Diagnostic Accuracy of the Short Physical Performance Battery for Detecting Frailty in Older People.

BACKGROUND: The Short Physical Performance Battery (SPPB) is widely used to predict negative health-related outcomes in older adults. However, the cutoff point for the detection of the frailty syndrome is not yet conclusive. OBJECTIVE: The aim of this study was to determine the diagnostic value of the SPPB for detecting frailty in community-dwelling older adults. DESIGN: This was a population-based cross-sectional study focusing on households in urban areas. A total of 744 people who were 65 years old or older participated in this study. METHODS: Frailty was determined by the presence of 3 or more of the following components: unintentional weight loss, self-reported fatigue, weakness, low level of physical activity, and slowness. Diagnostic accuracy measures of the SPPB cutoff points were calculated for the identification of frailty (individuals who were frail) and the frailty process (individuals who were considered to be prefrail and frail). Receiver operating characteristic curves were constructed. Odds ratios for frailty and the frailty process and respective CIs were calculated on the basis of the best cutoff points. A bootstrap analysis was conducted to confirm the internal validity of the findings. RESULTS: The best cutoff point for the determination of frailty was ≤ 8 points (sensitivity = 79.7%; specificity = 73.8%; Youden J statistic = 0.53; positive likelihood ratio = 3.05; area under the curve = 0.85). The best cutoff point for the determination of the frailty process was ≤ 10 points (sensitivity = 75.5%; specificity = 52.8%; Youden J statistic = 0.28; positive likelihood ratio = 1.59; area under the curve = 0.76). The adjusted odds of being frail and being in the frailty process were 7.44 (95% CI = 3.90-14.19) and 2.33 (95% CI = 1.65-3.30), respectively. LIMITATIONS: External validation using separate data was not performed, and the cross-sectional design does not allow SPPB predictive capacity to be established. CONCLUSIONS: The SPPB might be used as a screening tool to detect frailty syndrome in community-dwelling older adults, but the cutoff points should be tested in another sample as a further validation step.

What are the Main Physical Functioning Factors Associated With Falls Among Older People With Different Perceived Fall Risk?

BACKGROUND AND PURPOSE: Fall risk perceptions may influence the judgement over physical and functional competencies to avoid falls. However, few studies have explored the physical functioning characteristics associated with falls among older people with low perceived fall risk. This study aimed to identify the prevalence of falls and physical functioning factors associated with falling among community-dwelling older adults with low and high perceived fall risk. METHODS: We conducted a cross-sectional population based study with 773 community-dwelling elders. Perceived fall risk was investigated using Falls Efficacy Scale International. We considered fallers those who reported at least one fall in the previous 12 months. Physical functioning measures used were grip strength, usual gait speed, sit-to-stand test, five step test, timed up and go test, one-legged stance test, anterior and lateral functional reach test. RESULTS: At least one fall was reported by 103 (30%) participants with low perceived fall risk and by 196 (46%) participants with high perceived fall risk. The odds of falling were lower among those with greater grip strength and with a greater stance time in one-legged test, and the odds of falling among elders with high perceived fall risk were higher among those who took more time in performing the five step test. DISCUSSION: We believe that our results highlight the need of not neglecting the risk of falls among active older adults with low perceived fall risk, particularly in those elders that show reduced stability in a small base of support and a lower leg strength. In addition, we suggest that elders with high perceived fall risk should be assessed using anticipatory postural adjustment tests. Particularly, our results may help physiotherapists to identify eligible elders with different perceptions of fall risk for tailored interventions aimed at reducing falls. Copyright © 2016 John Wiley & Sons, Ltd.

Association among measures of mobility-related disability and self-perceived fatigue among older people: a population-based study.

OBJECTIVE: To investigate the relationship between self-perceived fatigue with different physical functioning tests and functional performance scales used for evaluating mobility-related disability among community-dwelling older persons. METHOD: This is a cross-sectional, population-based study. The sample was composed of older persons with 65 years of age or more living in Cuiabá, MT, and Barueri, SP, Brazil. The data for this study is from the FIBRA Network Study. The presence of self-perceived fatigue was assessed using self-reports based on the Center for Epidemiologic Studies-Depression Scale. The Lawton instrumental activities of daily living scale (IADL) and the advanced activities of daily living scale (AADL) were used to assess performance and participation restriction. The following physical functioning tests were used: five-step test (FST), the Short Physical Performance Battery (SPPB), and usual gait speed (UGS). Three models of logistic regression analysis were conducted, and a significance level of α<0.05 was adopted. RESULTS: The sample was composed of 776 older adults with a mean age (SD) of 71.9 (5.9) years, of whom the majority were women (74%). The prevalence of self-perceived fatigue within the participants was 20%. After adjusting for covariates, SPPB, UGS, IADL, and AADL remained associated with self-perceived fatigue in the final multivariate regression model. CONCLUSION: Our results suggest that there is an association between self-perceived fatigue and lower extremity function, usual gait speed and activity limitation and participation restriction in older adults. Further cohort studies are needed to investigate which physical performance measure may be able to predict the negative impact of fatigue in older adults.

Association among measures of mobility-related disability and self-perceived fatigue among older people: a population-based study

Objective: To investigate the relationship between self-perceived fatigue with different physical functioning tests and functional performance scales used for evaluating mobility-related disability among community-dwelling older persons. Method: This is a cross-sectional, population-based study. The sample was composed of older persons with 65 years of age or more living in Cuiabá, MT, and Barueri, SP, Brazil. The data for this study is from the FIBRA Network Study. The presence of self-perceived fatigue was assessed using self-reports based on the Center for Epidemiologic Studies-Depression Scale. The Lawton instrumental activities of daily living scale (IADL) and the advanced activities of daily living scale (AADL) were used to assess performance and participation restriction. The following physical functioning tests were used: five-step test (FST), the Short Physical Performance Battery (SPPB), and usual gait speed (UGS). Three models of logistic regression analysis were conducted, and a significance level of α<0.05 was adopted. Results: The sample was composed of 776 older adults with a mean age (SD) of 71.9 (5.9) years, of whom the majority were women (74%). The prevalence of self-perceived fatigue within the participants was 20%. After adjusting for covariates, SPPB, UGS, IADL, and AADL remained associated with self-perceived fatigue in the final multivariate regression model. Conclusion: Our results suggest that there is an association between self-perceived fatigue and lower extremity function, usual gait speed and activity limitation and participation restriction in older adults. Further cohort studies are needed to investigate which physical performance measure may be able to predict the negative impact of fatigue in older adults. .

Reflexo de gag em jovens e idosos sem indícios de disfagia orofaríngea / Gag reflex in young and old without evidence of oropharyngeal dysphagia

Introdução: A disfagia, muito comum em idosos, interfere negativamente na saúde humana. Identifi cá-la o quanto antes requer procedimentos adequados, dentre esses a pesquisa do refl exo de gag é uma questão controversa. Os objetivos deste trabalho foram: verifi car o gag, (refl exo de vômito), e o seu local de disparo em jovens e idosos sem indício de disfagia orofaríngea; comparar a ocorrência do gag e o local de disparo entre jovens e idosos; comparar a ocorrência do gag desta amostra aos da literatura (indivíduos sem e com disfagia). Material e Método:Testou-se o gag em 15 jovens e 15 idosos saudáveis, verifi cando-se ocorrência, tipo de gag e local de disparo, comparando os grupos entre si e com a literatura (Teste qui-quadrado de Pearson). Resultados: 80% dos jovens e dos idosos apresentaram gag. O local de disparo nos jovens foi igual à dos idosos (p=0,23). A presença e a ausência do gag nos jovens foi igual à literatura (p=0,17). A ausência nos idosos foi maior do que a literatura (p<0,001). Quando considerada toda a amostra, a ausência de gag e do hiper-gag foi maior do que a literatura (p<0,001), e a do gag normal, menor (p<0,001). Comparados aos sujeitos disfágicos (literatura), não houve diferenças quanto à ausência, mas sim quanto à presença de gag (normal e exacerbado) (p<0,001). Conclusões: Não houve relação entre o gag, nem locais de disparo, e a idade. A ocorrência do gag desta amostra se equiparou a um estudo com indivíduos saudáveis, e discordou de outro. Não houve relação entre o gag e a deglutição.

Introdution: Dysphagia is common in elderly patients and has negative effects in human health. To detect it as soon as possible it is necessary to use appropriated methods, being the gag testing controversial. The aims of this paper were: to verify the gag refl ex and the structure where it was defl agrated in young and elderly subjects without suspected oropharyngeal dysphagia; to compare these groups (young and elderly); to compare the gag presence to the literature data (dysphagic and non-dysphagic people). Material and Method: The gag refl ex was tested in 15 healthy youngsters and 15 healthy elderly individuals to verify the presence and type of gag and place it was defl agrated, comparing the data between young and elderly and these to the literature (Pearson's Chi-Square Test). Results: 80% of young and elderly had gag. The structure in which it was defl agrated was the same in both groups (p=0,23). The presence and absence of gag in young subjects was the same as data found in literature (p=0,17). The absent gag was greater than literature reports (p<0,001). When considered together, young and older people had absent and exacerbated gag as frequently as the literature reports (p<0,001), and inferior to normal gag references (p<0,001). Compared to dysphagic subjects (literature), the absent gag was equal, but gag and hipergag were different (p<0,001). Conclusions: There was no relationship between age, gag and place it was defl agrated. The occurrence of gag in this paper was the same to some healthy people, but different from others cited by literature. There was no relationship between gag and deglutition.

Introducción: La disfagia, muy común en los adultos mayores, afecta negativamente a la salud humana. Identifi carla lo antes posible requiere procedimientos adecuados, entre ellos, la búsqueda del refl ejo de gag es una questión polemica. Los objetivos de este estudio fueron: determinar el gag (refl ejo de vomito) y su lugar de disparo en jóvenes y adultos mayores sin ocurrencia de la disfagia orofaríngea; comparar la ocurrencia del gag y el lugar de disparo entre los jóvenes y adultos mayores, comparar la ocurrencia del gag de esta muestra a los de la literatura (personas con y sin disfagia). Material y método: el gag fue probada en 15 jóvenes y 15 adultos mayores sanos, para verifi car la ocurrencia, tipo de gag y lugar de disparo, comparando los grupos entre sí y con la literatura (Test Chi cuadrado de Pearson). Resultados: 80% de los jóvenes y de los adultos mayores presentaron gag. El lugar de disparo en los jovenes fue similar al de los adultos mayores (p = 0,23). La presencia y la ausencia del gag en los jovenes fue igual al de la literatura (p = 0,17). La ausencia en los adultos mayores fue superior al de la literatura (p <0001). Considerando la totalidad de la muestra, la ausencia de gag y hiper-gag fue superior al de la literatura (p <0,001), y la de gag normal, inferior (p <0001). Comparados a los sujetos disfágicos (literatura), no hubo diferencias en la ausencia, pero si en la presencia de gag (normal y exacerbado) (p <0,001). Conclusiones: No hubo relación entre el gag, o lugares de disparo, y la edad. La aparición de gag de esta muestra se equiparó a un estudio con sujetos sanos, y discordó de otro. No hubo relación entre gag y la deglución.

Análise clínica da deglutiçäo e dificuldades de alimentaçäo de idosos desnutridos em acompanhamento ambulatorial / Clinical analysis of swallowing and difficulties in feeding malnourished elderly ambulatory patients

Visa verificar se pacientes idosos acompanhados em ambulatório, com diagóstico de desnutriçäo, apresentam também dificuldades de deglutiçäo. Para tanto, nove idosos desnutridos de ambos os sexos, com idades entre 64 e 86 anos, foram submetidos a avaliaçäo fonoaudiológica específica para identificaçäo de alteraçöes em fase oral de deglutiçäo. Concluiu-se que idosos desnutridos säo mais susceptíveis ao desenvolvimento de alteraçöes de deglutiçäo, necessitando da atuaçäo conjunta de nutricionistas e fonoaudiólogos para que as dificuldades presentes sejam sanadas, prevenindo o aparecimento de outras alteraçöes e garantindo a melhoria da qualidade de vida

A relação entre o uso de aparelho de amplificação sonora individual - AASI - e a melhora da função cognitiva no envelhecimento / The links between hearing aid usage and the better of auditory perception and selective attention in aging

Descreve a importância do uso do aparelho de amplificação sonora individual (AASI) para melhora das funções cognitivas em idosos com deficiência auditiva. É analisando o impacto da deficiência auditiva na função cognitiva, por meio de entrevistas com seis pacientes idosos, seus familiares e terapeuta responsável pela reabilitação auditiva. Observa-se uma grande dificuldade de os idosos aceitarem a deficiência auditiva e perceber as alterações cognitivas provocadas por ela. Após o processo de reabilitação, a melhora da percepção auditiva, da função comunicativa, da integração social e das funções cognitivas puderam ser melhor percebidas pelos pacientes, familiares e amigos próximos. Conclui-se, então, que o uso da amplificação sonora individual pelo idoso pode impedir alterações cognitivas relacionadas à percepção auditiva e atenção, impedindo os desdobramentos psicossociais, posibilitando um envelhecimento com melhor qualidade de vida (AU)

A relaçäo entre o uso de aparelho de amplificaçäo sonora individual - AASI - e a melhora da funçäo cognitiva no envelhecimento / The links between hearing aid usage and the better of auditory perception and selective attention in aging

Descreve a importância do uso do aparelho de amplificaçäo sonora individual para melhora das funçöes cognitivas em idosos com deficiência auditiva

Prevenção da pneumonia aspirativa em enfermaria geriátrico-gerontológica: descrição das condutas fonoaudiológicas / Preventing aspiration pneumonia in the geriatric-gerontological ward: a description of phonoaudiologic measures

Esta pesquisa tem como objetivo descrever as condutas fonoaudiológicas estabelecidas no início da internação do paciente e relatar as modificações realizadas nestas condutas ao longo desta hospitalização. Para isso, foram estudados 63 pacientes, com variação de idade de 61 a 95 anos, os quais estiveram internados na enfermaria de geriatria entre o período de fevereiro a julho de 2000. Foram verificadas as condutas fonoaudiológicas iniciais estabelecidas (via alimentar, consistência da dieta, dependência alimentar, higiene oral, posicionamento durante a alimentação e estimulação miofuncional), as modificações realizadas nestas condutas e seus motivos e a história de pneumonia aspirativa antes e durante a internação. A ausência de pneumonia aspirativa dos pacientes estudados pode indicar afetividade no acompanhamento fonoaudiológico, que associado à atuação interdisciplinar, pode minimizar complicações e melhorar a qualidade de vida durante e após a internação (AU)

Prevençäo da pneumonia aspirativa em enfermaria geriátrico-gerontoloógica: descriçäo das condutas fonoaudiológicas / Preventing aspiration pneumonia in the geriatric-gerontological ward: a description of phonoaudiologic measures

Descreve as condutas fonoaudiológicas estabelecidas no início da internaçäo do paciente e relatar as modificaçöes realizadas nestas condutas ao longo desta hospitalizaçäo