Motoric cognitive risk syndrome and its association with falls: a secondary analysis of the Mexican Health and Aging Study.

OBJECTIVE: To reveal whether motoric cognitive risk syndrome (MCR) is associated with falls, recurrent falls, and complicated falls in older Mexican adults. MATERIALS AND METHODS: This is a secondary analysis of the Mexican Health and Aging Study. MCR was assessed in 2012 and included fall-related outcomes (recurrent [≥2], complicated [need for medical treatment] and number) in the 2018 follow-up. Competing risks analysis was performed, and subhazard ratios (sHRs) were estimated, adjusting for different variables. Negative binomial regression was used to estimate the incidence rate ratio (IRR) of the number of falls. RESULTS: A total of 1 929 participants were included, with a median age of 62 years and 58.3% female. The prevalence of MCR was 17.4% and was associated with falls sHR 1.11 (95%CI: 1.11, 1.12), recurrent falls sHR 1.16 (95%CI: 1.15, 1.16) and complicated falls sHR 1.25 (95%CI: 1.24, 1.25). The number of falls was also independently associated with baseline MCR (IRR 1.19; 95% CI 1.01, 1.40; p=0.039). CONCLUSION: MCR is independently associated with falls. Increasing the evidence on how MCR anticipates burdensome problems in older adults could lead to actions to halt them; therefore, including it in screening assessments could be clinically useful.

Characterization in end-of-life care of older people attended by geriatricians / Caracterización de la atención al final de la vida de personas mayores atendidas por geriatría

Background and objective Symptom control at the end of life is essential, and palliative sedation is a viable intervention option for the care of terminally ill patients. This study aims to characterize the elderly population receiving end-of-life care plans and their management with palliative sedation in a geriatric unit at a high complexity hospital. Materials and methods A cross-sectional study was conducted, and a descriptive analysis was performed. Medical records of 163 patients admitted to a high complexity hospital in Bogota, Colombia between January 2016 and December 2019 were reviewed. Results From 163, 141 patients received an end-of-life care plan, and 22 were managed with palliative sedation. The mean age was 84 years, the most frequent cause of death was respiratory infections and 44% of patients had a history of cancer. Prior to admission, functional decline and the presence of moderate to severe dementia were frequently found. About one in ten persons required palliative sedation, which lasted an average of 2.22±5 days. The most common refractory symptom was dyspnea (45.45%), followed by pain (36.36%). Conclusions Palliative sedation is prevalent in the elderly population and characterizing this population can provide increased knowledge to improve end-of-life care (AU)

Antecedentes y objetivos El control de síntomas al final de la vida es fundamental, y la sedación paliativa resulta una opción de intervención en el cuidado de pacientes con enfermedades terminales. El objetivo es caracterizar una población de personas mayores que recibieron un plan de atención del final de la vida, incluyendo sedación paliativa en una unidad de geriatría de un hospital de alta complejidad. Materiales y métodos Estudio de corte transversal, se realizaron análisis descriptivos y se utilizaron métodos de acuerdo con el tipo de variable. Se revisaron las historias clínicas de 163 pacientes entre enero de 2016 y diciembre de 2019 de un hospital de alta complejidad en Bogotá, Colombia. Resultados Sobre 163 pacientes, 141 recibieron plan de atención de final de vida y 22 fueron manejados con sedación paliativa. La edad promedio fue de 84 años y el 58% eran mujeres. La causa de muerte más frecuente fue respiratoria infecciosa; el 44% tenían antecedente oncológico. La declinación funcional previa al ingreso y la presencia de demencia moderada o severa fueron condiciones que frecuentemente se encontraron en quienes se reorientó el esfuerzo terapéutico. Una de cada 10 personas requirió sedación paliativa, cuya duración fue de 2,22±5 días, el síntoma refractario más frecuente fue la disnea (45,45%), seguido de dolor (36,36%). Conclusiones La sedación paliativa resulta frecuente en la población mayor con enfermedades no oncológicas. La caracterización de estas personas promueve el aumento del conocimiento y la preparación para mejorar el manejo del final de la vida (AU)

Oral health and self-rated health in community-dwelling older adults in Colombia.

BACKGROUND: The relationship between oral health and specific health conditions, such as cardiovascular disease or cognitive impairment, has been extensively studied. However, the effect of oral health status on self-rated health has not been assessed. This could be relevant in older people considering that poor self-rated health status and oral diseases are highly prevalent in this population. The aim of this study was to determine the association between different parameters of oral health and self-rated health status (SRHS) in Colombian community-dwelling older adults. METHODS: This is a secondary analysis of the SABE-Colombia study performed in 2015. The dependent variable was defined as the SRHS status assessed by the question "Compared with other people, your age: Do you consider your health status to be better, equal, or worse?" We considered four independent variables: total edentulism considering the high prevalence in older people, the GOHAI score to assess self-rated oral health, and the use of fixed and removable dental prostheses as potential modifiers of oral health. An adjusted ordinal logistic regression was performed by each independent variable. RESULTS: After the exclusion of missing data, 17,945 persons were included in the final analysis. A total of 10.6% reported worse SRHS, 37.6% reported equal SRHS, and 51.6% reported better SRHS. The worse SRHS group was older and had a higher proportion of dependence, cognitive impairment, and depressive symptoms. The frequency of total edentulism and the lower mean score of GOHAI were significant in the worse SHRS group. An ordinal logistic regression for each independent variable was performed, finding that edentulism increases the probability of worse SHRS, while the GOHAI and use of removable or fixed dental prostheses increase the probability of better SRHS. CONCLUSION: We found an association between total edentulism, GOHAI Index, the use of dental prostheses (both removable and fixed), and self-rated health status, showing the relevance of oral health status to self-rated health status independent of comorbidities and geriatric syndromes. This result supports the inclusion of oral health evaluation in comprehensive geriatric assessment.

Characterization in end-of-life care of older people attended by geriatricians.

BACKGROUND AND OBJECTIVE: Symptom control at the end of life is essential, and palliative sedation is a viable intervention option for the care of terminally ill patients. This study aims to characterize the elderly population receiving end-of-life care plans and their management with palliative sedation in a geriatric unit at a high complexity hospital. MATERIALS AND METHODS: A cross-sectional study was conducted, and a descriptive analysis was performed. Medical records of 163 patients admitted to a high complexity hospital in Bogota, Colombia between January 2016 and December 2019 were reviewed. RESULTS: From 163, 141 patients received an end-of-life care plan, and 22 were managed with palliative sedation. The mean age was 84 years, the most frequent cause of death was respiratory infections and 44% of patients had a history of cancer. Prior to admission, functional decline and the presence of moderate to severe dementia were frequently found. About one in ten persons required palliative sedation, which lasted an average of 2.22±5 days. The most common refractory symptom was dyspnea (45.45%), followed by pain (36.36%). CONCLUSIONS: Palliative sedation is prevalent in the elderly population and characterizing this population can provide increased knowledge to improve end-of-life care.

Factores asociados al desarrollo de delírium en pacientes ancianos en el postoperatorio de cirugía por fractura de cadera / Factors Related to the Development of Delirium in Elderly Patients in the Postoperative Period of Hip Fracture Surgery / Fatores associados ao desenvolvimento de Delirium em pacientes idosos no pós-operatório de cirurgia de fratura de quadril

Introducción: durante el postoperatorio por cirugía de cadera, el delírium es la complicación más frecuente en los pacientes ancianos, con una alta incidencia y prevalencia, la cual lleva a una alta morbimortalidad en ellos. Objetivo: identificar los factores asociados con delírium en pacientes ancianos durante su posto-peratorio de cirugía por fractura de cadera. Materiales y métodos: se realizó un estudio observacional analítico de corte retrospectivo con pacientes hospitalizados por el grupo de Ortogeriatría en el Hospital Universitario San Ignacio en Bogotá (Colombia), entre enero de 2017 y septiembre de 2020. Resultados: se incluyeron 210 personas, en quienes se documentó una incidencia de delírium del 28.57 %. En el análisis bivariado, las variables con asociación estadísticamente significativa fueron edad, dependencia, demencia previa, malnutrición, polifarmacia y tipo de anestesia. Sin embargo, en el análisis multivariado, las dos variables con asociación estadísticamente significativa fueron edad (OR: 1.05; IC95 %: 1.01-1.10; p = 0.014) y demencia (OR: 2.83; IC95 %: 1.28-6.27; p = 0.010). Conclusión: las variables asociadas con delírium reportadas en el estudio concuerdan con la literatura ya publicada. Esto abre las puertas a futuras investigaciones no solo para identificar nuevos o más factores asociados, sino también para adoptar medidas en conjunto con los programas de ortogeriatría, a fin de intervenir estos factores y, de esta manera, poder disminuir la incidencia y prevalencia del delírium y, por ende, su morbimortalidad.

Introduction: Post-operative delirium after hip surgery is the most common complication among the elderly, with a high incidence and prevalence, which leads to high morbidity and mortality rates among them. Objective: To identify the main factors associated with post-operative delirium after hip surgery among older adults. Materials and methods: a retrospective analytical observational study was conducted using data from patients hospitalized by the Orthogeriatric group at the San Ignacio University Hospital in Bogotá, Colombia, between January 2017 and September 2020. Results: 210 people were included in the study, with a documented incidence of delirium of 28.57% was documented. In the bivariate analysis, the variables with a statistically significant association with delirium were age, dependency, previous dementia, malnutrition, polypharmacy, and type of anesthesia used in the procedure. Nonetheless, in a multivariate analysis, the two variables with a statistically significant association were age (OR: 1.05; 95%CI: 1.01-1.10; p = 0.014) and dementia (OR: 2.83; 95% CI: 1.28-6.27; p = 0.010). Conclusion: the variables associated with postoperative delirium reported in our study align with the existing literature. This opens doors to future research not only to identify new or more risk factors, but also to adopt measures, jointly with the Orthogeriatric programs, to intervene such factors so that the incidence and prevalence of delirium can be reduced, and therefore, reduce the morbidity and mortality among the elderly.

Introdução: o delirium no pós-operatório de cirurgia de quadril é a complicação mais frequente em pacientes idosos, com alta incidência e prevalência, o que leva a alta morbimortalidade nos mesmos e, assim, o objetivo deste estudo foi identificar os fatores associados ao delirium em pacientes idosos no pós-operatório de cirurgia de fratura de quadril. Materiais e métodos: foi realizado um estudo observacional analítico retrospectivo com pacientes internados pelo grupo de Ortogeriatria do Hospital Universitário San Ignacio, em Bogotá, Colômbia, entre janeiro de 2017 e setembro de 2020. Resultados: foram incluídas 210 pessoas, nas quais foi documentado incidência de delirium de 28,57%. Na análise bivariada, as variáveis com associação estatisticamente significativa foram idade, dependência, demência prévia, desnutrição, polifarmácia e tipo de anestesia. Porém, na análise multivariada, as duas variáveis com associação estatisticamente significativa foram idade (or: 1,05; Ic 95% 1,01-1,10; p: 0,014) e demência (or: 2,83; Ic 95% 1,28-6,27, p: 0,010). Conclusão: as variáveis associadas ao delirium relatadas em nosso estudo concordam com a literatura publicada anteriormente. Isso abre as portas para pesquisas futuras não só para identificar novos ou mais fatores associados, mas também para adotar medidas em conjunto com programas de ortogeriatria para poder intervir nesses fatores e, assim, reduzir a incidência e prevalência de delirium e, portanto, a morbimortalidade

Self-reported glaucoma prevalence and related factors, contribution to reported visual impairment, and functional burden in a cross-sectional study in Colombia.

PURPOSE: Describe the self-reported prevalence of glaucoma in Colombian older adults, emphasizing the most important risk factors and associated daily-life functional alterations. METHODS: This a secondary analysis of the Health, Wellness, and Aging survey conducted in the year 2015. Diagnosis of glaucoma was obtained from self-report. Functional variables were assessed through activities of daily living questionnaires. A descriptive analysis followed by bivariate and multivariate regression models adjusting for confounding variables was conducted. RESULTS: Self-reported prevalence of glaucoma was 5.67%, with higher rate in women, OR 1.22 (1.13-1.40) p = .003, older age OR 1.02 (1.01-1.02) p < .001, and with higher education OR 1.38 (1.28-1.50) p < .001. Glaucoma was independently associated with diabetes OR 1.37 (1.18-1.61) p < .001 and hypertension 1.26 (1.08-1.46) p = .003. It also showed statistically significant correlations with poor SRH OR 1.15 (1.02-1.32) p < .001, self-reported visual impairment 1.73 (1.50-2.01) p < .001, and impairment in money management OR 1.59 (1.16-2.08) p = .002, grocery shopping OR 1.57 (1.26-1.96) p < .001 and preparing meals OR 1.31 (1.06-1.63) p = .013 and having had falls during the last year OR 1.14 (1.01-1.31) p = 0.041. CONCLUSION: Our findings suggest the self-reported prevalence of glaucoma in older adults in Colombia to be higher than reported data. Glaucoma and visual impairment in older adults represent a public health concern, since glaucoma was associated with adverse outcomes like functional loss and risk of falling, affecting the quality of life and their participation in society.

Does the association between smoking and mortality differ due to frailty status? A secondary analysis from the Mexican Health and Aging Study.

BACKGROUND: despite the well-known adverse health effects of smoking, evidence of these effects on frail individuals is still scarce. AIMS: to assess whether frailty influences the association between smoking and mortality. METHODS: individuals ≥50 years from the Mexican Health and Aging Study were analysed. Mortality rates from a 17-year follow-up were compared between smoking status groups (never, previous and current) and other smoking behaviour-related characteristics (pack-years, age commenced and cessation). Baseline variables were included to adjust the Cox regression models. First, models were adjusted for the whole sample, including an interaction term between the frailty index (FI) and smoking variables. A second set of models were stratified by FI levels: 0.00-0.10, 0.11-0.20, 0.21-0.30 and ≥ 0.31. RESULTS: from a total 14,025 individuals, mean age was 62.4 (95% confidence interval [95% CI]: 62.1-62.8) and 53.9% were women (95% CI: 52.4-55.6). Main results from the survival analyses showed that when including FI interaction term with smoking status, comparing current to never smoking, the hazard ratio (HR) was 2.03 (95% CI: 1.07-3.85, P = 0.029), and comparing current to previous smoking, the HR was 2.13 (95% CI: 1.06-4.26, P = 0.032). Models stratified by FI levels showed a significant HR only for the two highest level groups. Similar results were found for the smoking behaviour-related characteristics. DISCUSSION: our results suggest that frailty could modify smoking mortality risk. Other smoking characteristics were impacted by frailty, in particular, cessation. It was noteworthy that having ≥10 years of tobacco cessation was beneficial for frail individuals. CONCLUSIONS: smoking has a higher toll on frail individuals, but ceasing is still beneficial for this group.

Nutrition-Focused Care for Community-Living Adults: Healthcare Utilization and Economic Benefits.

OBJECTIVES: We assessed the impact of a recently reported nutritional quality improvement program (QIP) on healthcare resource utilization and costs for older, community-living adults in Bogotá, Colombia. METHODS: The study included 618 community-dwelling, older adults (> 60 years) who were at risk or malnourished and receiving outpatient clinical care. The intervention was a QIP that emphasized nutritional screening, dietary education, lifestyle counseling, 60-day consumption of oral nutritional supplements, and 90-day follow-up. For economic modeling, we performed 90-day budget impact and cost-effectiveness analyses from a Colombian third-party payer perspective. The base-case analysis quantified mean healthcare resource use in the QIP study population. Analysis was based on mean input values (deterministic) and distributions of input parameters (probabilistic). As the deterministic analysis provided a simple point estimate, the cost-effectiveness analysis focused on the probabilistic results informed by 1000 iterations of a Monte-Carlo simulation. RESULTS: Results showed that the total use of healthcare resources over 90 days was significantly reduced by > 40% (hospitalizations were reduced by approximately 80%, emergency department visits by > 60%, and outpatient clinical visits by nearly 40%; P < .001). Based on economic modeling, total cost savings of $129 740 or per-patient cost savings of $210 over 90 days could be attributed to the use of nutritional QIP strategies. Total cost savings equated to nearly twice the initial investment for QIP intervention; that is, the per-dollar return on investment was $1.82. CONCLUSIONS: For older adults living in the community in Colombia, the use of our nutritional QIP improved health outcomes while lowering costs of healthcare and was thus cost-effective.

[Bringing back sounds: prevention of hearing loss and auditory rehabilitation in the elderlyRecuperando os sons: prevenção da perda auditiva e reabilitação auditiva em pessoas idosas]. / Retomando los sonidos: Prevención de la hipoacusia y rehabilitación auditiva en las personas mayores.

Hearing loss is one of the leading causes of disability worldwide and its prevalence increases with age, though in most cases, this disability is potentially preventable and treatable. Thus, its prevention, early identification, and comprehensive rehabilitation should be points of action at the local level, since hearing loss has been linked to numerous adverse health outcomes affecting the physical, mental, social, and economic conditions of older people. The objective of this article is to highlight the importance of hearing loss prevention, promote rehabilitation throughout the life course, especially in older people, and describe strategies put forth by the World Health Organization and Pan American Health Organization.

A perda auditiva representa uma das principais causas de incapacidade em todo o mundo e sua prevalência aumenta com a idade. Representa um tipo de deficiência que, na maioria dos casos, é potencialmente prevenível e tratável e, por essa razão, sua prevenção, identificação precoce e reabilitação integral devem ser alguns dos pontos de ação no âmbito local, considerando que está relacionada a inúmeros desfechos adversos de saúde, incluindo os domínios físico, mental, social e econômico das pessoas idosas. O objetivo deste artigo é ressaltar a importância da prevenção da perda auditiva e de sua reabilitação ao longo da vida, especialmente nas pessoas idosas, e descrever estratégias propostas pela Organização Mundial da Saúde e pela Organização Pan-Americana da Saúde.

Effect of multicomponent exercise in cognitive impairment: a systematic review and meta-analysis.

BACKGROUND: Multicomponent physical exercise is the most recommended type of physical intervention in older adults. Experimental data suggest the relevance of the muscle-brain axis and the relationship between muscle contraction and release of brain-derived neurotrophic factor, however, the impact of this relationship on cognition remains unclear, especially in people with diagnosis of cognitive impairment. This study assesses the effect of multicomponent physical exercise on global cognition in people with mild cognitive impairment or dementia. METHODS: Randomized controlled trials published until January 2021 were searched across three electronic databases (PubMed, Scopus, and Cochrane Database). Data about exercises included in the multicomponent intervention (endurance, strength, balance, or flexibility), the inclusion of aerobic exercise, and the change in global cognition were extracted. The effect size was represented as a standardized mean difference. Risk of bias was assessed by the RoB2 tool. RESULTS: A total of 8 studies were included. The overall effect size suggested an effect of multicomponent exercise on global cognition. However, the subgroup analysis showed an effect only when aerobic exercise was included in the intervention. No effect when mild cognitive impairment and dementia were assessed separately was found. CONCLUSION: This study suggests that multicomponent physical exercise could have an effect on global cognition in people with mild cognitive impairment or dementia only when aerobic exercise is included in the intervention. Our results support the inclusion of structured physical exercise programs in the management of people with cognitive impairment.

Sit to stand muscle power reference values and their association with adverse events in Colombian older adults.

Recently, a valid method to assess lower-body muscle power based on a sit-to-stand field test (STS) has been published. Our study aimed to describe lower-body muscle power in older individuals aged ≥ 60 years and examine the relationship of muscle weakness with adverse events according to gender- and age-specific muscle weakness cut-off points. A total of 3689 Colombian older adults (57.6% women, age 69.1 ± 6.9 years) from the 2015 Survey on Health, Well-Being, and Aging in Latin America and the Caribbean (SABE) participated in this study. Lower-body muscle power normalized to body mass was estimated by the five-repetitions STS test. Anthropometric, physical performance and clinical characteristics were collected. Age-specific percentiles using the LMS method, cut-off points and association with adverse events were calculated. Lower-body muscle power was greater in men than among women (2.2 ± 0.7 vs. 1.6 ± 0.5 W·kg-1, respectively; p < 0.001) at all ages. Muscle power ranked in the 50th percentile between 2.38 and 1.30 W·kg-1 in men, whereas women ranked between 1.79 and 1.21 W·kg-1. According to the cut-off points, lower-limb muscle power < 1 standard deviation  in men was associated with having dynapenia, poor gait speed, cognitive impairment and mental, visual, hearing and memory problems. While, women were associated with having sarcopenia, dynapenia, poor gait speed, cognitive impairment, mental, hearing and memory problems, dementia and hospitalizations of > 24 h in the last year. Overall, participants with poor lower-limb muscle power had a significantly higher risk of adverse events [in men: odds ratio (OR) = 1.51, 95% confidence interval (CI) = 1.19-1.91, p < 0.001; in women: OR = 1.52, 95% CI = 1.27-1.87, p = 0.001] than their stronger counterparts. This study is the first to describe lower-limb muscle power values and cut-off points among a nationally representative sample of Colombian older adults. In men, 7 of the 14 adverse events studied were associated with lower muscle strength, whereas in women, it was 9 of the 14 adverse events.

Retomando los sonidos: Prevención de la hipoacusia y rehabilitación auditiva en las personas mayores

[RESUMEN]. La hipoacusia representa una de las principales causas de discapacidad a nivel mundial y su prevalencia aumenta a medida que se envejece. Representa un tipo de discapacidad que, en la mayoría de los casos, puede ser potencialmente prevenible y tratable, por lo que su prevención, identificación temprana y rehabilitación integral deberían ser algunos de los puntos de acción a nivel local ya que se ha relacionado con numerosos desenlaces adversos en salud, incluyendo los dominios físico, mental, social y económico de las personas mayores. El objetivo de este artículo es resaltar la importancia de la prevención de la hipoacusia y promover su rehabilitación a lo largo del curso de vida, especialmente en personas mayores, y describir estrategias que se han planteado desde la Organización Mundial de la Salud y la Organización Panamericana de la Salud.

[ABSTRACT]. Hearing loss is one of the leading causes of disability worldwide and its prevalence increases with age, though in most cases, this disability is potentially preventable and treatable. Thus, its prevention, early identification, and comprehensive rehabilitation should be points of action at the local level, since hearing loss has been linked to numerous adverse health outcomes affecting the physical, mental, social, and economic conditions of older people. The objective of this article is to highlight the importance of hearing loss prevention, promote rehabilitation throughout the life course, especially in older people, and describe strategies put forth by the World Health Organization and Pan American Health Organization.

[RESUMO]. A perda auditiva representa uma das principais causas de incapacidade em todo o mundo e sua prevalência aumenta com a idade. Representa um tipo de deficiência que, na maioria dos casos, é potencialmente prevenível e tratável e, por essa razão, sua prevenção, identificação precoce e reabilitação integral devem ser alguns dos pontos de ação no âmbito local, considerando que está relacionada a inúmeros desfechos adversos de saúde, incluindo os domínios físico, mental, social e econômico das pessoas idosas. O objetivo deste artigo é ressaltar a importância da prevenção da perda auditiva e de sua reabilitação ao longo da vida, especialmente nas pessoas idosas, e descrever estratégias propostas pela Organização Mundial da Saúde e pela Organização Pan-Americana da Saúde.

A nutritionally focused program for community-living older adults resulted in improved health and well-being.

OBJECTIVES: Among older adults, malnutrition is common and is associated with increased risk for impaired health and functionality, conditions further associated with poorer quality of life. In this study of community-living older adults, our objective was to quantify outcome changes following identification and treatment of malnutrition or its risk. DESIGN: Our intervention was a nutritional quality improvement program (QIP). The nutritional QIP included: (i) education of participants about the importance of complete and balanced macro- and micronutrient intake plus physical exercise, (ii) nutritional intervention with dietary counseling; and (iii) provision of oral nutritional supplements (ONS) for daily intake over 60 days. Follow-up measurements took place 30 days after ONS treatment ended, i.e., 90 days after start of intervention. SETTING AND PARTICIPANTS: We recruited 618 transitional-care, chronically ill, older adults (>60 years) with malnutrition/risk (per Mini Nutrition Assessment-Short Form, MNA-SF) from the outpatient clinic of Hospital Universitario San Ignacio, in Bogotá, Colombia. METHODS: For pre-post comparisons, we examined cognition (Mini-Mental State Exam, MMSE), physical abilities (Barthel Activities of Daily Living, ADL; Short Physical Performance Battery, SPPB), affective disorder status (Global Depression Scale, GDS), and quality of life (QoL; EuroQoL-5D-3L, EQ-5D-3L; EuroQoL-Visual Analog Scale, EQ-VAS). RESULTS: Participants were mean age 74.1 ± 8.7 y, female majority (69.4%), and had an average of 2.6 comorbidities with cardiovascular and respiratory diseases predominant (28.5%). QIP-based nutritional intervention led to significant improvements in cognitive (MMSE) and physical functions (ADL and SPPB), affective disorder status (GDS), and health-related quality of life (EQ-VAS); all differences (P < 0.001). Self-reported QoL (EQ-5D-3L) also improved. CONCLUSIONS AND IMPLICATIONS: Over 90 days, the nutritional QIP led to improvements in all measured outcomes, thus highlighting the importance of addressing malnutrition or its risk among community-living older adults. From a patient's perspective, maintaining mental and physical function are important and further linked with quality of life. BRIEF SUMMARY: For older, community-living adults, nutrition care can improve health and well-being outcomes. Care includes screening for malnutrition risk, dietary and exercise counseling, and daily nutritional supplements when needed. GOV IDENTIFIER: NCT04042987.

Healthcare for older people in Central and South America.

Latin American countries (LAC), with their culturally and ethnically diverse populations, form a region that is difficult to define and to understand. The region's health systems are deeply fragmented, which poses great challenges to overall equity levels in health. This is also one of the fastest ageing regions in the world, with increasing demands as well for acute and long-term care (LTC). Demographic and epidemiological transitions across the region are heterogeneous. In this context, health systems are in general, largely unprepared to face the challenge of promoting healthy ageing. This unpreparedness has been magnified by the Coronavirus disease-2019 pandemic. Here, we analyse the burden of disease in the older population and identify priorities to improve the care and quality of life for people living in LAC. Besides an adequately prepared workforce, we must remediate disparities and inequities; develop and implement integrated care; achieve patient-centred care and further develop palliative and end-of-life care; simultaneously, we must develop the structure and financing of LTC services and strengthen the role of public health making healthy ageing an essential component.

Síntomas depresivos y prevalencia de fragilidad en adultos mayores colombianos. Análisis secundario de la encuesta SABE Colombia 2015

Objetivo: Analizar la relación entre los síntomas depresivos y la prevalencia de fragilidad medida como fenotipo de fragilidad. Materiales y métodos: Estudio secundario de la encuesta SABE Colombia 2015. Se utilizaron las puntuaciones de la escala Yesavage como variable independiente, la prevalencia de fragilidad calculada con el fenotipo de fragilidad de Fried. Realizamos un análisis descriptivo y bivariado de la muestra, seguido de un análisis multivariado ajustando por variables de confusión. Resultados: Analizamos información de un total de 19 004 participantes mayores de 60 años, participantes sin deterioro cognitivo de la encuesta, a quienes se les administró la escala Yesavage. La media de edad fue 69.25 años, el 56 % de los participantes eran mujeres, la prevalencia de fragilidad fue del 12 % y se encontró síntomas depresivos en 57,4 % de la muestra. En el análisis multivariado encontramos asociaciones estadísticamente significativas entre las puntuaciones más altas de la escala Yesavage y la presencia de fragilidad (Yesavage 5-10) OR 1.20 (0.98-1.46) p valor 0.066 y (Yesavage >10) 2.05 (1.46-2.89) <0.001 después de ajustar por edad, sexo, comorbilidades, funcionalidad, escolaridad y estado marital Conclusiones: Nuestro estudio muestra asociaciones estadísticamente significativas entre la presencia de síntomas depresivos medidos con la escala Yesavage y la prevalencia de fragilidad según el índice de Fried. Aunque existe escasa evidencia en cuanto a la asociación de estas dos entidades en Latinoamérica, nuestros resultados son consistentes con estudios previos en la región.

Objetive: There is scarce evidence in Latin America that describes depression in the elderly population with fragility. The aim of this paper is to provide a better understanding of the relationship between depressive symptoms in elderly and the prevalence of frailty. Material and methods: We performed secondary analysis of the SABE Colombia 2015 survey. The Yesavage scale scores were used as an independent variable, the prevalence of frailty was estimated with the Fried fragility phenotype. We performed a descriptive and bivariate analysis of the sample, followed by a multivariate analysis adjusting for confounding variables. Results: We analyzed information from a total of 19,004 participants over 60 years of age, participants without cognitive impairment of the survey, who were administered the Yes-avage scale. The mean age was 69.25 years, 56 % of the participants were women, the prevalence of frailty was 12 % and depressive symptoms were found in 57.4 % of the sample. In the multivariate analysis we found statistically significant associations between frailty and the higher Yesavage scores (score 5-10) OR 1.20 (0.98-1.46) p valor 0.066 and (score> 10) 2.05 (1.46-2.89) <0.001 after adjusting for age, sex, comorbidities, functionality, schooling and marital status. Conclusions: Our study shows an independent relationship between depressive symptoms and frailty phenotype in the SABE Colombia 2015s survey There is lack of data and characterization of this population in Latin America regarding the relationship of these conditions, however our results are consistent with previous reports from this region.

Muscular Function as an Alternative to Identify Cognitive Impairment: A Secondary Analysis From SABE Colombia.

BACKGROUND: Identification of cognitive impairment is based traditionally on the neuropsychological tests and biomarkers that are not available widely. This study aimed to establish the association between motor function (gait speed and handgrip strength) and cognitive performance in the Mini-Mental State Examination, globally and by domains. A secondary goal was calculating a cut-off point for gait speed and handgrip strength to classify older adults as cognitively impaired. METHODS: This is a secondary analysis of SABE Colombia (Salud, Bienestar & Envejecimiento), a survey that was conducted in 2015 on health, wellbeing, and aging in Colombia. This study used linear regression models to search for an association between motor function and cognitive performance. The accuracy of motor function measurements in identifying cognitive impairment was assessed with receiver operating characteristic (ROC) curves. This study also analyzed other clinical and sociodemographical variables. RESULTS: Gait speed was associated with orientation (r 2 = 0.16), language (r 2 = 0.15), recall memory (r 2 = 0.14), and counting (r 2 = 0.08). Similarly, handgrip strength was associated with orientation (r 2 = 0.175), language (r 2 = 0.164), recall memory (r 2 = 0.137), and counting (r 2 = 0.08). To differentiate older adults with and without cognitive impairment, a gait speed cut-off point of 0.59 m/s had an area under the curve (AUC) of 0.629 (0.613-0.646), and a weak handgrip (strength below 17.5 kg) had an AUC of 0.653 (0.645-0.661). The cut-off points for handgrip strength and gait speed were significantly higher in male participants. CONCLUSIONS: Gait speed and handgrip strength are similarly associated with the cognitive performance, exhibiting the most extensive association with orientation and language domains of the Mini-Mental State Examination. Gait speed and handgrip strength can easily be measured by any clinician, and they prove to be useful screening tools to detect cognitive impairment.

Use of a nutrition-focused quality improvement program for community-living older adults at malnutrition risk is associated with better nutritional outcomes.

BACKGROUND & AIMS: Among older adults, malnutrition or its risk is common and is associated with increased morbidity and mortality plus increased need for healthcare utilization. We aimed to identify and treat malnutrition risk among older adults who received care at an outpatient clinic after a recent hospitalization and/or for management of a chronic disease. METHODS: From the outpatient clinic of Hospital Universitario San Ignacio, Bogotá, Colombia, we recruited older adults (>60 years) with malnutrition or its risk according to the Mini Nutritional Assessment-Short Form (MNA-SF). Patients were excluded if they had dementia or were not expected to live 90 days or more. Intervention was a nutrition-focused quality improvement program (QIP) including: i) education of patients and caregivers about the health importance of complete and balanced macro- and micronutrient intake plus physical exercise; and ii) nutritional intervention with dietary counseling and provision of oral nutritional supplements (ONS) for daily intake. To assess the effect of our intervention, we collected nutritional outcome data pre- and post-participation of patients in the nutrition-focused QIP. For pre-post comparisons, we used MNA-SF scores and calf circumference (a proxy for leg muscle mass) measures along with nutrition-related anthropometric determinations of body weight and body mass index (BMI). The ONS treatment phase was 60 days, with follow-up measurements up to 30 days after ONS treatment ended (90 days after intervention start). RESULTS: Of 677 enrolled patients, 618 completed the QIP, while 565 had complete anthropometric data. Patients had a mean age of 74.1 ± 8.7 years, an average of 2.6 comorbidities, included a high proportion of females (69.4%), with medium socioeconomic status (76%). After QIP intervention, 324 (52.4%) patients had improvement in nutritional outcomes; improvement was significant in all four measures (P-values < 0.001). Higher ONS adherence was associated with the highest improvement in nutritional status. CONCLUSIONS: For community-living older adults receiving outpatient care, comprehensive nutritional care offered via a nutrition-focused QIP was associated with significant improvements in indicators of nutritional status (MNA-SF scores and calf circumference) and maintenance or improvements in nutrition-related anthropometric measures (body weight and BMI). GOV IDENTIFIER: NCT04042987.

Motoric Cognitive Risk Syndrome: Prevalence and Cognitive Performance. A cross-sectional study.

Background: Motoric Cognitive Risk Syndrome (MCR) is a predementia stage where slow gait speed and subjective memory complaints are present. The purpose of this study was to estimate the prevalence of MCR and assess its relationship with sociodemographic factors and chronic conditions. Methods: This is a secondary analysis of the SABE Colombia study conducted in 2015. The analytic sample consisted of 17·577 participants. After determining MCR prevalence, logistic regression was performed to examine the correlates of MCR. Findings: The prevalence of MCR was 10·71 %. The median age was 71 years and women composed 74·63 % of the MCR group. After adjusting for confounding variables MCR was associated with increasing age (OR 1·69, CI 1·43 - 1·92), no or low education (OR 1·99, CI 1·67- 2·37), MMSE (OR 0·93, CI 0·91 - 0·95) and chronic conditions such as mental disorders (OR 1·36, CI 1·11-1·67), history of myocardial infarction (OR 1·24, CI 1·04 - 1·47), hypertension (OR 1·23, CI 1·08 - 1·40) and diabetes (OR 1.18, CI 1.01 - 1.37). Interpretation: This study found a prevalence of 10·71 % of MCR in Colombian older adults. Additionally, MCR was associated with chronic conditions and sociodemographic factors identified in prior studies. These results increase the awareness of a novel predementia stage whose identification can be performed by clinicians in the outpatient clinic, minimizing the cost of a full neuropsychologic evaluation performed in a memory clinic. Funding: Funded by the Administrative Department of Science, Technology and Innovation (Colciencias) and the Ministry of Health and Social Protection of Colombia.

Retomando los sonidos: Prevención de la hipoacusia y rehabilitación auditiva en las personas mayores / Bringing back sounds: prevention of hearing loss and auditory rehabilitation in the elderly / Recuperando os sons: prevenção da perda auditiva e reabilitação auditiva em pessoas idosas

RESUMEN La hipoacusia representa una de las principales causas de discapacidad a nivel mundial y su prevalencia aumenta a medida que se envejece. Representa un tipo de discapacidad que, en la mayoría de los casos, puede ser potencialmente prevenible y tratable, por lo que su prevención, identificación temprana y rehabilitación integral deberían ser algunos de los puntos de acción a nivel local ya que se ha relacionado con numerosos desenlaces adversos en salud, incluyendo los dominios físico, mental, social y económico de las personas mayores. El objetivo de este artículo es resaltar la importancia de la prevención de la hipoacusia y promover su rehabilitación a lo largo del curso de vida, especialmente en personas mayores, y describir estrategias que se han planteado desde la Organización Mundial de la Salud y la Organización Panamericana de la Salud.

ABSTRACT Hearing loss is one of the leading causes of disability worldwide and its prevalence increases with age, though in most cases, this disability is potentially preventable and treatable. Thus, its prevention, early identification, and comprehensive rehabilitation should be points of action at the local level, since hearing loss has been linked to numerous adverse health outcomes affecting the physical, mental, social, and economic conditions of older people. The objective of this article is to highlight the importance of hearing loss prevention, promote rehabilitation throughout the life course, especially in older people, and describe strategies put forth by the World Health Organization and Pan American Health Organization.

RESUMO A perda auditiva representa uma das principais causas de incapacidade em todo o mundo e sua prevalência aumenta com a idade. Representa um tipo de deficiência que, na maioria dos casos, é potencialmente prevenível e tratável e, por essa razão, sua prevenção, identificação precoce e reabilitação integral devem ser alguns dos pontos de ação no âmbito local, considerando que está relacionada a inúmeros desfechos adversos de saúde, incluindo os domínios físico, mental, social e econômico das pessoas idosas. O objetivo deste artigo é ressaltar a importância da prevenção da perda auditiva e de sua reabilitação ao longo da vida, especialmente nas pessoas idosas, e descrever estratégias propostas pela Organização Mundial da Saúde e pela Organização Pan-Americana da Saúde.