Relationship of protein, calcium and vitamin D consumption with body composition and fractures in oldest-old independent people.

BACKGROUND & AIM: Some studies state that the protein intake has a protective effect against bone mass loss, while others show that the combination of low calcium intake and high protein consumption increases the risk of fractures. Perhaps this phenomenon is also altered by the consumption of vitamin D after the age 80 years. This study aimed to identify if there is an association of protein, calcium and vitamin D intake with body composition and fractures in community dwelling 80 years or older independent people. METHODS: This is a cross-sectional observational analytic study. We invited community dwelling 80 years or older independent people, with chronic diseases under control, according to the scientific guidelines. The food intake was obtained through a one-day food record (FR) and Avanutri software (4.1 version) was used to calculate the intake of total calories, calcium, protein, and other food nutrients. The body composition and bone densitometry were evaluated by whole-body Dual Energy X-ray Absorptiometry (DXA). The morphometric vertebral fractures were assessed through conventional X-ray of the vertebral, level T4 to L4, on side face position - semi quantitative technique. RESULTS: One hundred and fifty-nine 80 years or older independent people, mean age 87.0 ± 3.9 years old were studied. The mean calcium intake was 834.6 ± 374.7 mg/day and vitamin D was 6.1 ± 24.3 µg/day, in both cases they were complemented by supplements to reach the recommendations. The mean protein intake was 72.9 ± 26.8 g/day, we found that 48.4% had low muscle mass; there was a frequency of 45.3% of osteoporosis; and vertebral fractures in 24.7% of them. The estimates of the logistic regression model with the outcome variable obesity and low muscle mass with reference to "low muscle mass" showed that the 80 years or older independent people who have a fracture are more likely to be obese with low muscle mass compared to those with only low muscle mass. CONCLUSION: In the studied population of 80 years or older independent people, we observed that among all the nutrients studied, only dietary protein per g/kg/day was associated with body composition and bone mineral density, but not with fracture, although the elderly who have fracture are more likely to be obese with low muscle mass compared to those not obese with low muscle mass. More studies about nutrients intakes and its relationship with muscle and bone health in this population is necessary.

Chronic pain among older adults and its impact on satisfaction with social participation: development and validation of the "Instrument to Assess Older Adults' Social Participation". A descriptive quantitative study

ABSTRACT BACKGROUND: We aimed to develop and validate a practical instrument to assess older adults' satisfaction with their social participation (SP). DESIGN AND SETTING: This methodological validation study was conducted at a public higher education institution. METHODS: A two-phase study was designed, developed, and validated to assess older adults' satisfaction with their SP. In the first phase, we conceptualized SP and developed an "instrument to assess older adults' satisfaction with their SP (IAPSI)," as approved by a committee of specialists, pre-tested, and partially validated. Second, we determined the IAPSI's reproducibility using Cronbach's alpha to measure internal consistency, Pearson's and Spearman's coefficients to measure correlations, the Bland-Altman plot and intraclass correlation coefficient (ICC) to measure reproducibility. We also generated a receiver operating characteristic (ROC) curve. RESULTS: 102 older adults (mean age, 87.29) participated in the first phase. Moderate internal consistency (Cronbach's alpha 0.7) and significant moderate correlations with quality of life by World Health Organization Quality of Life (WHOQOL)-bref and by WHOQOL-old social domains (Pearson's coefficients 0.54 and 0.64, respectively; P < 0.001) were found. The ROC curve indicated an IAPSI score of 17 as the threshold for the impact of pain on satisfaction with SP (83.3% sensitivity and 88.9% specificity, P < 0.001). In the second phase, 56 older adults (between 81 and 90 years old) participated. We found adequate intra- and inter-observer reproducibility for the IAPSI (ICC 0.96 and 0.78, respectively). CONCLUSION: We have developed a practical instrument with appropriate psychometric properties to assess older adults' satisfaction with their SP.

Effect of prolonged-release tapentadol in the management of moderate-to-severe chronic pain in elderly patients. Case reports / Efeito do tapentadol de liberação prolongada no manejo da dor crônica de moderada a intensa em pacientes idosos. Relato de casos

ABSTRACT BACKGROUND AND OBJECTIVES: Prolonged-release (PR) tapentadol has demonstrated efficacy, safety, and good tolerability for the management of moderate to severe chronic pain in patients over 65 years of age. The objective of this study was to describe three clinical cases in which tapentadol PR was used as treatment of moderate to severe chronic pain in individuals aged 75 to 83 years old. CASE REPORT: Two female patients (75 and 83 years old) and one male patient (78 years old) with chronic osteoarticular pain or low back pain of moderate to severe intensities and with functional limitation, who had undergone previous unsuccessful treatments and were functionally limited, underwent treatment with tapentadol PR. Tapentadol PR was associated with considerable improvement of pain in all three patients, leading to greater independence in performing daily activities. In addition, the use of tapentadol PR did not cause any significant adverse effects. CONCLUSION: Treatment with tapentadol PR seems to be effective and tolerable in the management of moderate to severe chronic pain in senior patients.

RESUMO JUSTIFICATIVA E OBJETIVOS: O tapentadol de liberação prolongada (LP) demonstrou eficácia, segurança e boa tolerabilidade para o tratamento de dor crônica moderada a grave em pacientes com mais de 65 anos de idade. O objetivo deste estudo foi descrever três casos clínicos em que o tapentadol de liberação prolongada foi usado como tratamento para dor crônica de moderada a grave em indivíduos de 75 a 83 anos de idade. RELATO DOS CASOS: Dois pacientes do sexo feminino (75 e 83 anos de idade) e um paciente do sexo masculino (78 anos de idade) com dor osteoarticular crônica ou dor lombar de intensidade moderada a intensa e com limitação funcional, que haviam sido submetidos a tratamentos anteriores sem sucesso e estavam limitados funcionalmente, foram submetidos a tratamento com tapentadol LP. O tapentadol LP foi associado a uma melhora considerável da dor em todos os três pacientes, levando a uma maior independência na realização das atividades diárias. Além disso, o uso do tapentadol LP não causou nenhum efeito adverso significativo. CONCLUSÃO: O tratamento com tapentadol parece ser eficaz e tolerável no tratamento da dor crônica moderada a grave em pacientes idosos.

Chronic pain among older adults and its impact on satisfaction with social participation: development and validation of the "Instrument to Assess Older Adults' Social Participation". A descriptive quantitative study.

BACKGROUND: We aimed to develop and validate a practical instrument to assess older adults' satisfaction with their social participation (SP). DESIGN AND SETTING: This methodological validation study was conducted at a public higher education institution. METHODS: A two-phase study was designed, developed, and validated to assess older adults' satisfaction with their SP. In the first phase, we conceptualized SP and developed an "instrument to assess older adults' satisfaction with their SP (IAPSI)," as approved by a committee of specialists, pre-tested, and partially validated. Second, we determined the IAPSI's reproducibility using Cronbach's alpha to measure internal consistency, Pearson's and Spearman's coefficients to measure correlations, the Bland-Altman plot and intraclass correlation coefficient (ICC) to measure reproducibility. We also generated a receiver operating characteristic (ROC) curve. RESULTS: 102 older adults (mean age, 87.29) participated in the first phase. Moderate internal consistency (Cronbach's alpha 0.7) and significant moderate correlations with quality of life by World Health Organization Quality of Life (WHOQOL)-bref and by WHOQOL-old social domains (Pearson's coefficients 0.54 and 0.64, respectively; P < 0.001) were found. The ROC curve indicated an IAPSI score of 17 as the threshold for the impact of pain on satisfaction with SP (83.3% sensitivity and 88.9% specificity, P < 0.001). In the second phase, 56 older adults (between 81 and 90 years old) participated. We found adequate intra- and inter-observer reproducibility for the IAPSI (ICC 0.96 and 0.78, respectively). CONCLUSION: We have developed a practical instrument with appropriate psychometric properties to assess older adults' satisfaction with their SP.

Pain in older adults with dementia: Brazilian validation of Pain Intensity Measure for Persons with Dementia (PIMD).

BACKGROUND: Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals. OBJECTIVE: To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p. METHODS: Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated. RESULTS: A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity (p < 0.001). CONCLUSION: The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication.

ANTECEDENTES: Embora existam várias formas de estimar a dor na demência ainda há necessidade de ferramentas com melhores itens para avaliação da presença e intensidade da dor nesses indivíduos. OBJETIVO: Analisar as propriedades psicométricas de uma ferramenta de avaliação da dor em idosos dementados, a "Pain Intensity Measure for Persons with Dementia Portuguese - PIMD-p". MéTODOS: Idosos expostos a situações potencialmente dolorosas, sendo esses dementados e com prejuízo na comunicação verbal, foram selecionados em uma unidade ambulatorial e uma instituição de longa permanência, em São Paulo. A PIMD-p foi aplicada por 2 pesquisadores (E1 e E2), de forma separada, num mesmo dia, e, com intervalo de no máximo 14 dias, essa foi reaplicada por apenas um deles (E3), e ainda, foi obtida a intensidade álgica inferida pelos cuidadores dos idosos participantes. Na análise estatística foram utilizados o Alfa de Cronbach, o Coeficiente de Spearman e o Índice de Correlação Intraclasses. RESULTADOS: Selecionada uma amostra de 50 idosos com média de idade de 86 anos, a maioria portadora de demência moderada e de dor de origem musculoesquelética. Apuradas para a PIMD-p uma boa consistência interna, segundo o alfa Cronbach (0,838); excelentes reprodutibilidades intra e interobservador (0,927 e 0,970, respectivamente; p < 0,001); e uma validade convergente, essa última obtida com as fortes e significativas correlações entre as intensidades dolorosas inferidas e os indicadores de dor do instrumento em estudo (exceto para o indicador "olhar expressivo"; corr = 0,106 e p = 0,462). CONCLUSãO: A PIMD-p se mostrou ser uma ferramenta com propriedades de medida adequadas para avaliar a presença e intensidade álgicas em idosos com demência e com prejuízo na comunicação verbal.

King's Parkinson's Disease Pain Questionnaire: reliability and convergent construct validity.

OBJECTIVES: to assess the evidence of reliability and convergent construct validity of the King's Parkinson's Disease Pain Questionnaire. METHODS: psychometric study of 75 older adults with Parkinson's disease. The instrument was applied by two researchers separately and reapplied by one researcher 15 days later. In terms of reliability, internal consistency was assessed using the Cronbach's alpha test and stability using the intraclass correlation coefficient. Scores of the King's Parkinson's Disease Pain Questionnaire were compared to those of the Geriatric Pain Measure in the assessment of construct validity. RESULTS: the mean Cronbach's alpha obtained between the three assessments was above 0.60, the intraclass correlation between the three assessments was above 0.90, and there was a weak but significant correlation between the two applied scales. CONCLUSIONS: the instrument showed adequate evidence of convergent construct validity and reliability, and can be used in clinical practice.

Pain in older adults with dementia: Brazilian validation of Pain Intensity Measure for Persons with Dementia (PIMD) / Dor em idosos com demência: validação da versão brasileira do instrumento Pain Intensity Measure for Persons with Dementia (PIMD)

Abstract Background Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals. Objective To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p. Methods Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated. Results A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity (p < 0.001). Conclusion The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication.

Resumo Antecedentes Embora existam várias formas de estimar a dor na demência ainda há necessidade de ferramentas com melhores itens para avaliação da presença e intensidade da dor nesses indivíduos. Objetivo Analisar as propriedades psicométricas de uma ferramenta de avaliação da dor em idosos dementados, a "Pain Intensity Measure for Persons with Dementia Portuguese - PIMD-p". Métodos Idosos expostos a situações potencialmente dolorosas, sendo esses dementados e com prejuízo na comunicação verbal, foram selecionados em uma unidade ambulatorial e uma instituição de longa permanência, em São Paulo. A PIMD-p foi aplicada por 2 pesquisadores (E1 e E2), de forma separada, num mesmo dia, e, com intervalo de no máximo 14 dias, essa foi reaplicada por apenas um deles (E3), e ainda, foi obtida a intensidade álgica inferida pelos cuidadores dos idosos participantes. Na análise estatística foram utilizados o Alfa de Cronbach, o Coeficiente de Spearman e o Índice de Correlação Intraclasses. Resultados Selecionada uma amostra de 50 idosos com média de idade de 86 anos, a maioria portadora de demência moderada e de dor de origem musculoesquelética. Apuradas para a PIMD-p uma boa consistência interna, segundo o alfa Cronbach (0,838); excelentes reprodutibilidades intra e interobservador (0,927 e 0,970, respectivamente; p < 0,001); e uma validade convergente, essa última obtida com as fortes e significativas correlações entre as intensidades dolorosas inferidas e os indicadores de dor do instrumento em estudo (exceto para o indicador "olhar expressivo"; corr = 0,106 e p = 0,462). Conclusão A PIMD-p se mostrou ser uma ferramenta com propriedades de medida adequadas para avaliar a presença e intensidade álgicas em idosos com demência e com prejuízo na comunicação verbal.

Intravenous zoledronate for postmenopausal women with osteopenia and osteoporosis: a systematic review and metanalysis.

BACKGROUND: Osteoporosis compromises bone strength and increases the risk of fractures. Zoledronate prevents loss of bone mass and reduces the risk of fractures. OBJECTIVES: To determine the efficacy and safety of zoledronate in postmenopausal women with osteopenia and osteoporosis. DESIGN AND SETTINGS: A systematic review and meta-analysis was conducted within the evidence-based health program at the Universidade Federal de São Paulo. METHODS: An electronic search of the CENTRAL, MEDLINE, Embase, and LILACS databases was performed until February 2022. Randomized controlled trials comparing zoledronate with placebo or other bisphosphonates were included. Standard methodological procedures were performed according to the Cochrane Handbook and the certainty of evidence for the Grading of Recommendations Assessment, Development, and Evaluation Working Group. Two authors assessed the risk of bias and extracted data on fractures, adverse events, bone turnover markers (BTM), and bone mineral density (BMD). RESULTS: Twelve trials from 6,652 records were included: nine compared zoledronate with placebo, two trials compared zoledronate with alendronate, and one trial compared zoledronate with ibandronate. Zoledronate reduced the incidence of fractures in osteoporotic [three years: morphometric vertebral fractures (relative risk, RR = 0.30 (95% confidence interval, CI: 0.24-0.38))] and osteopenic women [six years: morphometric vertebral fractures (RR = 0.39 (95%CI: 0.25-0.61))], increased incidence of post-dose symptoms [RR = 2.56 (95%CI: 1.80-3.65)], but not serious adverse events [RR = 0.97 (95%CI: 0.91-1.04)]. Zoledronate reduced BTM and increased BMD in osteoporotic and osteopenic women. CONCLUSION: This review supports the efficacy and safety of zoledronate in postmenopausal women with osteopenia for six years and osteoporosis for three years. PROSPERO REGISTRATION NUMBER: CRD42022309708, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309708.

King's Parkinson's Disease Pain Questionnaire: reliability and convergent construct validity / King's Parkinson's Disease Pain Questionnaire: fiabilidad y validez de constructo convergente / King's Parkinson's Disease Pain Questionnaire: confiabilidade e validade de construto convergente

ABSTRACT Objectives: to assess the evidence of reliability and convergent construct validity of the King's Parkinson's Disease Pain Questionnaire. Methods: psychometric study of 75 older adults with Parkinson's disease. The instrument was applied by two researchers separately and reapplied by one researcher 15 days later. In terms of reliability, internal consistency was assessed using the Cronbach's alpha test and stability using the intraclass correlation coefficient. Scores of the King's Parkinson's Disease Pain Questionnaire were compared to those of the Geriatric Pain Measure in the assessment of construct validity. Results: the mean Cronbach's alpha obtained between the three assessments was above 0.60, the intraclass correlation between the three assessments was above 0.90, and there was a weak but significant correlation between the two applied scales. Conclusions: the instrument showed adequate evidence of convergent construct validity and reliability, and can be used in clinical practice.

RESUMEN Objetivos: evaluar las evidencias de confiabilidad y validez convergente de constructo del King's Parkinson's Disease Pain Questionnaire. Métodos: estudio psicométrico con 75 adultos mayores con enfermedad de Parkinson. El instrumento fue aplicado por dos investigadores por separado y vuelto a aplicar por uno investigador después de 15 días. En cuanto a la confiabilidad, se evaluó la consistencia interna mediante la prueba alfa de Cronbach y la estabilidad mediante el coeficiente de correlación intraclase. Al evaluar la validez del constructo, las puntuaciones del King's Parkinson's Disease Pain Questionnaire se compararon con las de la Geriatric Pain Measure. Resultados: se obtuvo un alfa de Cronbach promedio entre las tres evaluaciones por encima de 0,60 y correlación intraclase por encima de 0,90, y una correlación débil pero significativa entre las dos escalas aplicadas. Conclusiones: el instrumento mostró evidencia adecuada de validez convergente de constructo y confiabilidad, y puede ser utilizado en la práctica clínica.

RESUMO Objetivos: avaliar as evidências de confiabilidade e de validade de construto convergente do King's Parkinson's Disease Pain Questionnaire. Métodos: estudo psicométrico com 75 idosos com doença Parkinson. O instrumento foi aplicado por dois pesquisadores separadamente e reaplicado por um dos pesquisadores após 15 dias. Na confiabilidade, a consistência interna foi avaliada pelo teste de alfa de Cronbach e a estabilidade pelo coeficiente de correlação intraclasse. Na avaliação da validade de construto, os escores do King's Parkinson's Disease Pain Questionnaire foram comparados ao escore da Geriatric Pain Measure. Resultados: foi obtido um alfa de Cronbach médio entre as três avaliações acima de 0,60 e correlação intraclasse entre as três avaliações acima de 0,90, bem como uma correlação fraca, mas significativa entre as duas escalas aplicadas. Conclusões: o instrumento apresentou adequadas evidências de validade de construto convergente e de confiabilidade, podendo ser utilizado na prática clínica.

Intravenous zoledronate for postmenopausal women with osteopenia and osteoporosis: a systematic review and metanalysis

ABSTRACT BACKGROUND: Osteoporosis compromises bone strength and increases the risk of fractures. Zoledronate prevents loss of bone mass and reduces the risk of fractures. OBJECTIVES: To determine the efficacy and safety of zoledronate in postmenopausal women with osteopenia and osteoporosis. DESIGN AND SETTINGS A systematic review and meta-analysis was conducted within the evidence-based health program at the Universidade Federal de São Paulo. METHODS: An electronic search of the CENTRAL, MEDLINE, Embase, and LILACS databases was performed until February 2022. Randomized controlled trials comparing zoledronate with placebo or other bisphosphonates were included. Standard methodological procedures were performed according to the Cochrane Handbook and the certainty of evidence for the Grading of Recommendations Assessment, Development, and Evaluation Working Group. Two authors assessed the risk of bias and extracted data on fractures, adverse events, bone turnover markers (BTM), and bone mineral density (BMD). RESULTS: Twelve trials from 6,652 records were included: nine compared zoledronate with placebo, two trials compared zoledronate with alendronate, and one trial compared zoledronate with ibandronate. Zoledronate reduced the incidence of fractures in osteoporotic [three years: morphometric vertebral fractures (relative risk, RR = 0.30 (95% confidence interval, CI: 0.24-0.38))] and osteopenic women [six years: morphometric vertebral fractures (RR = 0.39 (95%CI: 0.25-0.61))], increased incidence of post-dose symptoms [RR = 2.56 (95%CI: 1.80-3.65)], but not serious adverse events [RR = 0.97 (95%CI: 0.91-1.04)]. Zoledronate reduced BTM and increased BMD in osteoporotic and osteopenic women. CONCLUSION: This review supports the efficacy and safety of zoledronate in postmenopausal women with osteopenia for six years and osteoporosis for three years. PROSPERO REGISTRATION NUMBER: CRD42022309708, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309708.

Algorithm for screening and management of locomotive syndrome in elderly individuals and development of a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese.

OBJECTIVE: To develop a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese and to create an algorithm for locomotive syndrome screening and management. METHODS: The 25-question Geriatric Locomotive Function Scale-Portuguese was applied to individuals aged 60 years or older seen at the Geriatrics and Gerontology Department of Universidade Federal de São Paulo, between 2016 and 2018. Items of the 25-question Geriatric Locomotive Function Scale-Portuguese were submitted to exploratory factor analysis using the principal component method. Internal consistency was investigated using Cronbach's alpha coefficient. The ROC curve was used to determine the cut-off point of the short version developed. Finally, a simple and objective algorithm was created for locomotive syndrome screening and management using the Delphi method. RESULTS: A total of 202 elderly individuals aged 61 to 101 years (mean age, 84.67 years) were evaluated. Fifteen items were excluded from the 25-question Geriatric Locomotive Function Scale-Portuguese to compose the 10-question Geriatric Locomotive Function Scale-Portuguese, a 10-item instrument with appropriate psychometric properties. A cut-off point of ten (ROC curve) was determined for potential locomotive syndrome, with 96.5% sensitivity and 86.2% specificity. A very simple algorithm was developed for locomotive syndrome screening and management. CONCLUSION: The short version (10-question) of the Geriatric Locomotive Function Scale-Portuguese has appropriate psychometric properties and provides a practical tool for detection of locomotive problems in elderly individuals.

Algorithm for screening and management of locomotive syndrome in elderly individuals and development of a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese

ABSTRACT Objective To develop a short version of the 25-question Geriatric Locomotive Function Scale-Portuguese and to create an algorithm for locomotive syndrome screening and management. Methods The 25-question Geriatric Locomotive Function Scale-Portuguese was applied to individuals aged 60 years or older seen at the Geriatrics and Gerontology Department of Universidade Federal de São Paulo, between 2016 and 2018. Items of the 25-question Geriatric Locomotive Function Scale-Portuguese were submitted to exploratory factor analysis using the principal component method. Internal consistency was investigated using Cronbach's alpha coefficient. The ROC curve was used to determine the cut-off point of the short version developed. Finally, a simple and objective algorithm was created for locomotive syndrome screening and management using the Delphi method. Results A total of 202 elderly individuals aged 61 to 101 years (mean age, 84.67 years) were evaluated. Fifteen items were excluded from the 25-question Geriatric Locomotive Function Scale-Portuguese to compose the 10-question Geriatric Locomotive Function Scale-Portuguese, a 10-item instrument with appropriate psychometric properties. A cut-off point of ten (ROC curve) was determined for potential locomotive syndrome, with 96.5% sensitivity and 86.2% specificity. A very simple algorithm was developed for locomotive syndrome screening and management. Conclusion The short version (10-question) of the Geriatric Locomotive Function Scale-Portuguese has appropriate psychometric properties and provides a practical tool for detection of locomotive problems in elderly individuals.

Development and validation of the sleep assessment instrument for older adults with pain.

BACKGROUND: The co-occurrence of chronic pain and sleep disturbance contribute to a significant functional and social impact in older adults. However, there are no validated instruments to measure sleep disturbance and pain in this population that could be used to screen or diagnose individuals or monitor treatment effectiveness. OBJECTIVE: Our aim was to develop and validate a brief, practical, and comprehensive tool to assess the impact of co-occurring pain and sleep disturbance in older adults. METHODS: Development and validation of a measurement tool for assessing pain and sleep in older adults consisting of seven items. RESULTS: We applied the "Sleep Assessment Instrument for Pain in older adults" (SAIOAP) in a sample of 100 older individuals. A Cronbach's alpha of 0.602 indicated a moderate level of reliability, and item-total correlations of ≥0.4 for all items indicated good homogeneity. There were statistically significant correlations between the SAIOAP and sleep quality (PSQI, r=61.5), pain intensity (VNS, r=30.5), the multidimensional impacts of pain (GPM, r=40.5), depression (GEAP, r=45.5), comorbidity (r=27.9), and medication use (r=30.4). A ROC curve indicated a sensitivity of 73.2% and a specificity of 79.1% in relation to the prediction of sleep disturbances associated with pain in older adults. CONCLUSIONS: The SAIOAP presented adequate metric properties and was demonstrated to be a simple and practical tool for the assessment of the impact of pain on sleep in older adults.

Development and validation of the sleep assessment instrument for older adults with pain / Desenvolvimento e validação do instrumento de avaliação de sono para idosos com dor

Abstract Background: The co-occurrence of chronic pain and sleep disturbance contribute to a significant functional and social impact in older adults. However, there are no validated instruments to measure sleep disturbance and pain in this population that could be used to screen or diagnose individuals or monitor treatment effectiveness. Objective: Our aim was to develop and validate a brief, practical, and comprehensive tool to assess the impact of co-occurring pain and sleep disturbance in older adults. Methods: Development and validation of a measurement tool for assessing pain and sleep in older adults consisting of seven items. Results: We applied the "Sleep Assessment Instrument for Pain in older adults" (SAIOAP) in a sample of 100 older individuals. A Cronbach's alpha of 0.602 indicated a moderate level of reliability, and item-total correlations of ≥0.4 for all items indicated good homogeneity. There were statistically significant correlations between the SAIOAP and sleep quality (PSQI, r=61.5), pain intensity (VNS, r=30.5), the multidimensional impacts of pain (GPM, r=40.5), depression (GEAP, r=45.5), comorbidity (r=27.9), and medication use (r=30.4). A ROC curve indicated a sensitivity of 73.2% and a specificity of 79.1% in relation to the prediction of sleep disturbances associated with pain in older adults. Conclusions: The SAIOAP presented adequate metric properties and was demonstrated to be a simple and practical tool for the assessment of the impact of pain on sleep in older adults.

RESUMO Introdução: A co-ocorrência de dor crônica e de distúrbios do sono contribuem para um impacto funcional e social negativo em idosos. Porém, o binômio dor-sono não foi explorado em relação a questionários para idosos, a fim de auxiliar na triagem, no diagnóstico ou no monitoramento da eficácia do tratamento médico. Objetivo: Desenvolver e validar um instrumento breve, prático e abrangente para avaliar a concorrência de condições álgicas crônicas e distúrbios de sono em idosos. Métodos: Estudo descritivo e qualitativo de metodologia de desenvolvimento e validação de instrumento de medida para avaliação de dor e sono em idosos, composto por sete itens. Após a fundamentação teórica, desenvolveram-se os itens do instrumento, seguidos de um estudo quantitativo (validação), em que testamos pacientes idosos com dor crônica. Resultados: Aplicou-se o Instrumento de Avaliação de Sono para Dor em Idosos (IASID) a uma amostra de 100 idosos. Alcançou-se o alfa de Cronbach (0,602) de boa homogeneidade por correlação item-total (≥0,4). Encontramos correlações estatisticamente significativas entre o IASID e a qualidade do sono (PSQI, r=61,5%); a intensidade da dor (NVS, r=30,5%); seus impactos (GPM, r=40,5); depressão (GEAP, r=45,5%); comorbidades (r=27,9) e uso de medicamentos (r=30,4). A curva ROC apontou sensibilidade de 73,2% e especificidade de 79,1% para predição de distúrbios do sono associados à dor crônica em idosos. Conclusões: O IASID apresentou propriedades métricas adequadas e demonstrou ser uma ferramenta simples e prática para a avaliação do impacto da dor no sono em idosos.

Motor cortex transcranial direct current stimulation effects on knee osteoarthritis pain in elderly subjects with dysfunctional descending pain inhibitory system: A randomized controlled trial.

BACKGROUND: Although evidence has indicated a positive effect of transcranial direct current stimulation (tDCS) on reducing pain, few studies have focused on the elderly population with knee osteoarthritis (KOA). OBJECTIVE: To evaluate whether tDCS reduces KOA pain in elderly individuals with a dysfunctional descending pain inhibitory system (DPIS). METHODS: In a double-blind trial, individuals ≥ 60 years with KOA pain and a dysfunctional DPIS, we randomly assigned patients to receive 15 daily sessions of 2 mA tDCS over the primary motor cortex (anode) and contralateral supraorbital area (cathode) (M1-SO) for 20 min or sham tDCS. Change in pain perception indexed by the Brief Pain Inventory (BPI) at the end of intervention was the primary outcome. Secondary outcomes included: disability, quantitative sensory testing, pain pressure threshold and conditioned pain modulation (CPM). Subjects were followed-up for 2 months. RESULTS: Of the 104 enrolled subjects, with mean (SD) age of 73.9 (8.01) years and 88 (84.6%) female, 102 finished the trial. In the intention-to-treat analysis, the active tDCS group had a significantly greater reduction in BPI compared to the sham group (difference, 1.59; 95% CI, 0.95 to 2.23; P < 0.001; Cohen's d, 0.58); and, also a significantly greater improvement in CPM-pressure in the knee (P = 0.01) and CPM-pain in the hand (P = 0.01). These effects were not sustained at follow-up. The intervention was well tolerated, with no severe adverse effects. CONCLUSION: M1-SO tDCS is associated with a moderate effect size in reducing pain in elderly patients with KOA after 15 daily sessions of stimulation. This intervention has also shown to modulate the DPIS.

Locomotive Syndrome is associated with chronic pain and poor quality of life in Brazilian oldest old: LOCOMOV Project.

BACKGROUND: In 2007, the Japanese Orthopedic Association established the term "Locomotive Syndrome" (LS) for the concept of locomotor organ dysfunction with potential loss of independence. The purpose of this study was to identify characteristics of LS and establish a diagnostic cut-off for the Geriatric Locomotive Function Scale (GLFS 25-p) for the Brazilian population. METHODS: A cross-sectional observational study of the LOCOMOV Project cohort of independent outpatients aged ≥80 years was conducted. Questionnaires on functional status in Basic and Instrumental Activities of Daily Living (Katz and Lawton, respectively) and quality of life (WHOQOL-Bref) were applied, together with the Geriatric Locomotive Function Scale (GLFS 25-p) to identify individuals with LS. Mobility was assessed using the five-times sit-to-stand test, 4-m gait speed, two-step test, one-leg standing time with eyes open and hand-grip test. The data were analyzed using Student's t-test, the Chi-Square test, and multiple logistic regression (stepwise). The significance level was set at 0.05 (5%). RESULTS: A sample of 102 individuals with mean age of 87.3 (±4.2) years and predominantly female (73.5%) was assessed. We determined a cut-off score of 19 (sensitivity of 0.86 and specificity of 0.67) for diagnosis of LS, as assessed by the GLFS 25-p, and a high prevalence (55%) of the syndrome was found in the sample. In the multiple regression analysis, LS was directly associated with chronic pain (OR 22.24, 95%CI 3.13-157.87), use of a walking device (OR 17.121, 95%CI 1.94-150.49), and inversely associated with gait speed ≥0.8 m/s (OR 0.42, 95%CI 0.006-0.278), perception of good health (OR 0.153, 95%CI 0.029-0.799) and male gender (OR 0.086, 95%CI 0.0105-0.714). CONCLUSION: The LS in the oldest old proved a very common condition in this survey, especially in women, and was strongly associated with chronic pain, worse performance on physical tests and poor quality of life.

Transcranial direct current stimulation for fatigue in patients with Sjogren's syndrome: A randomized, double-blind pilot study.

BACKGROUND: Transcranial direct-current stimulation (tDCS) has shown promise to decrease fatigue. However, it has never been examined in primary Sjogren Syndrome (pSS). OBJECTIVE: To assess the effect of a tDCS protocol on fatigue in patients with pSS. METHODS: This is a parallel, double-blind pilot study (NCT04119128). Women aged 18-65 years, with pSS, on stable pharmacological therapy, with complaints of fatigue for at least three months, and with scores >5 on Fatigue Severity Scale (FSS) were included. We randomized 36 participants to receive five consecutive or sham tDCS sessions, with an intensity of 2 mA, for 20 min/day. RESULTS: After five tDCS sessions, fatigue severity assessed by the FSS (primary outcome) demonstrated a mean group difference of -0.85 [95% confidence interval (CI) -1.57, -0.13; effect size 0.80] favouring the active group. The active group presented significantly greater reductions in fatigue as measured by the EULAR Sjögren's Syndrome Patient Reported Index after five tDCS sessions [mean group difference: 1.40; 95%CI -2.33, -0.48; effect size 1.04]. Although there were no between-group differences in the secondary outcomes of sleep, mood and anxiety, within-group comparisons evidenced a small but significant difference in the active group for pain and sleep. There were no significant cortisol changes. All reported adverse events were mild and transitory. CONCLUSION: tDCS seems to be safe and reduce fatigue in pSS. A differential effect on pain and sleep may underlie its effects. Further studies are needed to optimise tDCS treatment strategies in pSS.

Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögren's syndrome: a cross-sectional study.

BACKGROUND: Fatigue is a frequent symptom in patients with primary Sjögren's syndrome (pSS) and can be a cause of or be associated with sleep disorders. OBJECTIVE: To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity. DESIGN AND SETTING: Analytical observational study conducted at an exercise psychobiology laboratory. METHODS: Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics. RESULTS: A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI. CONCLUSION: The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue.

Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögrens syndrome: a cross-sectional study

ABSTRACT BACKGROUND: Fatigue is a frequent symptom in patients with primary Sjögren's syndrome (pSS) and can be a cause of or be associated with sleep disorders. OBJECTIVE: To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity. DESIGN AND SETTING: Analytical observational study conducted at an exercise psychobiology laboratory. METHODS: Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics. RESULTS: A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI. CONCLUSION: The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue.

High Prevalence of Vertebral Fracture in a Very Elderly Community-Dwelling: "Longevous Project".

INTRODUCTION: Vertebral fractures (VF) are associated with poorer quality of life, morbidity, and mortality in aging, and are the main risk factors for new VF or fractures in other sites. Thus, to explore them in the elderly is important, especially considering the very elderly individuals (age ≥ 80), who belong to the fastest growing population in the world, a portion that is still very little studied. OBJECTIVE: To evaluate the prevalence, specific characteristics and associations of VFs in a very elderly population. METHOD: Observational, descriptive, and analytical cross-sectional study of the "Longevous Project" - São Paulo, Brazil, an ongoing prospective cohort that includes elderly of both gender, aged 80 yr or more. For the diagnosis of VF 2 methods were used VFA ("VF Assessment) by bone densitometry and X-ray, by 2 independent physicians, and using the Genant semiquantitative technique. The VFs by VFA were correlated with demographic, anthropometric, clinical, laboratory, and densitometric data. Statistical tests applied were qui-square and ANOVA. RESULTS: We analyzed data of 125 individuals with a mean age of 86.7 ± 4.1 yr and majority of female (71.2%). The prevalence of osteoporosis and osteopenia was 35.5% and 47.6%, respectively. A higher prevalence of VF was verified by VFA (30.4%) than by X-ray (20.8%), besides the majority was considered severe, 52.6% and 57.7%, by VFA and X-ray, respectively. A concordance index between the 2 methods was considered regular for the diagnosis of VF (Kappa = 0.419), and good for the VF severity (Kappa = 0.743). The VF were significantly associated to bone densitometry analysis VF (p = 0.05), and its severity was significantly correlated with total hip BMD (p = 0.049) and glomerular filtration rate (p = 0.017). CONCLUSION: This study observed a high prevalence of VF in a very elderly population, being the great majority severe fractures and suggests that VFA might be more effective to detect VF in oldest-old individuals.