / La fragilidad como predictora de mortalidad en una cohorte de edad avanzada.

OBJECTIVE: To determine the association between frailty in older persons and mortality in the city of Lleida (Spain) between 2009 and 2012. METHODS: We conducted a prospective longitudinal study based on persons living in the city of Lleida aged 75 years and older, covered by the public health system and living in single-family households. The cross-sectional study was performed between 2009 and 2010 and longitudinal study was carried out 3 years later (median 25 months). RESULTS: Survival was lower in frail individuals than in pre-frail and non-frail individuals (log rank=10.56; p=0.005). In addition to frailty (HR=4.95; 95%CI: 1.71-14.31). Age was also a significant predictor (HR=2.87; 95%CI: 1.02-8.26). CONCLUSION: A higher level of frailty was associated with an increased risk of death at 2 years in a prospective cohort of elderly persons older than 75 years living in their own homes in the city of Lleida.

[Association between Mini Nutritional Assessment and the Fried frailty index in older people living in the community]. / Asociación entre el Mini Nutritional Assessment y el índice de fragilidad de Fried en las personas mayores que viven en la comunidad.

BACKGROUND AND OBJECTIVE: To assess the association between Mini Nutritional Assessment (MNA) and the Fried frailty index in older people living in the community. MATERIAL AND METHOD: Cross-sectional study of individuals aged 75 and over living in the community. VARIABLES: nutritional status measured by Mini Nutritional Assessment Short Form (MNA-SF) and MNA, and frailty measured by Fried's frailty criteria. RESULTS: The sample consisted of 640 individuals with a mean age of 81.3±5.0 years; 39.7% were men. According to the MNA-SF, 76.9% of patients were well nourished, 19.8% were at risk of malnutrition and 1.9% were malnourished, while percentages were 78.1, 19.6 and 2.3%, respectively, according to the MNA. According to Fried criteria, 43.4% were not frail, 47% were pre-frail and 9.6% were frail. The largest proportion of frail subjects were at risk of malnutrition. The higher the score of MNA components, the higher was the frailty index. Likewise, there was a significant association between the 5 frailty criteria and the categories of MNA and MNA-SF. The area under the ROC curve for the MNA-SF was 0.75 while for the MNA it was 0.80. CONCLUSIONS: The results presented show a clear association between Mini Nutritional Assessment and Fried's criteria. They also suggest that the "nutritional risk" MNA category is the one most strongly associated with the Fried's frailty index.

Prevalencia y factores asociados a sospecha de malos tratos en la unidad geriátrica del área de urgencias del hospital / Prevalence and factors associated with suspected mistreatment in a geriatric unit in a hospital emergency area

Objetivo. Conocer la prevalencia de sospecha de maltrato e identificar los factores asociados en las personas mayores sin déficit cognitivo, que son atendidas por la unidad geriátrica ubicada en el servicio de urgencias del hospital. Métodos. Estudio descriptivo y transversal de una población de 65 años o más, valorada por la Unidad Funcional Interdisciplinaria Sociosanitaria (UFISS) geriátrica del servicio de urgencias del hospital Arnau de Vilanova de Lleida. El total de participantes fue de 127. La sospecha de maltrato se midió con el cuestionario de la American Medical Association (AMA) y la Canadian Task Force (CTF). Las variables estudiadas fueron las características sociodemográficas y la dependencia funcional. Resultados. La prevalencia de sospecha de maltrato fue del 29,1% (IC del 95%: 0,21-0,37). Los subtipos más frecuentes fueron por abandono y psicológico, y menos frecuente por negligencia. Los factores asociados fueron el sexo femenino, profesión previa no remunerada, ser viudo, y vivir solo. Conclusiones. Tres de cada 10 personas mayores fueron identificadas como posibles víctimas de maltrato. Debido al relativo aislamiento de muchos adultos mayores que son maltratados, una visita inesperada al servicio de urgencias puede ser la única oportunidad para su detección. Las unidades geriátricas ubicadas en esta área deberían incluir en la valoración integral, la sospecha de malos tratos a dicha población. Para ello, es necesario poder contar con un instrumento con un alto índice de sensibilidad y especificidad para la detección de los malos tratos en las personas mayores(AU)

Objective. To know the prevalence of mistreatment and to identify the associated factors among elderly people without cognitive impairment, seen in the geriatric unit, located in the hospital emergency area. Methods. Cross-sectional study of a population of 65 years or older assessed by the geriatric Interdisciplinary Social Welfare Functional Unit (ISSFU) of the emergency area in the Arnau de Vilanova hospital of Lleida. We excluded participants with cognitive impairment. The total number of participants was 127. The suspicion of mistreatment was measured using the Questionnaire of the American Medical Association (AMA) and the Canadian Task Force (CTF). The variables studied were social demographic characteristics and functional dependency. Results. Prevalence of suspicion of mistreatment was 29.1% (95% CI: 0.21-0.37). The most frequent subtypes were neglect and psychological, and less frequent was negligence. Associated factors were being female, being in unpaid work, being a widow and living alone. Conclusions. Three out of ten elderly people were identified as possible victims of abuse. Due to the relative isolation of many of the elderly who were abused, an unexpected visit to the emergency area may be the only opportunity for detection. Geriatric units located in this area should include the suspicion of mistreatment of this population in their comprehensive assessment. For this, it is necessary to have tool with a high degree of sensitivity and specificity for detection of abuse in the elderly(AU)

Estado de animo caracterizadopor soledad y tristeza: factores relacionados en personas mayores / Characterized mood by loneliness and sadness: factors related elderly

El objetivo de este estudio fue conocer el estado de animo y los factores que pueden influir en las personas mayores. Se trata de un estudio epidemiologico y transversal que incluye a personas mayores de 65 años de instituciones atendidos en diferentes niveles asistenciales en la ciudad de Lleida. Las variables incluida sfueron, ademas del estado de animo caracterizado por soledad y tristeza, las caracteristicas sociodemograficas y diversos parámetros del estado de salud. La depresion es una alteracion patologica del estado de animo. Es importante detectar este último ya que puede predecir la gravedad de la depresion en las personas de edad avanzada. El personal de enfermeria se encuentra en una situación privilegiada por su proximidad con los pacientes (AU)

The aim of this study was to determine the prevalence of mood and the factors that can affect older people. Cross-sectional epidemiological study including people aged ≥ 65 years of institutions with different levels of care located in the city of Lleida. The variables included, in addition to depressed mood characterized by loneliness and sadness, the sociodemographic characteristics and various health parameters. Depression is a pathological alteration of mood. It is important to detect because it can predict the severity of depression in elderly. The nursing staff is in a prime location for its proximity to patients (AU)

[Prevalence and factors associated with suspected mistreatment in a geriatric unit in a hospital emergency area]. / Prevalencia y factores asociados a sospecha de malos tratos en la unidad geriátrica del área de urgencias del hospital.

OBJECTIVE: To know the prevalence of mistreatment and to identify the associated factors among elderly people without cognitive impairment, seen in the geriatric unit, located in the hospital emergency area. METHODS: Cross-sectional study of a population of 65 years or older assessed by the geriatric Interdisciplinary Social Welfare Functional Unit (ISSFU) of the emergency area in the Arnau de Vilanova hospital of Lleida. We excluded participants with cognitive impairment. The total number of participants was 127. The suspicion of mistreatment was measured using the Questionnaire of the American Medical Association (AMA) and the Canadian Task Force (CTF). The variables studied were social demographic characteristics and functional dependency. RESULTS: Prevalence of suspicion of mistreatment was 29.1% (95% CI: 0.21-0.37). The most frequent subtypes were neglect and psychological, and less frequent was negligence. Associated factors were being female, being in unpaid work, being a widow and living alone. CONCLUSIONS: Three out of ten elderly people were identified as possible victims of abuse. Due to the relative isolation of many of the elderly who were abused, an unexpected visit to the emergency area may be the only opportunity for detection. Geriatric units located in this area should include the suspicion of mistreatment of this population in their comprehensive assessment. For this, it is necessary to have tool with a high degree of sensitivity and specificity for detection of abuse in the elderly.

Prevalence of frailty and factors associated with frailty in the elderly population of Lleida, Spain: the FRALLE survey.

The aim of this study was to assess the prevalence of frailty and to identify factors associated with frailty in older people living in the community through a cross-sectional study of community-dwelling persons age 75 and older. A total of 640 individuals were interviewed using the FRALLE survey between 2009 and 2010. This survey measures frailty through the five Fried criteria, and through questions on sociodemographics, health habits, health status, social relations and data on health-related quality of life. The mean age of the participants was 81.3 ± 5.0; 39.7% were men. The prevalence of frailty was 9.6% (95% confidence interval (CI): 7.6-11.5) and that of pre-frailty was 47% (95% CI: 42.7-51.2). After the logistic regression, age (over 85 years) (odds ratio (OR): 3.61; 95% CI: 1.65-7.91; p<0.001), depressive symptoms (OR: 3.13; 95% CI: 1.37-7.13; p=0.0006), comorbidity (OR: 5.20; 95% CI: 1.78-15.16; p=0.0002), cognitive impairment (OR: 3.22; 95% CI: 1.48-7.02; p=0.0003), poor social ties (OR: 0.57; 95% CI: 0.43-0.77; p<0.001) and poor physical health (OR: 0.98; 95% CI: 0.97-0.98; p<0.001) were significantly associated with frailty. There is great variability in the prevalence of frailty depending on the study considered. The lack of homogeneity in the measurement of the five criteria, the age of participants and the degree of dependence could explain the differences observed. Here, the factors associated with frailty were age, comorbidity, cognitive impairment and depressive symptoms, while the diversity of social interaction and health-related physical function were protective factors.

High rates of malnutrition in older adults receiving different levels of health care in Lleida, Catalonia: an assessment of contributory factors.

The aim of this study was to define the factors associated with the presence or risk of malnutrition in older adults (>65 years of age) attending health care centers in Lleida, Catalonia, using a cross-sectional study approach. Nutritional parameters assessed included the Mini Nutritional Assessment Scale, sociodemographic and psychosocial factors, functional and cognitive status, swallowing and oral problems, texture and route of administration of the diet, changes in dietary intake, and presence of digestive disorders. A total of 398 individuals (184 men) with an average age of 77 years were included in the assessment. Poor nutritional status was recorded in 58% of the individuals. Factors independently associated with unsatisfactory nutritional status included weight loss, functional dependence, cognitive impairment, loneliness, living without a partner, history of heart disease, lung disease, and the presence of acute vomiting.