Associação entre declínio cognitivo, sintomas depressivos e do medo de cair com a velocidade da marcha confortável em idosos comunitários / Association between cognitive decline, depressive symptoms and the fear of falling with the speed gait in community-dwelling older adults

Diminuições na velocidade da marcha (VM) estão associadas a desfechos adversos na saúde física e mental em idosos. Assim, torna-se relevante identificar fatores que podem associar-se com a VM confortável em idosos, de forma a propor estratégias para prevenção de alterações na mobilidade. Objetivo: verificar a associação entre declínio cognitivo, sintomas depressivos e do medo de cair com a VM confortável em idosos comunitários. Métodos: tratou-se de um estudo transversal, com amostra probabilística, incluindo 308 idosos comunitários. O desfecho do estudo foi a VM confortável, sendo considerado como baixo desempenho VM < 0,8m/s. As variáveis preditoras foram 1) declínio cognitivo avaliado pelo Mini Exame do Estado Mental, 2) sintomas depressivos avaliados com a Escala de Depressão Geriátrica Abreviada e 3) medo de cair avaliado pela Falls Efficacy Scale ­ Brasil. Para analisar a associação entre as variáveis foi utilizada a Regressão Logística Multivariada. Resultados: idosos tiveram chances significativamente maiores de apresentar baixo desempenho na VM confortável quando apresentaram declínio cognitivo (OR: 4,67; IC95%: 1,68; 12,94), sintomas depressivos (OR: 2,90; IC95%: 1,42; 5,92) e medo de cair (OR: 4,08; IC95%: 1,72; 9,71) quando comparados aos que não tiveram essas condições. Conclusão: o declínio cognitivo, sintomas depressivos e medo de cair foram associados ao baixo desempenho na VM confortável nos idosos amostrados. Esses achados podem servir para identificação precoce dos fatores que estão associados a alterações na VM confortável, contribuindo para a proposição de estratégias públicas em saúde e no direcionamento de atividades de promoção em saúde para idosos comunitários.(AU)

Decreases in gait speed (GS) are associated with adverse outcomes in the physical and mental health of the elderly. Thus, it is relevant to identify factors that can be associated with comfortable GS in community-dwelling older adults, to propose strategies to prevent changes in mobility. Objective: To verify the association between cognitive decline, depressive symptoms, and fear of falling with comfortable GS in community-dwelling older adults. Methods: This was a cross-sectional study with a probabilistic sample, including 308 community-dwelling older adults. The study outcome was comfortable GS, being considered as low-performance MV < 0.8m/s. Predictive variables were 1) cognitive decline assessed by the Mini-Mental State Examination, 2) depressive symptoms assessed by the Abbreviated Geriatric Depression Scale, and 3) fear of falling assessed by the Falls Efficacy Scale - Brasil. Multivariate Logistic Regression was used to verify the association between the variables. Results: Community-dwelling older adults were significantly more likely to have poor performance in comfortable GS when they presented cognitive decline (OR: 4.67; 95%CI: 1.68; 12.94), depressive symptoms (OR: 2.90; 95%CI: 1 .42; 5.92), and fear of falling (OR: 4.08; 95%CI: 1.72; 9.71) when compared to those who did not have these conditions. Conclusion: Cognitive decline, depressive symptoms, and fear of falling were associated with poor performance in comfortable GS in the community-dwelling older adults sampled. These findings can serve for early identification of factors that are associated with changes in comfortable GS, contributing to the proposition of public health strategies and in directing health promotion activities for community-dwelling older adults.(AU)

Are sociodemographic and anthropometric variables effective in screening probable and confirmed sarcopenia in community-dwelling older adults? A cross-sectional study

ABSTRACT BACKGROUND: Screening for probable and confirmed sarcopenia using sociodemographic and anthropometric indicators can be a practical, cheap, and effective strategy to identify and treat older people susceptible to this condition. OBJECTIVES: To identify cutoff points for sociodemographic and anthropometric variables in screening probable and confirmed sarcopenia in community-dwelling older adults. DESIGN AND SETTING: This was a cross-sectional study of community-dwelling older adults in Araranguá, Santa Catarina, Brazil. METHODS: Sociodemographic (age, education) and anthropometric (weight, height, body mass index [BMI], waist circumference [WC], and dominant calf circumference [DCC]) factors were considered as predictors. The outcomes were probable sarcopenia (reduction in muscle strength assessed by time ≥ 15 s in the five-time sit-to-stand test) and confirmed sarcopenia (reduction in strength and muscle mass). Receiver operating characteristic curve analysis was used to analyze the ability to track sociodemographic and anthropometric variables for sarcopenia. RESULTS: In 308 older adults, WC > 91 cm in women and age > 69 years in men were useful in screening for probable sarcopenia. The variables age, weight, BMI, WC, and DCC can be used to screen for sarcopenia in older women and men. CONCLUSION: Sociodemographic and anthropometric variables are simple and accessible tools for sarcopenia screening in older adults.

Are sociodemographic and anthropometric variables effective in screening probable and confirmed sarcopenia in community-dwelling older adults? A cross-sectional study.

BACKGROUND: Screening for probable and confirmed sarcopenia using sociodemographic and anthropometric indicators can be a practical, cheap, and effective strategy to identify and treat older people susceptible to this condition. OBJECTIVES: To identify cutoff points for sociodemographic and anthropometric variables in screening probable and confirmed sarcopenia in community-dwelling older adults. DESIGN AND SETTING: This was a cross-sectional study of community-dwelling older adults in Araranguá, Santa Catarina, Brazil. METHODS: Sociodemographic (age, education) and anthropometric (weight, height, body mass index [BMI], waist circumference [WC], and dominant calf circumference [DCC]) factors were considered as predictors. The outcomes were probable sarcopenia (reduction in muscle strength assessed by time ≥ 15 s in the five-time sit-to-stand test) and confirmed sarcopenia (reduction in strength and muscle mass). Receiver operating characteristic curve analysis was used to analyze the ability to track sociodemographic and anthropometric variables for sarcopenia. RESULTS: In 308 older adults, WC > 91 cm in women and age > 69 years in men were useful in screening for probable sarcopenia. The variables age, weight, BMI, WC, and DCC can be used to screen for sarcopenia in older women and men. CONCLUSION: Sociodemographic and anthropometric variables are simple and accessible tools for sarcopenia screening in older adults.

A autopercepção do ambiente de vizinhança está associado à sarcopenia provável em idosos comunitários? / ¿Estaría asociada la autopercepción del ambiente exterior con una probable sarcopenia en ancianos institucionalizados? / Is the self-perception of the neighborhood environment associated with probable sarcopenia in the community of older adults?

RESUMO A associação da sarcopenia com fatores sociodemográficos e de saúde já foi previamente apresentada na literatura. Contudo, pouco se sabe sobre como os fatores ambientais que podem estar relacionados a essa condição. O objetivo do estudo foi avaliar a associação entre a autopercepção do ambiente de vizinhança e a sarcopenia provável em idosos comunitários. Este é um estudo transversal, de base domiciliar com amostra probabilística, que incluiu 306 idosos comunitários de ambos os sexos. O desfecho foi a sarcopenia provável, categorizada com o tempo de realização no teste de sentar e levantar da cadeira >15 segundos, conforme proposto pelo European Working Group on Sarcopenia in Older People. As variáveis preditoras foram avaliadas de acordo com o abbreviated neighborhood environment walkability scale (A-NEWS), que inclui questões relacionadas à infraestrutura e à segurança do bairro, ruas, calçadas e tipos de uso do solo. Foram realizadas análises de regressão logística multivariada. A presença de supermercado/loja de conveniência/mercadinho/armazém, feira livre (OR: 0,45; IC 95%: 0,22-0,91) e ponto de ônibus (OR: 0,23; IC 95%: 0,10-0,50) foram fatores de proteção para a sarcopenia provável. Já o acúmulo de lixo e locais com esgoto a céu aberto próximos à residência (OR: 2,17; IC 95%: 1,16-4,05) foram fatores de risco. Verificou-se associação de comércios locais e pontos de ônibus próximos ao local de residência para proteção contra a sarcopenia provável, enquanto o acúmulo de lixo e locais com esgoto a céu aberto próximos à residência se mostraram fatores de risco para a sarcopenia provável.

RESUMEN La asociación entre sarcopenia y factores sociodemográficos y de salud se ha presentado previamente en la literatura. Sin embargo, es escasa la información sobre cómo los factores ambientales pueden relacionarse con esta condición. El objetivo de este estudio fue evaluar la asociación entre la autopercepción del ambiente exterior y una probable sarcopenia en ancianos institucionalizados. Este es un estudio transversal, de base domiciliaria con muestra probabilística, que incluyó a 306 ancianos institucionalizados de ambos sexos. El resultado fue una probable sarcopenia, categorizada con el tiempo necesario para sentarse y levantarse de una silla >15 segundos según lo propuesto por el Grupo Europeo de Trabajo en Sarcopenia en Personas Mayores. Las variables predictoras se evaluaron según el abbreviated neighborhood environment walkability scale (A-NEWS), que incluye temas relacionados con la infraestructura y seguridad del vecindario, calles, aceras y tipos de uso del suelo. Se realizó análisis de regresión logística multivariante. La presencia de supermercado/tienda de conveniencia/tienda/almacén, ferias (OR: 0,45; IC 95%: 0,22-0,91) y parada de autobús (OR: 0,23; IC 95%: 0,10-0,50) fueron los factores protectores contra una probable sarcopenia. La acumulación de basura y lugares con alcantarillado abierto cerca de la residencia (OR: 2,17; IC 95%: 1,16-4,05) fueron los factores de riesgo. Se encontró que as tiendas locales y paradas de autobús cercanas a la residencia estuvieron relacionadas a la protección contra una probable sarcopenia, mientras que la acumulación de basura y lugares con alcantarillado abierto cerca de la residencia estuvieron relacionados a una probable sarcopenia.

ABSTRACT The association of sarcopenia with sociodemographic and health factors has been previously presented in the literature. However, little is known about how environmental factors may be related to this condition. The study sought to verify the association between self-perception of a built neighborhood characteristics and probable sarcopenia in community-dwelling older adults. This was a cross-sectional study including 306 community-dwelling older adults of both genders. The outcome was probable sarcopenia, categorized with the time taken in the sit to stand test >15 seconds, as proposed by the European Working Group on Sarcopenia in Older People. The predictor variables were assessed using the neighborhood environment walkability scale (A-NEWS), which includes issues related to the infrastructure and security of the neighborhood, streets, sidewalks, and types of land use. Multivariate Logistic Regression analyses were performed. The presence of supermarkets/convenience stores/grocery stores/warehouses, open markets (OR: 0.45; 95%CI: 0.22-0.91) and bus stops (OR: 0.23; 95%CI: 0.10-0.50) were protective factors for probable sarcopenia. However, the accumulation of garbage and/or places with open sewage close to the residence (OR: 2.17; 95%CI: 1.16-4.05) were risk factors. There was a protective association of local businesses and bus stops near the place of residence for probable sarcopenia. However, the accumulation of garbage and/or places with open sewage near the residence proved to be risk factors for probable sarcopenia.

A Escala de Depressão Geriátrica pode ser utilizada para rastrear quedas em idosos comunitários? / Can the Geriatric Depression Scale be used to track falls in community-dwelling older adults?

Sintomas depressivos estão associados a ocorrência de quedas em idosos, portanto, torna-se importante definir pontos de corte diferenciados entre os sexos na Escala de Depressão Geriátrica Abreviada (GDS-15) que discriminem maior propensão a quedas, para identificar e implementar estratégias de reabilitação preventivas precoces. Objetivo: Determinar a acurácia da GDS-15, com valores diferenciados entre os sexos, para rastrear quedas em idosos comunitários e verificar a associação entre sintomas depressivos e quedas utilizando-se os pontos de corte propostos. Método: Estudo transversal, com amostra probabilística, incluindo 308 idosos comunitários. Considerou-se o histórico de quedas nos últimos 12 meses, classificado de forma dicotômica (sim ou não) como variável dependente e a avaliação dos sintomas depressivos através da GDS-15 como variável independente. Utilizou-se a Receiver Operating Characteristic Curve para analisar a sensibilidade e especificidade da GDS-15, e a Regressão Logística Multivariável para verificar a associação entre sintomas depressivos e quedas. Resultados: Os pontos de corte que melhor discriminaram quedas na GDS foram ≥4 pontos para mulheres [AUC:0,61 (IC95%: 0,54;0,69)] e ≥3 pontos para homens [AUC:0,65 (IC95%: 0,57;0,74)]. Em ambos os sexos, os idosos com sintomas depressivos apresentaram maiores chances de sofrer quedas em comparação aos que não tiveram os sintomas, sendo 3,05 (IC95%: 1,16;8,05) vezes maior nos homens e 2,28 (IC95%: 1,21;4,31) vezes maior nas mulheres, mesmo após o ajuste para faixa etária, multimorbidade e nível de atividade física. Conclusão: A GDS-15 pode ser utilizada para o rastreio de quedas em idosos, sendo indicado utilizar valores discriminativos diferenciados entre os sexos.

Depressive symptoms are associated with the occurrence of falls in older adults, therefore, it is important to define different cutoff points between the sexes in the Abbreviated Geriatric Depression Scale (GDS-15) that discriminate a greater propensity for falls, to identify and implement early preventive rehabilitation strategies. Objective: To determine the accuracy of GDS-15, with different values between sexes, to track falls in community-dwelling older adults and verify the association between depressive symptoms and falls using the proposed cutoff points. Method: Cross-sectional study, with random sampling including 308 older adults. The history of falls in the last 12 months, classified dichotomously (yes or no), was considered as a dependent variable and the assessment of depressive symptoms using the GDS-15 as an independent variable. Receiver Operating Characteristic Curve was used to analyze the sensitivity and specificity of GDS-15, and Multivariable Logistic Regression to verify the association between depressive symptoms and falls. Results: The cutoff points that best discriminated falls in the GDS were ≥4 points for women [AUC:0.61 (95%CI: 0.54;0.69)] and ≥3 points for men [AUC:0.65 (95%CI: 0.57;0.74)]. In both sexes, the older adults with depressive symptoms were more likely to suffer falls, compared to those who did not have the symptoms, being 3.05 (95%CI: 1.16;8.05) times higher in men and 2.28 (95%CI: 1.21;4.31) times higher in women, even after adjusting for age, multimorbidity and level of physical activity. Conclusion: GDS-15 can be used to screen falls in older adults, and it is indicated to use discriminative values differentiated between sexes