Identifying clinically meaningful muscle power enhancements and their functional correlates in hospitalized older patients.

BACKGROUND: This study aimed to determine the threshold of muscle power and strength enhancements that lead to functional gains after exercise intervention in an acute care unit. METHODS: A total of 302 older patients (intervention: 169, control: 133) from two randomized clinical trials were included (mean age 86.7 years). We measured maximal strength (1RM) and muscle power via a velocity transducer during leg press exercise at 30% and 60% of 1RM. A multicomponent exercise program, including power training, balance, and gait exercises performed over 3 to 6 consecutive days, served as the intervention. We used an anchor-based method to correlate muscle function increases with the Short Physical Performance Battery (SPPB) and gait velocity (GVT) to define clinically meaningful improvements (CMI). RESULTS: In the intervention group, marked differences were found in maximal power at 30% of 1RM between SPPB responders and non-responders (relative 83.5% vs. 34.8%; absolute 33.0 vs. 12.8 W; P<0.05) and at 60% of 1RM (relative 61.1% vs. 22.4%; P<0.05). GVT responders demonstrated significantly greater improvements in both relative and absolute maximal power than non-responders at both 30% and 60% of 1RM (P<0.05), as well as greater absolute 1RM gains (21.2 vs. 15.2 kg, P<0.05). CMI for muscle power based on SPPB and GVT ranged from 30.2% to 48.7%, whereas for 1RM, it was 8.2% based on GVT. CONCLUSION: Muscle power gains were most notable in patients with improvements in the SPPB and GVT, highlighting the critical role of muscle power in functional recovery in these patients.

Body Adiposity Index as a Predictor of Body Fat in an Oldest Old and Independent Cohort of Brazilian Older Adults.

BACKGROUND: Anthropometry and body mass index (BMI) do not assess body composition or its distribution in older adults; thus, individuals may have different fat percentages but similar BMI values. The body adiposity index (BAI) was recently proposed as a feasible and inexpensive method for estimating the percentage of body fat based on measurements of hip circumference and height. The present study evaluated whether BAI and BMI are useful alternatives to dual-energy X-ray absorptiometry (DXA), which is rarely used in clinical practice, for predicting body fat in independent long-lived older adults. METHODS: In this cross-sectional study, we used DXA to calculate the percentage of body fat, which was compared with BAI and BMI values. We performed Pearson correlation analyses and used Cronbach's alpha, described by Bland and Altman, to compare the reliability between the indexes. RESULTS: Among 157 evaluated individuals (73.2% women, mean age 87±3.57 years), men had a lower percentage of total fat, as assessed by DXA, and lower BAI indices than women. The correlation between BAI and DXA was moderate (r=0.59 for men and r=0.67 for women, p<0.001). We confirmed the reliability based on Cronbach's alpha coefficients of 0.67 in men and 0.77 in women. We also observed that the BAI was strongly positively correlated with BMI in both men and women. CONCLUSION: The BAI, used in combination with BMI, can be an alternative to DXA for the assessment of body fat in the oldest old in clinical practice, mainly women, and can be used to add information to BMI.

Reduced Handgrip Strength Is Associated with 1 Year-Mortality in Brazilian Frail Nonagenarians and Centenarians.

The aim of the present study was to investigate the association between handgrip strength and mortality in Brazilian frail nonagenarians and centenarians. Eighty-one oldest old were included (mean age [SD]: 94.2 [3.8] years). Data on strength was assessed by handgrip strength. Mortality rate of the participants was evaluated at 1-year follow-up after the functional assessment. A logistic regression analysis was used to assess differences in categories of handgrip strength between groups regarding the mortality rate. Forty-six participants (56.8%) had reduced handgrip strength. After 1 year, there were 16 deaths. Those older adults with a low handgrip strength had higher prevalence (28.3% vs. 8.6%) and increased risk of mortality than those with preserved handgrip strength (Odds ratio=4.4, confidence interval 95% 1.1, 18.4) (p=0.042). Reduced handgrip strength is associated with higher mortality rate at 1-year follow-up in Brazilian frail nonagenarians and centenarians.

Serum 25 hydroxyvitamin D concentrations in individuals over 80 years old and their correlations with musculoskeletal and health parameters.

PURPOSE: The present study aims to evaluate the serum concentrations of 25 hydroxyvitamin D[25(OH)D] in individuals aged ≥80 years, independent, free-living in Sao Paulo, Brazil (Lat 23.5 oS), and to investigate their associations with musculoskeletal system, physical performance and health markers. METHOD: This cross-sectional study included 212 community dwellers aged ≥80 years and evaluated serum 25(OH)D, PTH, calcium, albumin, phosphorus, creatinine, bone markers, and bone mineral density. Physical performance was evaluated with stationary march, Flamingo, and functional reach tests, questionnaires to assess falls and fractures in the previous year, energy expenditure (MET), and Charlson index. Physical activity was evaluated with the International Physical Activity Questionnaire. RESULTS: Vitamin D deficiency (<20 ng/mL) was observed in 56% and severe vitamin D deficiency (<10 ng/mL) in 13% of those individuals. Serum concentrations of 25(OH)D were significantly and positively associated with BMD total hip (p = 0.001), femoral neck (p = 0.011) and 33% radius (p = 0.046) BMDs, MET (p = 0.03) and functional reach test (p = 0.037) and negatively with age (p = 0.021), PTH (p = 0.004) and osteoporosis diagnosis (p = 0.012). Long-lived individuals with 25(OH)D ≥ 20 ng/mL had higher total hip and femoral neck BMDs (p = 0.012 and p = 0.014, respectively) and lower PTH (p = 0.030). In multiple linear regression analysis, age and osteoporosis diagnosis remained negatively associated with 25(OH)D levels (p = 0.021 and p = 0.001, respectively), while corrected calcium and cholecalciferol use remained positively associated (p = 0.001 and p = 0.024, respectively). CONCLUSION: We observed high vitamin D inadequacy prevalence in those Brazilian community dwellers' oldest old. Serum concentrations of 25(OH)D were positively associated with bone mass and dynamic balance, and negatively with PTH and osteoporosis diagnosis. Additionally, 25(OH)D ≥ 20 ng/mL was associated with better bone mass and lower PTH levels.

Clinical-Functional Vulnerability, Functional Capacity, and Falls in Octogenarians with Different Physical Activity Levels-A Cross-Sectional Study.

AIM: To compare differences between frailty, functional capacity, and fall prevalence among community-dwelling oldest-old adults regarding their physical activity levels. METHODS: Two hundred and thirty-nine octogenarians (80+ years) were allocated according to their physical activity as insufficiently active (<150 min week-1; n = 98; 84.4 ± 3.7 years), active (150 to 300 min week-1, n = 81, 83.9 ± 3.1 years), and very active (>300 min week-1, n = 60; 83.8 ± 3.4 years). Frailty (CFVI-20 questionnaire), functional capacity (Five Times Sit-to-Stand Test, Timed Up and Go, Balance, and handgrip strength), fall history, and physical activity were assessed. RESULTS: The insufficiently active group was the frailest and presented the worst functional performance compared to the other groups. The fall prevalence was higher in the insufficiently active (60.9%) compared to the active (26.4%) and very active (12.7%) groups. CONCLUSIONS: The group of insufficiently active octogenarians showed the greatest frailty, worst functional capacity, and higher fall prevalence than the active and very active groups. The engagement in physical activity of at least 300 min week-1 is essential to reverse or minimize the deleterious effects of aging on frailty, functional capacity, and falls in octogenarians.

Body mass index and 12-year mortality among older Mexican Americans aged 75 years and older.

BACKGROUND: The role of obesity in mortality in the very old and old-oldest Hispanic population has not been studied. The objective of this study was to examine the effect of body mass index (BMI) on 12-year mortality among older Mexican Americans aged 75 years and older. METHODS: Twelve year prospective cohort study consisting of a population-based sample of 1415 non-institutionalized Mexican American men and women aged 75 and older from 5 southwestern states: Arizona, California, Colorado, New Mexico, and Texas. Data was from Wave 5 of the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005-2016). Socio-demographics, body mass index (BMI), self-reported medical conditions, disability, depressive symptoms, falls, Mini-Mental-State-Examination (MMSE), and Short Physical Performance Battery (SPPB) were assessed at baseline during 2004-2005. BMI (Kg/m2) was classified as underweight (< 18.5), normal weight (18.5 to < 25), overweight (25 to < 30), obesity category I (30 to < 35), and obesity category II/morbid obesity (≥ 35). For assessment of mortality, deaths were ascertained through the National Death Index and report from relatives. Cox proportional hazards regression analysis was performed to estimate the hazard ratio (HR) of 12-year mortality as a function of BMI categories at baseline. RESULTS: The mean BMI was 27.5 ± 1.7 with participants classified as 1.8% underweight, 30.8% normal weight, 39.2% overweight, 20.7% obesity category I, and 7.6% obesity category II/morbid obesity. Mexican Americans aged ≥75 years with overweight or obesity category I had a reduced HR of death (0.82, 95% CI = 0.70-0.96 and 0.75, 95% CI = 0.62-0.91, respectively) over 12-years of follow-up. The HR of death for underweight and obesity category II/morbid obesity participants was 1.59 (95% CI = 1.03-2.45) and 1.12 (95% CI = 0.85-1.46), respectively. Female participants and those with high scores in the MMSE and SPPB had decreased risk of death. CONCLUSIONS: This study showed the protective effect of overweight and obesity on mortality in Mexican Americans above 75 years of age, which might have implications when treating older adults with overweight and obesity.

The Performance Index Identifies Changes Across the Dual Task Timed Up and Go Test Phases and Impacts Task-Cost Estimation in the Oldest-Old.

Introduction: Dual tasking is common in activities of daily living (ADLs) and the ability to perform them usually declines with age. While cognitive aspects influence dual task (DT) performance, most DT-cost (DT-C) related metrics include only time- or speed- delta without weighting the accuracy of cognitive replies involved in the task. Objectives: The primary study goal was to weight the accuracy of cognitive replies as a contributing factor when estimating DT-C using a new index of DT-C that considers the accuracy of cognitive replies (P-index) in the instrumented timed up and go test (iTUG). Secondarily, to correlate the novel P-index with domains of the Mini-Mental State Examination (MMSE). Methods: Sixty-three participants (≥85 years old) took part in this study. The single task (ST) and DT iTUG tests were performed in a semi-random order. Both the time taken to complete the task measured utilizing an inertial measurement unit (IMU), and the accuracy of the cognitive replies were used to create the novel P-index. Clinical and sociodemographic data were collected. Results: The accuracy of the cognitive replies changed across the iTUG phases, particularly between the walk 1 and walk 2 phases. Moreover, weighting 0.6 for delta-time (W1) and 0.4 for cognitive replies (W2) into the P-index enhanced the prediction of the MMSE score. The novel P-index was able to explain 37% of the scores obtained by the fallers in the "spatial orientation" and "attention" domains of the MMSE. The ability of the P-index to predict MMSE scores was not significantly influenced by age, schooling, and number of medicines in use. The Bland-Altman analysis indicated a substantial difference between the time-delta-based DT-C and P-index methods, which was within the limits of agreement. Conclusions: The P-index incorporates the accuracy of cognitive replies when calculating the DT-C and better reflects the variance of the MMSE in comparison with the traditional time- or speed-delta approaches, thus providing an improved method to estimate the DT-C.

SPARC Metrics Provide Mobility Smoothness Assessment in Oldest-Old With and Without a History of Falls: A Case Control Study.

Aging-related neuromuscular and neurocognitive decline induces unsmooth movements in daily functional mobility. Here, we used a robust analysis of linear and angular spectral arc length (SPARC) in the single and dual task instrumented timed up-and-go (iTUG) test to compare functional mobility smoothness in fallers and non-fallers aged 85 and older. 64 participants aged 85 and older took part in this case control study. The case group (fallers, n = 32) had experienced falls to the ground in the 6 months prior to the assessment. SPARC analyses were conducted in all phases of the single and dual task iTUGs. We also performed correlation mapping to test the relation of socio-demographic and clinical features on SPARC metrics. The magnitude of between-group differences was calculated using D-Cohen effect size (ES). SPARC was able to distinguish fallers during the single iTUG (ES ≈ 4.18). Turning while walking in the iTUG induced pronounced unsmooth movements in the fallers (SPARC ≈ -13; ES = 3.52) and was associated with the ability to maintain balance in the functional reach task. This information is of importance in the study of functional mobility in the oldest-old and to assess the efficacy of fall-prevention programs.

Capacidade funcional de idosos longevos: análise transversal baseada em um modelo de decisão / Functional capacity in the oldest old: cross-sectional analysis based on a decision model

INTRODUÇÃO: Idosos com 80 anos ou mais, ou longevos, são o subgrupo etário que mais cresce no mundo. Nesse segmento, a incapacidade funcional (IF) é mais prevalente que em outras faixas etárias. OBJETIVO: Caracterizar a capacidade funcional e analisar potenciais associações em idosos longevos de uma capital brasileira, com base em um modelo de decisão. MÉTODO: Estudo transversal com 100 idosos longevos, não institucionalizados, assistidos pela Estratégia Saúde da Família do Recife (PE), selecionados por amostra probabilística. Foram avaliados dados sociodemográficos, econômicos e clínicos coletados por meio de entrevistas domiciliares, aferição de medidas antropométricas e buscas nos prontuários. Para análise bivariada, foi empregado o teste χ2 de Pearson, considerando o nível de significância p < 0,05, e para a multivariada foi construída uma árvore de decisão com base em um algoritmo Exhaustive CHAID. RESULTADOS: A prevalência de IF na amostra correspondeu a 67,0%. Na análise bivariada, contribuíram para esse desfecho: renda (p = 0,032), situação previdenciária (p < 0,01), situação nutricional (p = 0,010), doenças neurológicas (p < 0,01), neoplasias (p < 0,01), saúde autopercebida (p = 0,025) e rede de apoio social (p = 0,032), permanecendo na análise multivariada: renda (p = 0,003), rede de apoio social (p = 0,032) e situação nutricional (p = 0,040). A árvore de decisão possibilitou a identificação das variáveis mais associadas ao desfecho, sendo capaz de prever adequadamente a dependência moderada, com assertividade de 72,1%. CONCLUSÃO: O modelo de decisão mostrou-se uma ferramenta oportuna na dedução dos determinantes mais relevantes da IF. Seu uso potencialmente contribui para ampliar a precisão diagnóstica e identificação de populações de risco.

INTRODUCTION: The oldest old adults, aged 80 years and above, is the fastest growing age group in the world. In this section of the population, functional disability (FD) is more prevalent compared to other age groups. OBJECTIVE: To characterize functional capacity and analyze potential associations in the oldest old from a Brazilian capital city, based on a decision model. METHODS: Cross-sectional study of 100 non-institutionalized oldest old participants assisted at the Family Health Strategy of Recife, in the Brazilian northeastern state of Pernambuco, selected by probabilistic sample. Sociodemographic, economic, and clinical data were collected by means of home interviews, anthropometric measurements, and medical records. For bivariate analysis, Pearson's chi-square test was used, establishing significance at p < 0.05. For the multivariate analysis, a decision tree was built from the Exhaustive CHAID algorithm. RESULTS: The prevalence of FD in the sample corresponded to 67.0%. In the bivariate analysis, the following data contributed to this outcome: income (p = 0.032), social security status (p < 0.01), nutritional status (p = 0.010), neurological diseases (p < 0.01), neoplasms (p < 0.01), self-perceived health (p = 0.025) and social support network (p = 0.032), remaining in the multivariate analysis: income (p = 0.003), social support network (p = 0.032), and nutritional status (p = 0.040). The decision tree allowed the identification of the variables most strongly associated with the outcome, being able to adequately predict moderate dependence, with 72.1% assertiveness. CONCLUSION: The decision model proved to be a timely tool in deducing the most relevant determinants of FD. Its use potentially contributes to increase the accuracy of the diagnosis and to identify populations at risk.

A relação entre os mecanismos que influenciam o propósito de vida e seus impactos na longevidade em idosos com mais de 80 anos / The relationship between the mechanisms that influence purpose in life and its impacts on longevity in the oldest-old / La relación entre los mecanismos que influyen en el propósito de la vida y sus impactos sobre la longevidad en las personas mayores de 80 años

Revisão integrativa da literatura que investigou a relação entre mecanismos que influenciam o propósito de vida (PDV) e seus impactos na longevidade,em idosos com mais de 80 anos. Encontraram-se oito trabalhos (bases de dados: LILACS, Medline, CINAHL, Web of Science, Scopus e SciELO).O PDV elevado aumenta as chances de um envelhecimento bem-sucedido e melhores desfechos em saúde; porém, não protege de depressão no futuro.O PDV deve ser fortalecido por intervenções que considerem questões existenciais e subjetivas de longevos.

Integrative literature review investigated the relationship between the mechanisms that influence purpose in life (PIL) and its impacts on longevity in the oldest-old. Eight papers were selected (databases: LILACS, Medline, CINAHL, Web of Science, Scopus and SciELO). High levels of PIL increases chances of successful aging and better outcomes in health. However, it does not protect against depression in the future.PIL must be strengthened through interventions considering existential and subjective issues of the oldest-old.

Revisión de literatura integradora que investigó la relación entre los mecanismos que influyen en el propósito de la vida (POS) y sus impactos en la longevidad, en personas mayores de 80 años. Se encontraron ocho estudios (bases de datos: LILACS, Medline, CINAHL, Web of Science, Scopus y SciELO). POS elevado aumenta las posibilidades de envejecimiento exitoso y mejores resultados de salud; sin embargo, no lo protege de la depresión en el futuro. El POS debe fortalecerse mediante intervenciones que tengan en cuenta los problemas existenciales y subjetivos de las personas de larga vida.

Capacidade funcional no idoso longevo: revisão integrativa / The functional capacity in the older elderly person: an integrative review / Capacidad funcional en ancianos de larga vida: revisión integradora

Este artigo tem como objetivo analisar, tanto a produção científica que versa sobre a manutenção da capacidade funcional em idosos longevos, quanto aquela que trata dos possíveis agravantes à saúde desse grupo etário. Para tanto, foi realizada uma revisão integrativa; houve, porém, muita dificuldade em encontrar literatura cientifica voltada para este grupo etário. Pode-se observar que, além das doenças que acometem estes idosos, fatores psicossociais, como a depressão e o isolamento são responsáveis pela perda de autonomia e independência deste grupo.

This article aims to analyze both the scientific production that deals with the maintenance of functional capacity in the elderly, as well as the one that deals with the possible health problems of this age group. To this end, an integrative review was performed; However, it was very difficult to find scientific literature for this age group. It can be observed that, in addition to the diseases that affect these elderly, psychosocial factors such as depression and isolation are responsible for the loss of autonomy and independence of this group.

Este artículo tiene como objetivo analizar tanto la producción científica que se ocupa del mantenimiento de la capacidad funcional en los ancianos, como la que se ocupa de los posibles problemas de salud de este grupo de edad. Con este fin, se realizó una revisión integradora; Sin embargo, fue muy difícil encontrar literatura científica para este grupo de edad. Se puede observar que, además de las enfermedades que afectan a estos ancianos, los factores psicosociales como la depresión y el aislamiento son responsables de la pérdida de autonomía e independencia de este grupo.

Functional capacity, renal function and vitamin D in community-dwelling oldest old.

PURPOSE: The aim of this study was to evaluate the association between the decline in estimated glomerular filtration rate (eGFR) and serum 25(OH)D with the physical and mental functional capacity of elderly individuals aged 80 years or older. METHODS: We evaluated the functional capacity in its multidomain aspects: Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), Mental State Mini-Exam (MMSE), Verbal Fluency Test (VF), handgrip strength and time to sit and rise from a chair five times, combined creatinine and cystatin C-based eGFR and 25(OH)D levels in 205 independent asymptomatic and community-dwelling elderly subjects in a cross-sectional study. RESULTS: Every 1 year of life, there was reduction of about 10% chance of adequate performance in functional capacity. Each 1 ml/min/m2 in eGFR was associated with 2% better chance of adequate performance in the IADL. We found no association between eGFR and cognition. Serum 25(OH)D between 15.00 and 22.29 ng/ml increased the chance of better performance in VF, IADL, handgrip strength and sit and rise from the chair compared to the lower level of serum vitamin D. CONCLUSIONS: Decreased renal function associated with age compromises the ability to perform activities for independent life in the community, but we did not observe influence in specific domains of cognition and physical performance. Low serum level of 25(OH)D appears to be a marker of greater risk of functional decline than eGFR measurement in independent oldest old dwelling in the community.

Prevalence of late-life depression and its correlates in a community-dwelling low-educated population aged 75+ years: The Pietà study.

BACKGROUND: The number of individuals with advanced age is growing worldwide, especially in developing countries. Depression is the most common mental disorder in the elderly. The aim of this study was to evaluate the prevalence rates and the correlates of late-life depression (LLD) and clinically significant depressive symptoms (CSDS) in a population aged 75+ years. METHODS: We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil, and used the MINI to diagnose LLD according to DSM-IV criteria and the GDS-15 to identify CSDS. Quality of life was assessed by the WHOQOL-OLD scale. RESULTS: Overall, 639 individuals (64% female, with a mean age of 81.1 ±â€¯5.2 and 2.6 ±â€¯2.8 years of schooling) were evaluated; 70 (11.1%) were diagnosed with LLD and 146 (25.6%) with CSDS. Depressed subjects (both with LLD and CSDS) had poorer measures of quality of life. Logistic regression analyses showed that LLD was independently associated to a history of falls/fracture, a diagnosis of cognitive impairment-no dementia, the number of regular drugs used, lack of reading habit and, inversely, to systolic blood pressure. LIMITATIONS: The use of MINI which has not been validated in the elderly. No information was available on the number of previous depressive episodes or on the age of first episode. CONCLUSION: Both dimensional and categorical diagnoses of depression were prevalent among community-dwelling oldest-old individuals. Different clinical and personal variables were associated with depression, which negatively influenced the quality of life of the affected individuals.

Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old.

OBJECTIVES: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. DESIGN: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. SETTING: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. SUBJECTS: This study included 2543 GPs from 29 countries. MAIN OUTCOME MEASURES: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. RESULTS: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98). CONCLUSIONS: GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points • General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age). • In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years. • However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60. • These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.

Disability in older adults with acute low back pain: the study Back Complaints in the Elderly - (Brazil).

BACKGROUND: The increase in the older adult and oldest old population in Brazil is growing. This phenomenon may be accompanied by an increase in musculoskeletal symptoms such as low back pain. This condition is usually associated with disability. OBJECTIVE: To verify the association between pain intensity and disability in older adults with acute low back pain and assess whether these variables differ depending on the age group and marital status. METHODS: This is a cross-sectional study conducted with 532 older adults with acute low back pain episodes. Pain intensity was assessed through the Numeric Pain Scale and disability through the Late Life Function and Disability Instrument, which shows two dimensions: "frequency" and "limitation" in performing activities. The association between pain and disability was analyzed. RESULTS: For the interaction effect between age groups and marital status, we found that the oldest old living with a partner performed activities of the personal domain less often compared to the oldest old living alone. The oldest old group living with a partner had a lower frequency of performing activities, but did not report feeling limited. The association of pain with disability was minimal (rho<0.20) and thus considered irrelevant. CONCLUSION: Disability in older adults with acute low back pain was influenced by the interaction between age groups and marital status and is not associated with pain intensity.

Cognitive performance of community-dwelling oldest-old individuals with major depression: the Pietà study.

BACKGROUND: Individuals with late-life depression (LLD) may present cognitive symptoms. We sought to determine whether a brief cognitive battery (BCB) could identify cognitive and functional deficits in oldest-old individuals with LLD and a low level of education. METHODS: We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the MINI and GDS-15 to diagnose major depression and evaluate its severity, respectively. The cognitive evaluation comprised the Mini-Mental State Examination (MMSE), BCB, clock-drawing test, category fluency test (animals) and Pfeffer's Functional Activities Questionnaire (FAQ). RESULTS: Fifty-four (11.6%) of the included individuals were diagnosed with LLD; on average, these participants were aged 81.0 ± 4.8 years and had 3.9 ± 3.4 years of schooling, and 77.8% of the subjects with LLD were female. Depressed individuals scored lower than subjects without dementia/depression on the MMSE overall (p < 0.001) and on several of the MMSE subscales, namely, time (p < 0.001) and spatial orientation (p = 0.021), attention/calculation (p = 0.019), and language (p = 0.004). Individuals with LLD performed worse on the incidental and (p = 0.011) immediate memory (p = 0.046) and learning tasks (p = 0.039) of the BCB. Individuals with LLD also performed worse on the category fluency test (p = 0.006), clock-drawing test (p = 0.011) and FAQ (p < 0.001). Depression severity was negatively correlated with incidental memory (ρ = -0.412; p = 0.003) and positively correlated with FAQ score (ρ = 0.308; p = 0.035). In the multiple regression analysis, only temporal orientation and FAQ score remained independently associated with LLD. CONCLUSION: Individuals with depression and a low level of education presented several cognitive and functional deficits. Depression severity was negatively correlated with incidental memory and functionality. Our findings serve as a description of the presence of cognitive dysfunction in individuals with LLD and suggest that these deficits may be identified based on the results of a BCB.

Ultrasonographic assessment of thyroid volume in oldest-old individuals

ABSTRACT Objective The aim of this study was to describe the relationship between thyroid volume and age, gender, anthropometric characteristics, and echogenicity in oldest-old subjects in an iodine-sufficient area. Subjects and methods The study included 81 independent elderly individuals aged ≥ 80 years (65 [80.2%] women). We determined these individuals' anthropometric characteristics, body mass index (BMI), and lean body mass, as well as thyroid volume and echogenicity by ultrasonography. Results We observed that octogenarians and nonagenarians had different profiles of thyroid echogenicity. The volume of the thyroid was smaller in nonagenarians than octogenarians (p = 0.012, r = 0.176), and subjects aged 80-89 years had more often hypoechoic glands than those aged ≥ 90 years (p = 0.01 versus 0.602). Conclusion The identification of ultrasonographic differences in oldest-old individuals will contribute to establishing preclinical markers, such as echogenicity, to identify individuals at risk of developing autoimmune thyroid disease. Future prospective studies should identify if 80-89-year-old individuals with hypoechoic glands progress to hypothyroidism, and if the absence of changes in echogenicity (i.e. a normal thyroid parenchyma) would have a positive impact on longevity among nonagenarians.

Perceived poor health is positively associated with physical limitations and chronic diseases in Brazilian nonagenarians and centenarians.

AIM: The oldest old are in most need of help. The present study examined the association between perceived health, physical functioning and diagnosed chronic disease in a sample of Brazilian nonagenarians and centenarians. METHODS: The 2008 Brazilian Household Survey dataset was used. The 2008 Brazilian Household Survey interviewed 292 553 individuals aged 14 years and older from the 26 Brazilian states plus the Federal District, selected in a multistage procedure. Our analytical sample focused on those aged 90 years and older. This yielded a final sample of 819 individuals. Logistic regression was used to examine the association between self-reported health and health conditions. RESULTS: Nearly 7% (n = 56) of the total sample were centenarians. High rates of physical limitations and chronic disease were reported by the participants. Participants reporting their health as poor were, on average, twofold more likely to report limitations in activities of daily living, and 1.7-fold more likely to report a chronic disease. CONCLUSIONS: Perceived poor health was positively associated with physical limitations and chronic disease in Brazilian oldest-old. These findings highlight the need for feasible interventions aiming to improve health and quality of life in this population, especially because this is the fastest growing age group worldwide. Geriatr Gerontol Int 2016; 16: 1196-1203.

Effects of two physical exercise protocols on physical performance related to falls in the oldest old: A randomized controlled trial.

AIM: To compare the effects of 16-week multicomponent and resistance training, and 6-week detraining on physical variables related to a higher risk of falls in very old people. METHODS: A randomized, three-arm, controlled trial was carried out. A total of 69 community-dwelling older adults aged 80 years and older were allocated to three groups: control, multicomponent training and resistance training. They were assessed at baseline, after 16-week training and 6-week detraining. The control group did not perform any intervention. The multicomponent group performed protocol consisting of warm-up, aerobic, strength, balance and cool-down exercises. The resistance group underwent strength exercises using six adapted machines. The training sessions had progressive intensity, lasted 16 weeks and 12 included three 1-h sessions per week. The assessment consisted of anamneses, five-repetition sit-to-stand, one-leg standing, tandem and dual task tests. For statistical analysis, α = 0.05 was used. RESULTS: There were no significant differences between groups and assessments in any variable when analyzed by intention to treat. However, when analyzed, the older adults who adhered to the training, the multicomponent group, had a significant improvement in the sit-to-stand and the one-leg standing (right support) tests. There was a significant main effect between times on the one-leg standing (left support) test. CONCLUSION: In very old people, multicomponent training seems to be more beneficial and presents fewer adverse events when the adherence to protocol is higher.

Do frailty and cognitive impairment affect dual-task cost during walking in the oldest old institutionalized patients?

The objective of this study was to investigate dual-task costs in several elderly populations, including robust oldest old, frail oldest old with MCI, frail oldest old without MCI, and frail elderly with dementia. Sixty-four elderly men and women categorized into frail without MCI (age 93.4 ± 3.2 years, n = 20), frail with MCI (age 92.4 ± 4.2 years, n = 13), robust (age 88.2 ± 4.1 years, n = 10), and patients with dementia (age 88.1 ± 5.1 years, n = 21). Five-meter gait ability and timed-up-and-go (TUG) tests with single and dual-task performance were assessed in the groups. Dual-task cost in both 5-m habitual gait velocity test and TUG test was calculated by the time differences between single and dual-task performance. The robust group exhibited better 5-m gait and TUG test performances in the single and dual-task conditions compared with the other three groups (P < 0.001), and the frail and frail + MCI groups exhibited better performances than the dementia group (P < 0.001). No significant differences were observed between the frail and frail + MCI groups. However, all groups exhibited lower gait velocities in the verbal and arithmetic task conditions, but the dual-task cost of the groups were similar. Robust individuals exhibited superior single and dual-task walking performances than the other three groups, and the frail and frail + MCI individuals exhibited performances that were superior to those of the patients with dementia. However, the dual-task costs, i.e., the changes in gait performance when elderly participants switch from a single to a dual task, were similar among all four of the investigated groups. Therefore, these results demonstrated that the magnitude of the impairment in gait pattern is independent of frailty and cognitive impairment status.