Visceral adipose tissue measured by DXA predicts metabolic syndrome in low-income community-dwelling elderly: Insights from the São Paulo Aging & Health (SPAH) study.

While visceral fat measured by dual-energy X-ray absorptiometry (DXA) is accurate in identifying middle-aged people at increased cardiometabolic risk, consistent data for the elderly are still lacking. We aimed to investigate the association between DXA-derived visceral adipose tissue (VAT) and metabolic syndrome (MetS) and to establish optimal cutoffs for VAT to predict MetS in a low-income elderly Brazilian cohort. A total of 449 women and 258 men (≥65 years) from the community were enrolled in this study. Participants underwent clinical and laboratory evaluations, along with body composition analysis by Hologic Discovery A densitometer. VAT was measured in the android region of the DXA scan. MetS was diagnosed using NCEP-ATPIII criteria. Multivariate logistic regression analyzed the relationship between VAT and MetS. Receiver-operating characteristic (ROC) curve analysis evaluated VAT's predictive accuracy for MetS, with optimal cutoffs determined by Youden's test to balance sensitivity and specificity. Mean ages were 76.6 ± 4.7 years for men and 77.1 ± 4.9 years for women. Mean BMIs were 26.5 ± 3.8 kg/m2 for men and 29.0 ± 5.2 kg/m2 for women. One hundred and seventy-five (41.5 %) men and 274 (61 %) women had MetS. After adjustments for confounders, multivariate analysis showed that VAT was independently associated with MetS in both men (OR 1.41, 95%CI 1.15-1.72) and women (OR 1.33, 95%CI 1.16-1.54, per each 100 g increase). Optimal VAT cutoffs to predict MetS were 642.5 g for men (AUC = 0.740) and 600.5 g for women (AUC = 0.729). Subanalysis for non-overweight/non-obese subjects yielded lower VAT cutoffs. Thus, VAT measured by DXA was significantly associated with MetS in older adults, regardless of BMI, emphasizing the critical role of VAT in predicting MetS. Therefore, VAT by DXA holds promise for evaluating MetS risk in the elderly. Further longitudinal studies are needed to investigate VAT's impact on major cardiovascular event incidence in this demographic.

Relationship of Community Mobility, Vital Space, and Faller Status in Older Adults.

Community mobility, encompassing both active (e.g., walking) and passive (e.g., driving) transport, plays a crucial role in maintaining autonomy and social interaction among older adults. This study aimed to quantify community mobility in older adults and explore the relationship between GPS- and accelerometer-derived metrics and fall risk. METHODS: A total of 129 older adults, with and without a history of falls, were monitored over an 8 h period using GPS and accelerometer data. Three experimental conditions were evaluated: GPS data alone, accelerometer data alone, and a combination of both. Classification models, including Random Forest (RF), Support Vector Machines (SVMs), and K-Nearest Neighbors (KNN), were employed to classify participants based on their fall history. RESULTS: For GPS data alone, RF achieved 74% accuracy, while SVM and KNN reached 67% and 62%, respectively. Using accelerometer data, RF achieved 95% accuracy, and both SVM and KNN achieved 90%. Combining GPS and accelerometer data improved model performance, with RF reaching 97% accuracy, SVM achieving 95%, and KNN 87%. CONCLUSION: The integration of GPS and accelerometer data significantly enhances the accuracy of distinguishing older adults with and without a history of falls. These findings highlight the potential of sensor-based approaches for accurate fall risk assessment in community-dwelling older adults.

Disentangling the relationship between biological age and frailty in community-dwelling older Mexican adults.

BACKGROUND: Older adults have highly heterogeneous aging rates. OBJECTIVE: To explore the association of biological age (BA) and accelerated aging with frailty in community-dwelling older adults. METHODS: We assessed 735 community-dwelling older adults from the Coyocan Cohort. BA was measured using AnthropoAge, accelerated aging with AnthropoAgeAccel, and frailty using Fried's phenotype and the frailty index. We explored the association of BA and accelerated aging (AnthropoAgeAccel ≥ 0) with frailty at baseline and characterized the body composition and physical function phenotype of accelerated aging in non-frail/frail participants. We also explored accelerated aging as a risk factor for frailty progression after 3-years of follow-up. RESULTS: Older adults with accelerated aging have higher frailty prevalence and indices, lower handgrip strength and gait speed. AnthropoAgeAccel was associated with higher frailty indices (ß = 0.0053, 95%CI 0.0027-0.0079), and increased odds of frailty at baseline (OR 1.16, 95%CI 1.09-1.25). We observed sex-based differences in body composition and physical function linked to accelerated aging in non-frail participants; however, these differences were absent in pre-frail/frail participants. Accelerated aging at baseline was associated with higher risk of frailty progression over time (OR 1.74, 95%CI 1.11-2.75). CONCLUSIONS: Despite being intertwined, biological accelerated aging is largely independent of frailty in community-dwelling older adults.

ANTECEDENTES: Los adultos mayores tienen tasas de envejecimiento heterogéneas. OBJETIVO: Explorar la asociación entre edad biológica (EB) y envejecimiento acelerado (EA) con fragilidad en adultos mayores. MÉTODOS: Análisis de 735 adultos mayores de la Cohorte de Coyocán. Se estimó EB con AnthropoAge, EA con AnthropoAgeAccel y fragilidad con el fenotipo de Fried y el índice de fragilidad (IF). Se exploró la asociación de EB y EA (AnthropoAgeAccel ≥ 0) con fragilidad; se caracterizamos su presencia simultánea sobre fenotipos de composición corporal y función física. Se determinó el riesgo del EA para progresión del fenotipo de fragilidad a tres 3 años de seguimiento. RESULTADOS: Los adultos mayores con EA presentaron mayor prevalencia de fragilidad e IF, menor fuerza de prensión y velocidad de marcha. Los resultados de AnthropoAgeAccel se asociaron a IF (ß = 0.0053, IC95% 0.0027-0.0079) y al fenotipo de fragilidad (RM = 1.16, IC 95 % = 1.09-1.25). Existieron diferencias por sexo en composición corporal y función física relacionadas con EA solo en participantes no frágiles. El EA en la evaluación basal se asoció con progresión de la fragilidad con el tiempo (RM = 1.74, IC 985 % = 1.11-2.75). CONCLUSIONES: A pesar su asociación, el EA es independiente de la fragilidad en adultos mayores que viven en la comunidad.

Exposing telomere length's impact on malnutrition risk among older adults residing in the community: Insights from cross-sectional data analysis.

BACKGROUND: Successful aging is associated with an increase in life expectancy. For a better understanding of the aging process, recognize the relationship between telomere length and nutritional status is a novel approach in geriatric science. Telomers shortening coincides with a decrease in life expectancy, and an increased risk of malnutrition-related diseases. GOALS: The goal of this study was to investigate whether a shorter telomere length is associated with a greater likelihood of malnutrition in community-dwelling older adults. METHODS: A cross-sectional study with a probabilistic sample of 448 older people aged 60 years old or over, and living in the urban area of an inland Brazilian municipality was conducted. The information was gathered in two stages: a) a personal interview was conducted to obtain sociodemographic, cognitive, and functional autonomy data. The Mini Nutritional Assessment was used to assess the risk of malnutrition. b) a blood sample was taken to proceed with the relative quantitative study of telomere length using real-time qPCR method. The differences between the groups were estimated using Pearson's v2 and Fisher's exact tests. In the data analysis, descriptive statistics and multiple logistic regression were applied. RESULTS: In 34.15% of the total sample, malnutrition was recognized as a risk factor. Older people with the shortest telomere length had more chances of getting malnutrition (OR = 1.63; IC:95% = 1.04-2.55) compared to those with longer telomeres, independent of age groups, family income, multimorbidity, cognitive decline, and depressive symptoms. CONCLUSION: The creation of clinical trials and the implementation of therapies to reduce the risk of malnutrition will be aided using the telomere length as an aging innovative biomarker, connected with nutritional status.

Intergenic Interactions of ESR1, GSTO1 and AGER and Risk of Dementia in Community-Dwelling Elderly (SADEM Study).

BACKGROUND: Dementia causes the loss of functional independence, resulting in a decrease in the quality of life of those who suffer from it. AIMS: This study aimed to investigate the interactions influencing susceptibility to the development of dementia through multifactor dimensionality reduction (MDR). METHODS: the study population was made up of 221 cases and 534 controls. We performed an MDR analysis as well as a bioinformatic analysis to identify interactions between the genes GSTO1_rs4925, AGER_rs2070600, and ESR1_rs3844508 associated with susceptibility to dementia. RESULTS: We observed associations between the polymorphism of GSTO1 and risk of dementia for the site rs4925 with the recessive model (OR = 1.720, 95% CI = 1.166-2.537 p = 0.006). Similarly, the site AGER rs2070600 showed risk of dementia with an additive model of inheritance (OR = 7.278, 95% CI = 3.140-16.868; p < 0.001). Furthermore, we identified the best risk model with a high precision of 79.6% that, when combined with three environmental risk factors, did not give an OR = 26.662 95%CI (16.164-43.979) with p < 0.001. CONCLUSIONS: The MDR and bioinformatics results provide new information on the molecular pathogenesis of dementia, allowing identification of possible diagnostic markers and new therapeutic targets.

Analysis of body composition, functionality and muscle-specific strength of older women with obesity, sarcopenia and sarcopenic obesity: a cross-sectional study.

During aging, changes in body composition can result in sarcopenic obesity, which is a condition in which obesity occurs accompanied by the loss of muscle mass and strength caused by sarcopenia. Although the effects of obesity and sarcopenia on body composition are known, the muscle-specific strength in older women with sarcopenic obesity remains under-researched. The objective of this study was to evaluate community-dwelling older women for the absence or presence of obesity, sarcopenia and sarcopenic obesity and compare them in terms of body composition, functional physical performance and muscle-specific strength. One hundred and fifty-six older women (± 74 years) were evaluated for body composition using Dual X-ray Absorptiometry, handgrip strength with a Jamar dynamometer and functional performance using gait speed and timed up and go tests. The presence of obesity, sarcopenia and sarcopenic obesity was found in 32.7%, 15.4% and 25% of the sample, respectively. Comparing groups, community-dwelling older women with sarcopenic obesity exhibited poorer functional physical performance (TUG ± 14 s), and lower muscle-specific strength (± 1.18). Sarcopenic obesity was associated with muscle-specific strength (95% IC 0.016-0.241), and TUG (95% CI 1.001-1.137). These findings indicate that the combination of obesity and sarcopenia has a negative impact on skeletal muscle, reducing muscle-specific strength and physical performance in older women with more declines than either disease alone. Therefore, this comprehensive assessment gives useful information for incorporating muscle-specific strength into the diagnosis of sarcopenic obesity in the older people.

Osteosarcopenia predicts greater risk of functional disability than sarcopenia: a longitudinal analysis of FraDySMex cohort study.

OBJECTIVES: Aging involves significant changes in body composition, marked by declines in muscle mass and bone mineral density alongside an increase in fat mass. Sarcopenia is characterized by low strength and muscle mass, and osteosarcopenia is the coexistence of sarcopenia and osteopenia/osteoporosis. Physiologically, there is a crosstalk between muscle and bone tissues mediated by several pathways. Both, sarcopenia and osteosarcopenia, have been related with adverse outcomes such as functional disability. However, there is a lack of longitudinal studies. Therefore, this study aimed to assess whether sarcopenia and osteosarcopenia phenotypes increased the risk of functional disability in a longitudinal cohort of community-dwelling adults. DESIGN: This study constitutes a secondary longitudinal analysis of data derived from the prospective cohort FraDySMex (Frailty, Dynapenia, and Sarcopenia in Mexican adults). SETTING AND PARTICIPANTS: FraDySMex is conducted in community-dwelling adults aged 50 years or older living in Mexico City. Data from 2014 to 2015 was considered as baseline evaluation, and the 2019 wave was the follow-up evaluation. Individuals with complete baseline and follow-up evaluations were included in the analysis. MEASUREMENTS: Sarcopenia diagnosis adhered to the FNIH criteria, while osteopenia/osteoporosis classification followed WHO guidelines. Osteosarcopenia was defined as the concurrent presence of sarcopenia and osteopenia/osteoporosis. Functional disability was identified by the Lawton Instrumental Activities of Daily Living (IADL) Scale. Adjusted mixed-effects logistic regression models were estimated to evaluate the effect of body composition phenotype on the risk of functional disability. RESULTS: The final sample included 320 adults with complete longitudinal data. The majority of were women (83.4%) and had 7-12 years of education (48.4%). At the baseline evaluation, 50.9% aged 50-70. The osteosarcopenia phenotype was associated with a higher risk of functional disability (OR: 2.17, p = 0.042) compared with the no osteopenia/sarcopenia group. Conversely, sarcopenia (OR: 1.50, p = 0.448) and osteopenia/osteoporosis (OR: 1.50, p = 0.185) phenotypes were not associated with functional disability. CONCLUSIONS: Our study underscores that osteosarcopenia significantly increased the risk of functional disability, particularly in terms of Instrumental Activities of Daily Living (IADL). These results emphasize the importance of screening for sarcopenia, osteopenia/osteoporosis, and osteosarcopenia across various clinical settings. Early detection and intervention hold promise for averting functional disability and mitigating associated adverse outcomes in adults.

A case management strategy to reduce falls in older people with a history of falls: A randomized controlled trial.

The present study aimed to determine whether a remotely delivered intervention, based on an individual case management, can reduce falls and their consequences in community-dwelling older people with a history of multiple falls. In this randomized controlled trial, 32 participants were randomized to the intervention group, which comprised a 16-week case management program involving a multidimensional assessment, targeted interventions according to the identified fall risk factors, and development of individualized care plans. The intervention was performed by trained gerontologists, under weekly supervision of professionals with experience in falls. The control group (n = 30) received usual care. Falls were monitored over 12 months with monthly falls calendars and telephone calls. Remotely delivered case management presented an 82 % uptake of recommendations. There was a trend toward a reduced fall incidence in the intervention vs control group, with lower fall, fall injury and fracture rates in the intervention group compared with the control group at both the 16-week and 12-month time-points, with the difference statistically significant for injurious fall rates at 12 months - IRR=0.18 (95 % CI = 0.04 to 0.74).

Effect of the use of potentially inappropriate medications on the mortality of Brazilian older adults: SABE cohort study.

OBJECTIVE: Investigate the association between potentially inappropriate medication (PIM) use and the risk of death among community-dwelling older Brazilian adults. METHODS: Participants from the Health, Well-Being, and Aging Cohort Study (SABE) in São Paulo, Brazil, between 2000 and 2016 were included. The dependent variable was all-cause mortality, measured as the time elapsed until death. The exposure of interest was the use of PIM according to the Beers Criteria 2019 version. All covariates, except for sex and education, were considered time-varying. RESULTS: PIM use was not associated with mortality after adjusting for covariates (HR = 0.99; 95 % CI: 0.88-1.12). There was a significant interaction between PIM use and age (HR = 0.98; 95 % CI: 0.96-0.99). CONCLUSION: The association between PIM use and the risk of death was moderated by age. Future studies should consider the impact of necessary medication omissions when assessing the mortality risk associated with PIM use.

Does Escalating Violence and Associated Fear of Crime Worsen Psychological Well-Being in Community Dwellers Living in a Rural Setting? Results From the Atahualpa Project Cohort.

BACKGROUND: Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence. METHODS: Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders. RESULTS: A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (ß = .24; 95% CI = 0.14-0.35) and anxiety (ß = .31; 95% CI = 0.24-0.37), after adjustment for relevant confounders. CONCLUSIONS: This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being.

Qualitative Evaluation of a Health Literacy Program for Older Adults Who Live in a Community Dwelling in Brazil.

To address current gaps in health literacy research and practice in low-resource settings, the 'Alfa-Health Program' was designed to improve health literacy in older adults who live in a community dwelling in a socioeconomically disadvantaged community in North-East Brazil. In this longitudinal qualitative study, participants were interviewed before and after participating in the group-based program that was delivered November 2017 to December 2017 in the Primary Care Health Unit. Semi-structured interviews were guided by a previously validated health literacy instrument, translated and adapted for use in Brazil. Data was analyzed using Framework analysis. Of the 21 participants, the majority were age 60 to 69 years with a median of 4-years of school education. Our analysis identified self-reported improvements in health knowledge, behaviors, and skills that matched program content and indicated that participants were supported to manage their health conditions more autonomously. Other themes reflect the distributed nature of health literacy and the potential for group-based health literacy programs to facilitate feelings of social support and cohesion through co-learning. However, age-related deficits in memory and external and structural factors remained important barriers to program participation. This study provides insight into developing health literacy in low-resource settings with older adults, where health literacy is compounded by social determinants and cognitive and sensory changes that contribute to health disparities. Although the targeted Alfa Health Program addresses calls to ensure that priority is proportionate to need by reaching and engaging population groups who are disproportionately affected by low health literacy, further work is needed to adapt the program for people who are unable to read or write. [HLRP: Health Literacy Research and Practice. 2024;8(3):e140-e150.].

PLAIN LANGUAGE SUMMARY: Our team developed a health literacy program for older adults living in Brazil. We explored the impact of the program by interviewing participants before and after the program. Participants reported improvements in health knowledge, behaviors, and skills and reflected on feelings of social support that they received from the program. However, difficulties with memory and challenges getting to the program were important barriers to participation.

Potentially inappropriate medication on communitydwelling older adults: Longitudinal analysis using the International Mobility in Aging Study. / Medicación potencialmente inapropiada en adultos mayores de la comunidad: análisis longitudinal del estudio IMIAS

Introduction: Medications are a fundamental part of the treatment of multiple pathologies. However, despite their benefits, some are considered potentially inappropriate medications for older people given their safety profile. Epidemiological data differences related to potentially inappropriate medications make it difficult to determine their effects on elderly people. Objective: To estimate the prevalence and types of potentially inappropriate medications using the 2019 Beers Criteria® in a cohort of adults older than 65 years. Materials and methods: We performed an observational, multicenter, retrospective, longitudinal study of a four-year follow-up of potentially inappropriate medications in community-dwelling older adults. Results: We followed 820 participants from five cities for four years (2012-2016) and evaluated them in three different moments (m1 = 2012, m2 = 2014, and m3 = 2016). The average age was 69.07 years, and 50.9% were women. The potentially inappropriate medication prevalence in the participants was 40.24%. The potentially inappropriate medications' mean among the studied subjects in the first moment was 1.65 (SD = 0.963), in the second was 1.73 (SD = 1.032), and in the third was 1.62 (SD = 0.915). There were no statistical differences between measurements (Friedman test, value = 0.204). The most frequent potentially inappropriate medications categories were gastrointestinal (39.4%), analgesics (18.8%), delirium-related drugs (15.4%), benzodiazepines (15.2%), and cardiovascular (14.2%). Conclusions: About half of the population of the community-dwelling older adults had prescriptions of potentially inappropriate medications in a sustained manner and without significant variability over time. Mainly potentially inappropriate medications were gastrointestinal and cardiovascular drugs, analgesics, delirium-related drugs, and benzodiazepines.

Introducción. Los fármacos son parte fundamental del tratamiento de múltiples enfermedades. Sin embargo, a pesar de sus beneficios, algunos se consideran medicamentos potencialmente inapropiados en adultos mayores, dado su perfil de seguridad. Las diferencias en los datos epidemiológicos relacionados con los medicamentos potencialmente inapropiados dificultan el establecimiento de sus efectos en adultos mayores. Objetivo. Estimar la prevalencia longitudinal y los tipos de medicamentos potencialmente inapropiados, utilizando los criterios Beers® del 2019 en una cohorte de adultos mayores de 65 años. Materiales y métodos. Se realizó un estudio observacional, multicéntrico, retrospectivo y longitudinal, de cuatro años de seguimiento de los medicamentos potencialmente inapropiados en adultos mayores de la comunidad. Resultados. Se evaluaron 820 participantes de cinco ciudades durante cuatro años (2012 a 2016) en tres momentos (m1: 2012, m2: 2014 y m3; 2016). La edad promedio fue de 69,07 años y el 50,9 % eran mujeres. La prevalencia de medicamentos potencialmente inapropiados en los participantes fue del 40,24 %. El promedio de estos medicamentos entre los sujetos estudiados en el primer momento fue de 1,65 (DE = 0,963), en el segundo fue de 1,73 (DE = 1,032) y en el tercero fue de 1,62 (DE = 0,915). No hubo diferencias estadísticas entre las mediciones (prueba de Friedman, p = 0,204). Las categorías de los medicamentos potencialmente inapropiados más frecuentes fueron: gastrointestinales (39,4 %), analgésicos (18,8 %), relacionados con delirium (15,4 %), benzodiacepinas (15,2 %) y cardiovasculares (14,2 %). Conclusiones. En cerca de la mitad de la población de adultos mayores de la comunidad, se prescribieron medicamentos potencialmente inapropiados de manera sostenida y sin variabilidad importante en el tiempo. Los más recetados fueron aquellos para tratar malestares gastrointestinales y cardiovasculares, analgésicos, para el delirium y benzodiacepinas.

Performance of the Brazilian Fracture Assessment Risk Tool (FRAX) model and the age-dependent intervention thresholds according to National Osteoporosis Guideline Group (NOGG) guidelines on fracture prediction in community-dwelling older adults: the São Paulo Ageing and Health (SPAH) Study.

The SPAH study is a population-based prospective cohort of Brazilian community-dwelling elderlies with higher fracture risk than observed in the studies used to construct the Brazilian FRAX model. In this study, the FRAX tool was a good fracture predictor within this high-risk elderly cohort, especially when calculated without bone density. PURPOSE: To determine the performances of FRAX and age-dependent intervention thresholds according to National Osteoporosis Guideline Group (NOGG) guidelines with and without bone mineral density (BMD) regarding fracture prediction in community-dwelling elderly Brazilians. METHODS: Seven hundred and five older adults (447 women; 258 men) were followed for 4.3 ± 0.8 years. FRAX risk for hip and major osteoporotic fractures with and without BMD was calculated at baseline. The bivariate analysis investigated the associations between the absolute probability of fracture (FRAX), as well as the age-dependent intervention thresholds (NOGG), and the incidence of vertebral fracture (VF), non-vertebral fracture (NVF), and major osteoporotic fractures (MOF), segregated by sex. Age-adjusted Poisson's multiple regression and ROC curves were constructed to determine FRAX and NOGG's accuracies as fracture predictors. RESULTS: Fractures occurred in 22% of women and 15% of men. FRAX with and without BMD was higher in women with all types of fractures (p < 0.001). Only NOGG risk classification without BMD was associated with NVF (p = 0.047) and MOF (p = 0.024). FRAX was associated with NVF in the multiple regression, regardless of BMD. ROC curves of FRAX with and without BMD had AUCs of 0.74, 0.64, and 0.61 for NVF, VF, and MOF, respectively. The most accurate risk cutoffs for FRAX were 8% for MOF and 3% for hip fractures. No statistically significant associations were found in men. CONCLUSION: FRAX predicted NVF more accurately than VF or MOF in elderlies, regardless of BMD. These results reiterate that FRAX may be used without BMD, even considering that Brazilian elderlies have known higher fracture risk.

Relationship between Social Participation, Children's Support, and Social Frailty with Falls among Older Adults in Colombia.

BACKGROUND: There is limited research on social factors related to falls among older adults. This study assessed the association between falls during the past year with social participation, children's support, relationship with children, and social frailty. METHODS: Participants were 17,687 community-dwelling older adults from the 2015 Survey on Health, Well-being, and Aging (SABE) in Colombia. Covariates included sociodemographic characteristics, environmental barriers, psychotropic intake, vision problems, memory loss, multimorbidity, and fear of falling. RESULTS: In multivariate logistic regression analyses, being socially frail (vs. no-frail) was associated with higher odds of falls (odds ratio [OR]=1.20; 95% confidence interval [CI] 1.10-1.32). Participating in groups (OR=1.07; 95% CI 1.03-1.11), helping others (OR=1.04; 95% CI 1.02-1.06), or volunteering (OR=1.09; 95% CI 1.01-1.17) were also associated with higher odds of falls. These findings were partly explained because most group participants reside in cities where they are more exposed to environmental barriers. In contrast, receiving help, affection, and company from children (OR=0.95; 95% CI 0.93-0.97) was associated with lower fall odds than not receiving it. Moreover, having a good relationship with children was associated with lower odds of falls (OR=0.75; 95% CI, 0.66-0.85) compared to an unsatisfactory relationship. CONCLUSION: Support from children and having a good relationship with them were associated with fewer falls; however, social frailty and participation in social groups were associated with more falls.

Effects of a case management-based intervention on non-motor risk factors for falls in older people with history of falls: a randomised clinical trial.

BACKGROUND: Falls are directly related to morbidity and mortality of older people. Multifactorial approaches that are individualised and based on fall risk factors are necessary. This study aims to verify the effects of a case management-based intervention on non-motor risk factors for falls in community-dwelling older people with a history of falls. METHODS: The intervention applied a multidimensional assessment of risk factors for falls, a discussion about the identified risk factors, the preparation of an individualised plan with the participant, and the application, monitoring and review of the plan. RESULTS: There was a significant interaction between groups and assessments only in the visuospatial domain (P = 0.031). After simple main effects analysis, differences between groups and assessments were not significant, although there was a tendency of worse visuospatial performance in the control group in the follow-up assessment (P = 0.099). There were no significant differences between groups or between assessments in other variables. CONCLUSION: The intervention has the potential to maintain non-motor risk factors for falls in community-dwelling older people with a history of falls. However, more clinical trials are needed to prove its effects.

Elder Abuse and Depressive Symptoms: The Mediating Role of Loneliness in Older Adults.

BACKGROUND: Elder abuse (EA), depressive symptoms, and loneliness represent a growing risk to the health, well-being, and premature mortality of older adults. However, the role of loneliness in the relationship between EA and depressive symptoms has not yet been examined. AIMS: To investigate the associations between these constructs and to explore the possible mediating role of loneliness in the relationship between EA and depressive symptoms in a representative sample of older Mexican people. METHODS: A representative community-dwelling survey of older adults aged 60 and older was conducted in two cities in Mexico (Mexico City and Xalapa) in 2018-2019. Measurements of EA, loneliness, depressive symptoms, health, and sociodemographic data were collected. Regression and mediation models were tested to analyze the associations between these variables. RESULTS: The prevalence of EA was 16.3%, loneliness was 50%, and depressive symptoms were 25.5%. The odds ratio (OR) for the occurrence of depressive symptoms was 2.7 when the combined effects of EA and loneliness were considered. The proportion of the effect that could explain the mediating role of loneliness was 31%. CONCLUSION: To effectively reduce depressive symptoms in older individuals affected by emotional or psychological abuse and neglect, it is crucial to address both the mediating influence of loneliness and EA itself in therapeutic and preventive interventions.

Relationship between aging and excess body fat with markers of inflammation, skeletal muscle mass and strength in Mexican community-dwelling people.

INTRODUCTION: Aging is accompanied by changes in body composition, such as an increase in fat mass (FM), a decrease in skeletal muscle mass index (SMMI) and muscle strength, combined with a chronic inflammatory process (CI). OBJECTIVE: Determine the relationship between age and excess body fat with markers of chronic inflammation, skeletal muscle mass and strength. METHODS: A cross-sectional alitical study was carried out in a convenience sample of adults 45 to 59 years old (n = 100) and older adults 60 to 74 years old (n = 133). All participants had their body composition measured with an impedance meter. They were subsequently divided into two groups: (i) with excess fat (WEF), (ii) without excess fat (NEF), in order to relate excess fat and age with inflammation, muscle mass and strength. RESULTS: NEF adults and older adults had similar values of SMMI (9.1 ± 1.5 vs. 8.8 ± 1.3, p > 0.05) and strength (28 ± 8 vs. 27 ± 8.6, p > 0.05). Likewise, WEF adults showed significantly lower values than NEF adults in the SMMI (7.9 ± 0.8 vs. 9.1 ± 1.5, p < 0.05) and strength (28 ± 8 vs. 22 ± 5, p < 0.001). Also, WEF older adults presented significantly lower values in the SMMI (15.9 ± 1.8 vs. 22.8 ± 5.1, p < 0.05) and strength (17.9 ± 4.8 vs. 27 ± 8.6, p < 0.001). CONCLUSIONS: Our findings suggest that excess fat mass is a risk factor that has a significantly greater influence than aging per se on the index of skeletal muscle mass and strength.

Relationship between mastication and malnutrition in community-dwelling older adults: a meta-analysis.

PURPOSE: To determine the relationship between mastication and malnutrition in community-dwelling older adults. RESEARCH STRATEGIES: To establish the eligibility criteria, the acronym PECOS was used: Population: non-institutionalized older adults; Exposure: older adults with malnutrition; Control: older adults without malnutrition; Outcome: masticatory problems in malnourished older adults; Study types: observational studies. SELECTION CRITERIA: It selected studies assessing malnutrition and mastication difficulties in non-institutionalized adults over 60 years old, of both sexes. Mastication and malnutrition were evaluated with questionnaires on self-reported symptoms and clinical and instrumental assessments. There were no restrictions on language, year of publication, or ethnicity. DATA ANALYSIS: The included studies were evaluated for methodological quality with the Joanna Briggs Institute tool for cross-sectional studies. For the cross-sectional studies included, the odds ratio (OR) was calculated with 95% confidence intervals. RESULTS: After searching the databases, 692 references were retrieved, with three studies selected for quantitative and qualitative analysis. The values obtained in the meta-analysis for association show that malnutrition and mastication difficulties were 2.21 times as likely to occur (OR = 2.21; 95%CI = 0.93 - 5.26; I2 = 94%) as individuals without malnutrition (p < 0.001). The assessment of the risk of bias presented a high-risk, a moderate-risk, and a low-risk study. The certainty of evidence was rated very low with the GRADE tool. CONCLUSION: Individuals at risk of malnutrition are 2.21 times as likely to have mastication difficulties.

Association between vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling Brazilian older adults: results from ELSI-Brazil study.

Low serum 25(OH)D levels (< 30 nmol/L) have been associated with increased depressive symptom scores over time, and it is believed that functionality may play a mediating role in the relationship between 25(OH)D and depressive symptoms. To comprehend the association between these factors could have significant implications for public health policy. The aim of this study was to verify the association between simultaneous vitamin D insufficiency and depressive symptoms, and functional disability in community-dwelling older adults. This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), collected between 2015 and 2016. The outcomes were functional disability assessed through basic activities of daily living (ADL) and instrumental activities of daily living (IADL). The exposures were vitamin D insufficiency (< 30 nmol/L) and depressive symptoms (≥ 4 points in 8-item version of the Center for Epidemiological Studies-Depression). Crude and adjusted Poisson regression was performed to estimate associations. A total of 1781 community-dwelling older adults included in this study, 14.6% had disability in ADL and 47.9% in IADL; 59.7% had vitamin D insufficient levels, and 33.2% depressive symptoms. The concomitant presence of vitamin D insufficient and depressive symptoms increased the prevalence of ADL by 2.20 (95% CI: 1.25; 3.86) and IADL by 1.54 (95% CI: 1.24; 1.91), respectively. Therefore, preventive strategies to keep older adults physically and socially active, with a good level of vitamin D, are essential to avoid depression and functional disability.

Associations of upper- and lower-limb muscle strength, mass, and quality with health-related quality of life in community-dwelling older adults.

AIM: This study aimed to investigate the associations between upper- and lower-limb muscle strength, mass, and quality and health-related quality of life (HRQoL) among community-dwelling older adults. METHODS: A cross-sectional study was conducted with 428 Brazilian community-dwelling older adults aged 60 to 80 years. Upper- and lower-limb muscle strength were evaluated through the handgrip strength (HGS) test and the 30-s chair stand test, respectively. Muscle mass was assessed by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Muscle quality was evaluated using the muscle quality index (MQI). HRQoL was assessed using the World Health Organization Quality of Life Brief Version questionnaire. RESULTS: Lower-limb, but not upper-limb, muscle strength and quality were independently associated with HRQoL, particularly within the domains of physical capacity, environment, and overall HRQoL for both males and females (P < 0.05). DXA- and BIA-derived analyses provided similar results in relation to muscle mass and muscle quality. CONCLUSIONS: Lower-limb, but not upper-limb, muscle strength and quality were independently associated with HRQoL among community-dwelling older adults. Moreover, the results obtained from both BIA and DXA were similar, highlighting that BIA can serve as a viable surrogate method for estimating body composition in resource-limited clinical settings. Geriatr Gerontol Int 2024; 24: 683-692.