Gait, dual task and history of falls in elderly with preserved cognition, mild cognitive impairment, and mild Alzheimer's disease.

BACKGROUND: Studies with functional and applicable methods and new cognitive demands involving executive function are needed to improve screening, prevention and rehabilitation of cognitive impairment and falls. OBJECTIVE: to identify differences in gait, dual task performances, and history of falls between elderly people with preserved cognition, mild cognitive impairment and mild Alzheimer's disease. METHOD: A cross-sectional study was conducted. The sample consisted of 40 community-dwelling older adults with preserved cognition, 40 older adults with mild cognitive impairment, and 38 older adults with mild Alzheimer's disease. The assessment consisted of anamneses, gait (measured by the 10-meter walk test), dual task (measured by the Timed Up and Go Test associated with the motor-cognitive task of calling a phone number), and history of falls in the past year. RESULTS: There were no differences among all groups for all variables. However, the Alzheimer's disease Group performed significantly worse in the dual task than the other groups. No item of dual task could distinguish people with preserved cognition from those with mild cognitive impairment. The groups with cognitive impairment included more fallers, and specific characteristics in history of falls between groups were identified. CONCLUSION: Dual task could distinguish Alzheimer's disease patients specifically from other cognitive profiles.

Profile of the elderly in physical therapy and its relation to functional disability / Perfil do idoso na fisioterapia e sua relação com a incapacidade funcional

BACKGROUND: As the population ages, changes occur in the epidemiological profile towards the current predominance of chronic degenerative diseases which, when untreated, lead to loss of functional capacity and require long-term assistance. OBJECTIVES: To describe the profile of the elderly attending the geriatric physical therapy service and to identify factors associated with functional disability. METHOD: A cross-sectional descriptive analytical study was conducted. The medical records of elderly individuals were analyzed using the first physical therapy assessment, which included sociodemographic, clinical and mobility data. To determine the degree of disability (mild/moderate), the Brazilian Multidimensional Functional Assessment Questionnaire (BOMFAQ) was used. Descriptive analysis and univariate logistic regression were performed, followed by multivariate logistic regression. RESULTS: The sample comprised 130 elderly patients with a mean age of 73.3 [standar deviation (SD)=7.2] years-old, predominantly female (63.9%), sedentary (71.5%) and presenting three to four diseases (47.7%). The mean of activities with difficulty in the BOMFAQ was 6.7 (SD=4.8), 35 (26.9%) individuals presented mild disability and 95 (73.1%) moderate. The participant characteristic that presented a greatest risk of disability was self-reporting of poor health (OR=12.4). The factors identified, which together can determine functional decline, were sedentary lifestyle, presence of dizziness, polypharmacy and high pain intensity. CONCLUSIONS: Elderly individuals attended by the geriatric physical therapy service showed a profile associated with disability, characterized by potentially modifiable factors. This profile also reinforces the demand for long-term care for this population.

CONTEXTUALIZAÇÃO: Com o envelhecimento populacional, houve alterações no perfil epidemiológico, com o predomínio atual das doenças crônico-degenerativas que, quando não tratadas, levam à perda da capacidade funcional e exigem assistência de longo prazo. OBJETIVOS: Descrever o perfil do idoso atendido no serviço de fisioterapia geriátrica e identificar fatores associados à incapacidade funcional. MÉTODO: Foi realizado estudo transversal descritivo analítico. Os prontuários dos idosos foram analisados por meio da primeira avaliação fisioterapêutica, que incluiu dados sociodemográficos, clínicos e de mobilidade. Para determinar o grau de deficiência (leve/ moderada), foi aplicado o Brazilian Multidimensional Functional Assessment Questionnaire (BOMFAQ). A análise descritiva e a regressão logística univariada foram realizadas, seguidas de regressão logística multivariada. RESULTADOS: A amostra foi composta por 130 pacientes idosos, com mais de 73,3±7,2 anos de idade, predominantemente do sexo feminino (63,9%), sedentários (71,5%) e apresentando de três a quatro doenças (47,7%). A média de atividades com dificuldade no BOMFAQ foi de 6,7±4,8; 35 (26,9%) indivíduos apresentaram incapacidade leve e 95 (73,1%), moderada. A característica que apresentou maior risco de incapacidade foi o autorrelato de saúde ruim (OR=12,4). Os fatores identificados, que juntos podem determinar o declínio funcional, foram sedentarismo, presença de tontura, polifarmácia e alta intensidade da dor. CONCLUSÕES: Os idosos atendidos pelo serviço de fisioterapia geriátrica mostraram um perfil associado com deficiência, caracterizada por fatores potencialmente modificáveis. Esse perfil também reforça a demanda por cuidados de longa duração para essa população.

Profile of the elderly in physical therapy and its relation to functional disability.

BACKGROUND: As the population ages, changes occur in the epidemiological profile towards the current predominance of chronic degenerative diseases which, when untreated, lead to loss of functional capacity and require long-term assistance. OBJECTIVES: To describe the profile of the elderly attending the geriatric physical therapy service and to identify factors associated with functional disability. METHOD: A cross-sectional descriptive analytical study was conducted. The medical records of elderly individuals were analyzed using the first physical therapy assessment, which included sociodemographic, clinical and mobility data. To determine the degree of disability (mild/moderate), the Brazilian Multidimensional Functional Assessment Questionnaire (BOMFAQ) was used. Descriptive analysis and univariate logistic regression were performed, followed by multivariate logistic regression. RESULTS: The sample comprised 130 elderly patients with a mean age of 73.3 [standar deviation (SD)=7.2] years-old, predominantly female (63.9%), sedentary (71.5%) and presenting three to four diseases (47.7%). The mean of activities with difficulty in the BOMFAQ was 6.7 (SD=4.8), 35 (26.9%) individuals presented mild disability and 95 (73.1%) moderate. The participant characteristic that presented a greatest risk of disability was self-reporting of poor health (OR=12.4). The factors identified, which together can determine functional decline, were sedentary lifestyle, presence of dizziness, polypharmacy and high pain intensity. CONCLUSIONS: Elderly individuals attended by the geriatric physical therapy service showed a profile associated with disability, characterized by potentially modifiable factors. This profile also reinforces the demand for long-term care for this population.

Effects of an adapted physical activity program on the physical condition of elderly women: an analysis of efficiency / Efeitos de um programa de atividade física adaptada na capacidade física e parâmetros de saúde de mulheres idosas: análise de eficiência

BACKGROUND: Specific research tools and designs can assist in identifying the efficiency of physical activity in elderly women. OBJECTIVES: To identify the effects of physical activity on the physical condition of older women. METHODS: A one-year-long physical activity program (123 sessions) was implemented for women aged 60 years or older. Four physical assessments were conducted, in which weight, height, BMI, blood pressure, heart rate, absences, grip strength, flexibility, VO2max, and static and dynamic balance were assessed. The statistical analyses included a repeated measures analysis, both inferential (analysis of variance - ANOVA) and effect size (Cohen's d coefficient), as well as identification of the participants' efficiency (Data Envelopment Analysis - DEA). RESULTS: Despite the observation of differences that depended on the analysis used, the results were successful in the sense that they showed that physical activity adapted to older women can effectively change the decline in physical ability associated with aging, depending on the purpose of the study. The 60-65 yrs group was the most capable of converting physical activity into health benefits in both the short and long term. The >65 yrs group took less advantage of physical activity. CONCLUSION: Adherence to the program and actual time spent on each type of exercise are the factors that determine which population can benefit from physical activity programs. The DEA allows the assessment of the results related to time spent on physical activity in terms of health concerns.

CONTEXTUALIZAÇÃO: Ferramentas e desenhos específicos de pesquisa podem ajudar na identificação da eficiência da atividade física em mulheres idosas. OBJETIVOS: Identificar os efeitos da atividade física sobre a eficiência da condição física de mulheres idosas. MÉTODOS: Aplicou-se um programa de atividade física de um ano (123 sessões) para mulheres com idade de 60 anos ou mais. Foram realizadas quatro coletas de dados físicos, avaliando peso, altura, índice de massa corporal (IMC), pressão arterial, frequência cardíaca, ausências, força de preensão, flexibilidade, VO2max, além de equilíbrio estático e dinâmico. As análises estatísticas incluíram uma análise de medidas repetidas, tanto inferencial (análise da variância - ANOVA) quanto do tamanho do efeito (coeficiente d de Cohen), além da identificação da eficiência dos participantes (análise por envoltório de dados - DEA). RESULTADOS: Apesar das diferenças observadas nos resultados das análises realizadas, eles permitiram apontar que a atividade física adaptada para mulheres idosas pode efetivamente mudar as capacidades físicas associadas ao envelhecimento. As mulheres com idades entre 60-65 anos são mais capazes de reverter a atividade física em benefícios para a saúde no curto e longo prazo. No entanto, as mulheres mais velhas, dentro do grupo >65 anos, tiveram mais dificuldade em tirar proveito da atividade física. CONCLUSÃO: A adesão ao programa e o tempo gasto em cada tipo de exercício determinam a população que pode se beneficiar de programas de atividade física. A DEA permite ponderar os resultados relativos ao tempo de atividade física realizada em termos de condições de saúde.

Effects of an adapted physical activity program on the physical condition of elderly women: an analysis of efficiency.

BACKGROUND: Specific research tools and designs can assist in identifying the efficiency of physical activity in elderly women. OBJECTIVES: To identify the effects of physical activity on the physical condition of older women. METHOD: A one-year-long physical activity program (123 sessions) was implemented for women aged 60 years or older. Four physical assessments were conducted, in which weight, height, BMI, blood pressure, heart rate, absences, grip strength, flexibility, VO2max, and static and dynamic balance were assessed. The statistical analyses included a repeated measures analysis, both inferential (analysis of variance--ANOVA) and effect size (Cohen's d coefficient), as well as identification of the participants' efficiency (Data Envelopment Analysis--DEA). RESULTS: Despite the observation of differences that depended on the analysis used, the results were successful in the sense that they showed that physical activity adapted to older women can effectively change the decline in physical ability associated with aging, depending on the purpose of the study. The 60-65 yrs group was the most capable of converting physical activity into health benefits in both the short and long term. The >65 yrs group took less advantage of physical activity. CONCLUSION: Adherence to the program and actual time spent on each type of exercise are the factors that determine which population can benefit from physical activity programs. The DEA allows the assessment of the results related to time spent on physical activity in terms of health concerns. Article registered in Clinicaltrials.gov under number NCT01558401.

Effect of plantar vibration stimuli on the balance of older women: a randomized controlled trial.

OBJECTIVE: To identify the effect of vibratory stimuli applied to the plantar region on the balance of women 60 years or older. DESIGN: A randomized controlled trial (blinded assessor). SETTING: University research laboratory. PARTICIPANTS: All women (N=30; age, ≥60y) selected had a balance deficit, assessed by using the One-Leg Stance test with eyes open (EO). INTERVENTIONS: Participants were randomly divided into an experimental group, which received vibratory stimuli, and a control group, which received no intervention. MAIN OUTCOME MEASURES: Functional reach (FR) test and center-of-pressure (CoP) sway area (force platform). RESULTS: There was a significant difference in the time factor of the experimental group for the FR test and CoP sway area with eyes closed (EC). For the group × time interaction, there was improvement in balance in anterior-posterior (AP) CoP sway velocity with EO and EC. There also was improvement in CoP sway area with EC. CONCLUSION: Vibratory stimuli applied to the plantar region have beneficial effects on balance in women 60 years or older, with greater effectiveness in anterior displacement, postural control of the AP axis, and the EC condition.

Comparison of hemodynamic and nutritional parameters between older persons practicing regular physical activity, nonsmokers and ex-smokers.

BACKGROUND: Sedentary lifestyle combined with smoking, contributes to the development of a set of chronic diseases and to accelerating the course of aging. The aim of the study was to compare the hemodynamic and nutritional parameters between elderly persons practicing regular physical activity, nonsmokers and ex-smokers. METHODS: The sample was comprised of 40 elderly people practicing regular physical activity for 12 months, divided into a Nonsmoker Group and an Ex-smoker Group. During a year four trimestrial evaluations were performed, in which the hemodynamic (blood pressure, heart rate- HR and VO2) and nutritional status (measured by body mass index) data were collected. The paired t-test and t-test for independent samples were applied in the intragroup and intergroup analysis, respectively. RESULTS: The mean age of the groups was 68.35 years, with the majority of individuals in the Nonsmoker Group being women (n = 15) and the Ex-smoker Group composed of men (n = 11). In both groups the variables studied were within the limits of normality for the age. HR was diminished in the Nonsmoker Group in comparison with the Ex-smoker Group (p = 0.045) between the first and last evaluation. In the intragroup analysis it was verified that after one year of exercise, there was significant reduction in the HR in the Nonsmoker Group (p = 0.002) and a significant increase in VO2 for the Ex-smoker Group (p = 0.010). There are no significant differences between the hemodynamic and nutritional conditions in both groups. CONCLUSION: In elderly persons practicing regular physical activity, it was observed that the studied variables were maintained over the course of a year, and there was no association with the history of smoking, except for HR and VO2.

Associação entre déficit visual e aspectos clínico-funcionais em idosos da comunidade / Association between visual deficit and clinical-functional characteristics among community-dwelling older adults

Objetivo: Identificar os fatores funcionais associados com o déficit visual em idosos da comunidade. MÉTODOS: Foram avaliados 96 idosos quanto à acuidade visual por meio da tabela direcional de Snellen e categorizados em relação à baixa visão (acuidade visual <0,3) e visão normal (acuidade visual >0,3). Os fatores funcionais analisados foram: número de quedas, presença de doenças visuais, saúde mental, pela Geriatric Depression Scale (GDS), funcionalidade nas atividades diárias pelo Brazilian OARS Multidimensional Functional Assessment Questionnaire (BOMFAQ) e a mobilidade funcional pelo Timed Up & Go Test (TUG). A análise inferencial foi realizada por meio dos testes Qui-Quadrado, Mann-Whitney e Coeficiente de Correlação de Spearman, considerando α=0,05. RESULTADOS: Apresentaram baixa visão 17,7 por cento (n=17) dos idosos. Em relação aos idosos com visão normal, os idosos com baixa visão apresentaram idade mais avançada (p<0,001), maior número de doenças de olho e anexos (p=0,023), maiores pontuações para humor deprimido (p=0,002), pior equilíbrio no TUG (p=0,003) e maior número de atividades instrumentais de vida diária comprometidas (p=0,009). Na análise de correlação, quanto menor a acuidade visual, maior a idade, o número de quedas, o número de atividades comprometidas e o tempo no TUG. CONCLUSÕES: Os idosos com déficit visual desta amostra exibiram maior comprometimento funcional. Os dados deste estudo contribuem para a elaboração de uma avaliação fisioterapêutica voltada aos aspectos que possam identificar as limitações funcionais dos idosos com déficit visual e, consequentemente, estabelecer um plano terapêutico mais direcionado a sanar as dificuldades no cotidiano desses idosos.

Objective: To identify functional factors associated with visual deficits among community-dwelling older adults. METHODS: Ninety-six older adults were assessed for visual acuity by means of the Snellen Eye Chart and categorized as low vision (visual acuity < 0.3) or normal vision (visual acuity >0.3). The functional factors analyzed were the number of falls, presence of eye diseases, mental health according to the Geriatric Depression Scale (GDS), functional status in daily activities according to the Brazilian OARS Multidimensional Functional Assessment Questionnaire (BOMFAQ) and functional mobility according to the Timed Up & Go Test (TUG). Inferential analysis was performed using the chi-square test, Mann-Whitney test and Spearman correlation coefficient, taking α=0.05. RESULTS: Low vision was found in 17.7 percent (n=17) of the older adults. Compared to the older adults with normal vision, those with low vision had more advanced age (p<0.001) and more eye and adnexa diseases (p=0.023), higher scores for depressed mood (p=0.002), worse balance in the TUG (p=0.003) and higher numbers of impaired instrumental activities of daily living (p=0.009). Lower visual acuity was correlated with more advanced age, greater number of falls, greater number of impaired activities and longer time spent on the TUG. CONCLUSIONS: The visually impaired older adults in this sample showed greater functional impairment. The data from the present study will contribute to the development of physical therapy assessments that can identify functional limitations among visually impaired older adults and thus establish a better therapeutic plan for resolving the daily difficulties of these individuals.

Exercise-associated thermographic changes in young and elderly subjects.

This study aimed at evaluating the thermographic changes associated with localized exercise in young and elderly subjects. An exercise protocol using 1 kg load was applied during 3 min to the knee flexors of 14 elderly (67 +/- 5 years) and 15 young (23 +/- 2 years) healthy subjects. The posterior thigh's skin temperature of the exercised limb and contralateral limb were measured by infrared thermography on pre-exercise, immediately post-exercise, and during the 10-min period post-exercise. Difference (p < 0.01) between elderly and young subjects was observed on pre-exercise temperature. Although differences were not observed between pre-exercise and immediately post-exercise temperature in the exercised limb, thermographic profile displayed heat concentration in exercised areas for both groups. Temperature reduction was only observed for the young group on the 10-min post-exercise (p < 0.05) in the exercised limb (30.7 +/- 1.7 to 30.3 +/- 1.5 degrees C). In contrast, there was a temperature reduction post-exercise (p < 0.01) in the contralateral limb for both groups. These results present new evidences that elderly and young subjects display similar capacity of heat production; however, the elderly subjects presented a lower resting temperature and slower heat dissipation. This work contributes to improve the understanding about temperature changes in elderly subjects and may present implications to the sports and rehabilitation programs.