ABSTRACT
BACKGROUND AND PURPOSE: The Short Physical Performance Battery (SPPB) is widely used for older adults since it has a high level of validity, reliability, and responsiveness in measuring function in this population. However, only a few studies of diagnostic accuracy have assessed SPPB capacity in detecting frailty and prefrailty by estimating more detailed measurement properties. Thus, the present study aimed to evaluate the SPPB's diagnostic accuracy in detecting frailty and prefrailty, in addition to identifying cut-off points for walking time and chair stand time. METHODS: This is a cross-sectional study composed of 786 community-dwelling older adults 60 years or older, in which sociodemographic and anthropometric data, frailty phenotype, and total SPPB score, as well as walking time and chair stand time, were assessed. Analysis of a receiver operating characteristic curve was performed to identify the cut-off point, sensitivity, and specificity in the total SPPB score, as well as the walking time and chair stand time for frailty and prefrailty screening. Accuracy and positive and negative predictive values were subsequently calculated. RESULTS AND DISCUSSION: The cut-off points identified for the total SPPB score, walking time, and chair stand time were 9 points or less (accuracy of 72.6%), 5 seconds or less, and 13 seconds or less, respectively, for frailty screening and 11 points or less (accuracy of 58.7%), 4 seconds or less, and 10 seconds or less, respectively, for prefrailty screening. The walking time showed greater frailty discriminatory capacity compared with the chair stand time (effect size = 1.24 vs 0.64; sensitivity = 69% vs 59%; and specificity = 84% vs 75%). CONCLUSIONS: The total SPPB score has good diagnostic accuracy to discriminate between nonfrail and frail older adults using a cut-off point of 9 or less, being better to identify the true negatives (older adults who are not frail). Although the SPPB's diagnostic accuracy measures for detecting prefrailty were low to moderate, this instrument can help in screening prefrail older adults from the cutoff point of 11 or less in the total SPPB score. Identification of prefrail older adults enables implementing early treatment in this target audience and can prevent their advance to frailty.
ABSTRACT
Abstract Introduction: An important consequence of the aging of people with DM2 is physical disability, particularly the loss of mobility. Objective: To determine sociodemographic, clinical-functional, and psycho-cognitive factors related to the reduction in hand grip strength (HGS) in elderly patients with type 2 diabetes mellitus (DM2) and to verify the relationship between HGS and fragility. Method: This is an observational cross-sectional study with 156 elderly individuals aged 60 years and over, both male and female, diagnosed with DM2. The participants were assessed according to sociodemographic, clinical-functional, psycho-cognitive, and functional mobility data. HGS was evaluated using a manual dynamometer. The tests performed were: Mann-Whitney or Kruskal-Wallis, and Chi-square. The level of significance was set at 5% (p < 0.05). Results: A significant relationship was observed between HGS and each of the following: sex (p < 0.001), age range (p = 0.04), marital status (p = 0.004), physical activity (p = 0.06), number of conditions diagnosed (p = 0.002), use of insulin therapy (p = 0.03), complaint of pain in lower limb power (p < 0.001), falls in the last year (p = 0.004), fear of falling (p = 0.003), Mini-Mental State Examination (p = 0.01), Geriatric Depression Scale (p = 0.008), fragility phenotype (p < 0.001). Conclusion: HGS was reduced in elderly women with DM2, those who did not have a marital life had five or more diseases diagnosed with insulin therapy, did not engage in regular physical activity, complained of lower limb pain, had a history of two or more falls in the last year, had a fear of falling, had a cognitive deficit, had depressive symptoms, and were fragile.
Resumo Introdução: Uma consequência importante do envelhecimento das pessoas com DM 2 é a incapacidade física, particularmente a perda de mobilidade. Objetivo: Determinar os fatores sociodemográficos, clínico-funcionais e psico-cognitivos relacionados à redução da força de preensão palmar (FPP) em idosos com Diabetes Mellitus tipo 2 (DM 2) e verificar a relação entre FPP e fragilidade. Método: Trata-se de um estudo observacional, transversal, com 156 idosos de 60 anos ou mais, com diagnóstico de DM 2, masculino e feminino. Os sujeitos foram avaliados segundo dados sociodemográficos, clínicos, funcionais, psicocognitivos e de mobilidade funcional. A FPP foi avaliada por meio do Dinamômetro Manual. Foram realizados os testes de Mann-Whitney ou Kruskal-Wallis e Qui-quadrado. O nível de significância foi estabelecido em 5% (p < 0,05). Resultados: Houve relação significante entre FPP e as variáveis: carga de fragilidade (p < 0,001), sexo (p < 0,001), faixa etária (p = 0,04), estado civil (p = 0,004), atividade física (p = 0,06), número de patologias (p = 0,002), uso de insulinoterapia (p = 0,03), queixa de dor em membros inferiores (p < 0,001), queda no último ano (p = 0,004), medo de cair (p = 0,003), MMSE (p = 0,01), GDS (p = 0,008), fenótipo de fragilidade (p < 0,001). Conclusão: A FPP é reduzida em idosas com DM 2 sem vida conjugal, com cinco ou mais doenças diagnosticadas, com uso de insulinoterapia, não praticantes de atividade física regular, que se queixaram de dor nos membros inferiores, com história de duas ou mais quedas no último ano, medo de cair, com déficit cognitivo, que apresentava sintomas depressivos e eram frágeis
Resumen Introducción: Una consecuencia importante del desarrollo de las tareas con DM 2 es una incapacidad física, particularmente una pierda de movilidad. Objetivo: Determinar los factores sociodemográficos, clínico-funcionales y psico-cognitivos relacionados a la reducción de la fuerza de asimiento palmar (FPP) en ancianos con Diabetes Mellitus tipo 2 (DM 2) e verificar la relación entre FPP y fragilidad. Método: Estudio observacional, transversal, con 156 ancianos de 60 años o más, con DM 2, masculino y femenino. Los sujetos fueron evaluados según datos sociodemográficos, clínicos, funcionales, psicocognitivos y de movilidad funcional. La FPP fue evaluada por medio del Dinamómetro Manual. Se realizaron las pruebas de Mann-Whitney o Kruskal-Wallis y Qui-cuadrado, p < 0,05. Resultados: La relación entre el FPP y las variantes de carga de fragilidad (p < 0,001), sexo (p < 0,001), faixa etária (p = 0,04), estado civil (p = 0,004), atividad física ( p = 0,06), número de patologias (p = 0,002), uso de insulinoterapia (p = 0,03), queixa de dor en miembros inferiores (p < 0,001), queda no último año (p = 0,004), medo de cair (p = 0,003), MMSE (p = 0,01), GDS (p = 0,008), fenótipo de fragilidade (p < 0,001). Conclusión: La FPP se reduce en ancianas con DM 2 sin vida conyugal, con cinco o más enfermedades diagnosticadas, con uso de insulinoterapia, no practicantes de actividad física regular, que se quejaron de dolor en los miembros inferiores, con historia de dos o más caídas en el último año, miedo a caer, con déficit cognitivo, que presentaba síntomas depresivos y eran frágiles.
