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.

Characteristics of falls in elderly persons residing in the community: a population-based study / Características das quedas em idosos que vivem na comunidade: estudo de base populacional

Abstract Object: to examine the characteristics to the last fall of Brazilian elderly persons who experienced falls in 2008 and 2009, and to identify if there is a relationship with sociodemographic characteristics, physical health, comorbidities, clinical conditions and the circumstances of the falls. Methods: a cross-sectional, population based study was carried out with participants aged 65 and older from Barueri in the state of São Paulo and Cuiabá in the state of Mato Grosso, Brazil. Households were enrolled within each census region according to population density and the number of elderly persons living in each region. A multidimensional questionnaire composed of sociodemographic factors and data regarding falls was used. Associations were analyzed using contingency tables, and Fisher's Exact or Pearson's Chi-square test was used. Results: 774 elderly people were included in the study, 299 of whom reported falling in the previous year. Of these, 176 (58.9%) had fallen once and 123 (41.1%) reported having fallen twice or more. Among fallers the mean age was 72.53 (±6.12) years and 214 (71.6%) were female. About 107 (35.8%) of the elderly reported having fallen forwards, 79 (26.4%) fell to the side and 42(14%) fell backwards. Regarding the circumstances of the falls, 107 (35.8%) reported having lost their balance, 79 (26.4%) said they had stumbled and 42 (14%) said they had slipped. There was an association between the mechanism and circumstances of the falls and having fallen once or twice or more. There was an association between the circumstances of falls and the number of medications taken. Conclusion: The characteristics of falls were different among elderly persons who had fallen once or twice or more, which may guide health professionals, the elderly and their families in relation to specific fall prevention strategies. AU

Resumo Objetivo: Explorar as características da última queda em idosos brasileiros que caíram em 2008 e 2009 e identificar se há relação com as características sociodemográficas, de saúde física, comorbidades, condições clínicas e com as circunstâncias de quedas. Método: Estudo transversal, de base populacional, com idosos de 65 anos de idade ou mais, de Barueri, SP e Cuiabá, MT, Brasil. Foi utilizado um inquérito multidimensional contendo dados sociodemográficos, de saúde física e mental e de quedas. As associações foram analisadas por meio de tabelas de contingência e foi usado o teste Exato de Fisher ou de qui-quadrado de Pearson. Resultados: 774 idosos foram incluídos no estudo e destes, 299 (38,6%) relataram queda no último ano, sendo que 176 (58,9%) caíram uma vez e 123 (41,1%) relataram ter caído duas vezes ou mais. Entre os caidores, a idade média foi de 72,5 (±6,1) Cerca de 107 (35,8%) dos idosos relataram ter caído para frente,79 (26,4%) para os lados e 42 (14%) para trás. Quanto às circunstâncias, 107 (35,8%) idosos relataram ter perdido o equilíbrio, 79 (26,4%) referiram ter tropeçado e 42 (14%) ter escorregado. Houve associação entre o mecanismo e as circunstâncias das quedas e ter caído uma vez ou duas vezes ou mais. Houve associação entre as circunstâncias das quedas e o número de medicações. Conclusão: As características das quedas são diferentes para os idosos que caíram uma ou duas ou mais vezes, o que pode nortear os profissionais de saúde, idosos e seus familiares em relação a estratégias específicas para prevenção de quedas. AU

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.

Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study / Fatores relacionados à sonolência diurna excessiva em idosos da comunidade: um estudo exploratório

Excessive daytime sleepiness (EDS) imposes a wide range of adverse health-related outcomes in older people, such as disability, which impair everyday activities and may increase the risk of fall. Few studies have explored EDS in Brazilian older people living in the community who are typically cared in primary health services. This study aims to investigate the prevalence of EDS and its sociodemographic, physical and mental health correlates among community-dwelling older adults. This is an exploratory, population-based study derived from Frailty in Brazilian Older Adults (FIBRA) study including adults aged 65 years and older. Participants with a score ≥ 11 points on the Epworth Sleepiness Scale were considered as having excessive daytime sleepiness. A structured, multidimensional questionnaire was used to investigate sociodemographic, physical and mental health, and self-rated health variables. The sample was composed of 776 older adults, of whom 21% (n = 162) presented excessive daytime sleepiness. Multivariate regression analysis revealed that EDS is associated with obesity (OR = 1.50; 95%CI 1.02 - 2.20), urinary incontinence (OR = 1.53; 95%CI 1.01 - 2.31), poor self-rated health (OR = 1.54; 95%CI 1.06 - 2.24), and depression symptoms (OR = 1.49; 95%CI 1.00 - 2.20). Our results suggest that healthcare professionals should identify older adults with EDS and implement intervention strategies to minimize the negative impact of the co-occurrence of this condition with obesity, depression and urinary incontinence over health and quality of life.

A Sonolência Diurna Excessiva (SDE) está relacionada a vários efeitos adversos na saúde de pessoas idosas, como a incapacidade funcional, que compromete as atividades do cotidiano e aumenta o risco de quedas. Poucos estudos têm explorado a SDE em idosos brasileiros que vivem na comunidade, que são tipicamente cuidados em serviços de atenção primária em saúde. Este estudo tem como objetivo investigar a prevalência da SDE e sua correlação com dados sociodemográficos, físicos e sobre a saúde mental de idosos que vivem na comunidade. Este é um estudo exploratório de base populacional, derivado da Rede de Estudos de Fragilidade de Idosos Brasileiros (FIBRA) com idosos com de 65 anos ou mais. Participantes com um escore ≥ 11 pontos na Escala de Sonolência de Epworth foram considerados como tendo SDE. Um questionário estruturado, multidimensional foi usado para investigar as variáveis sociodemográficas, físicas, saúde mental, e qualidade de vida. A amostra foi composta por 776 idosos, dos quais 21% (n = 162) apresentavam SDE. A análise de regressão múltipla revelou que a SDE está associada à obesidade (OR = 1.50; IC95% 1.02 - 2.20), incontinência urinária (OR = 1.53; IC95% 1.01 - 2.31), má qualidade de vida (OR = 1.54; IC95% 1.06 - 2.24) e sintomas depressivos (OR = 1.49; IC95% 1.00 - 2.20). Nossos resultados sugerem que profissionais da saúde devem identificar os idosos com SDE e implementar intervenções para minimizar o impacto negativo da coocorrência dessas condições com obesidade, depressão e incontinência urinária sobre a saúde e qualidade de vida.

Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study.

Excessive daytime sleepiness (EDS) imposes a wide range of adverse health-related outcomes in older people, such as disability, which impair everyday activities and may increase the risk of fall. Few studies have explored EDS in Brazilian older people living in the community who are typically cared in primary health services. This study aims to investigate the prevalence of EDS and its sociodemographic, physical and mental health correlates among community-dwelling older adults. This is an exploratory, population-based study derived from Frailty in Brazilian Older Adults (FIBRA) study including adults aged 65 years and older. Participants with a score ≥ 11 points on the Epworth Sleepiness Scale were considered as having excessive daytime sleepiness. A structured, multidimensional questionnaire was used to investigate sociodemographic, physical and mental health, and self-rated health variables. The sample was composed of 776 older adults, of whom 21% (n = 162) presented excessive daytime sleepiness. Multivariate regression analysis revealed that EDS is associated with obesity (OR = 1.50; 95%CI 1.02 - 2.20), urinary incontinence (OR = 1.53; 95%CI 1.01 - 2.31), poor self-rated health (OR = 1.54; 95%CI 1.06 - 2.24), and depression symptoms (OR = 1.49; 95%CI 1.00 - 2.20). Our results suggest that healthcare professionals should identify older adults with EDS and implement intervention strategies to minimize the negative impact of the co-occurrence of this condition with obesity, depression and urinary incontinence over health and quality of life.

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. .

Gait speed correlates in a multiracial population of community-dwelling older adults living in Brazil: a cross-sectional population-based study.

BACKGROUND: Gait speed is a strong predictor of a wide range of adverse health outcomes in older adults. Mean values for gait speed in community-dwelling older adults vary substantially depending on population characteristics, suggesting that social, biological, or health factors might explain why certain groups tend to self-select their gait speed in different patterns. The vast majority of studies reported in the literature present data from North American and European populations. There are few population-based studies from other regions with a different ethnicity and/or social and health conditions. To address this, the present study identified the mean usual and fast gait speeds in a representative multiracial population of community-dwelling older adults living in a developing country, and explored their association with sociodemographic, mental and physical health characteristics. METHODS: This was a cross-sectional population-based study of a sample of 137 men and 248 women, aged 65 years and over. Usual gait speed and fast gait speed were measured on a 4.6 m path. Participants were classified into slow, intermediate, and faster groups by cluster analysis. Logistic regression analysis was used to estimate the independent effect of each factor on the odds of presenting with a slower usual and slower fast gait speeds. RESULTS: Participants had a mean (SD) usual gait speed of 1.11 (0.27) m/s and a mean fast gait speed of 1.39 (0.34) m/s. We did not observe an independent association between gait speed and race/ethnicity, educational level, or income. The main contributors to present a slower usual gait speed were low physical activity level, stroke, diabetes, urinary incontinence, high concern about falling, and old age. A slower fast gait speed was associated with old age, low physical activity, urinary incontinence and high concern about falling. CONCLUSION: A multiracial population of older adults living in a developing country showed a similar mean gait speed to that observed in previously studied populations. The results suggest that low physical activity, urinary incontinence and high concern about falling should not be neglected and may help identify those who might benefit from early intervention.

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.

Perfil das condutas alimentares de idosos com delirium durante a internação hospitalar / Profile of feeding procedures of the elderly with delirium during hospitalization

É comum pacientes com delirium apresentarem dificuldades alimentares como resistência à alimentação, inabilidade em lidar com o alimento e aspiração do alimento ao deglutir, devido a uma alteração temporária na cognição.O objetivo foi descrever as condutas fonoaudiológicas alimentares estabelecidas para idosos hospitalizados com diagnóstico de delirium e verficar a ocorrência de pneumonia aspirativa durante este período de internação. Foram estudados 33 prontuários de pacientes internados em uma enfermaria Geriátrica, com idade entre 60 e 90 anos. A seleção desses pacientes foi realizada através do diagnóstico médico de delirium e as informações foram coletadas através da base de dados fonoaudiológicos. Os dados foram reunidos em um protocolo e divididos em: perfil da população, condutas fonoaudiológicas realizadas e a ocorrência de pneumonia aspirativa. Após tabulação e análise estatística dos dados, observamos que, quanto ao perfil da população, 51,5 por cento eram do sexo masculino, 36,4 por cento tinham 81 a 90 anos, 54,5 por cento permaneceram entre um a quinze dias internados, 39,4 por cento permaneceram com delirium durante um a sete dias e 57,6 por cento receberam alta hospitalar. Quanto às condutas fonoaudiológicas, 36,4 por cento utilizaram a via oral para alimentação; 94,7 por cento ingeriram alimentos de consistência pastosa geriátrica; 54,4 por cento eram dependentes totais para o posicionamento e 100 por cento dos pacientes não apresentaram pneumonia aspirativa nesse período. Concluiu-se que é possível alimentar por via oral os pacientes com delirium, desde que eles não apresentem riscos de aspiração e sejam diariamente acompanhados pelo fonoaudiólogo

Disfagia do idoso: estudo videofluoroscópico de idosos com e sem doença de Parkinson / Elderly dysphagia: videofluoroscopy study of elder patients with and without Parkinson's disease

Objetivo: descrever as alterações nas fases oral, farínfea e esofágica da deglutição de pacientes idosos com doença de Parkinson (DP) avaliados pela videofluoroscopia, comparando com as queixas relatadas pelos mesmos; comparar as alterações entre pacientes com doença de Parkinson e um grupo de idosos com mais de 60 anos sem alterações neurológicas (grupo controle). Método: foram levantadas as principais queixas quanto à deglutição e avaliados pela videofluoroscopia 25 pacientes com doença de Parkinson (DP), sendo 19 do sexo masculino e 6 do sexo feminino entre o II e IV estágio da doença, segundo a escala modificada de Hoehn e Yahr. Os pacientes foram avaliados em todas as consistências alimentares. Os achados foram comparados com o grupo controle. Resultados: na fase oral, as alterações mais comuns foram: dificuldade no movimento de preparo e organização do bolo alimentar, fechamento labial inadequado, tremor da língua em repouso e durante a mastigação e permanência do meio de contraste em cavidade oral. Na fase faríngea foi observada estase em valéculas, recessos piriformes e esfíncter esofágico superior, necessidade de múltiplas deglutições para limpeza e aspiração laringo-traqueal. Na fase esofágica, presença de contrações terciárias, diminuição do peristaltismo, presença de refluxo gastroesofágico. Conclusão: pacientes com doença de Parkinson podem apresentar alterações nas fases oral, faríngea e esofágica da deglutição mais freqüentes do que em idosos sem alterações neurológicas

[Clinical and radiological study of swallowing in patients with deglutition disorders, classified into two age groups: adults and older people]. / Avaliação clínica e videofluoroscópica de pacientes com distúrbios da deglutição--estudo comparativo em dois grupos etários: adultos e idosos.

BACKGROUND: The abnormalities of swallowing process have multifactor and complex etiologies. The videofluoroscopy has been pointed as the exam of greater utility in diagnostic investigation for these cases. This method, when preceded of an adequate anamnesis, can characterize conveniently the level of the dysfunction and usually identify the cause of abnormality with great precision. AIMS: To study the clinical complaints and findings of the videofluoroscopy examination in patients with deglutition disorders and no clinical evidence associated with neurological disorder, classified into two age groups: adults and older people, and to analyze: symptomatic manifestations, kinds of disorders (oropharyngeal or esophageal) and the capacity of clarifying the clinical complaints through the method of images. MATERIALS AND METHODS: Seventy patients with complaint of the capacity of deglutition were analyzed. They had no clinical evidence of associated neurological syndromes or disorders and were classified into two age groups: adults (GI)-- < or = 65 years (n = 36) and older (GII) > 65 years (n = 34). All patients were submitted to anamnesis to obtain the information about their complaints concerning deglutition. The complaints were characterized as high or low, according to their predominant location of manifestation. All the patients were submitted to videofluoroscopy of the deglutition; these alterations were characterized as oropharyngeal or esophageal. The capacity of clarifying the clinical complaints by videofluoroscopy was evaluated in both groups. RESULTS: Among the complaints analyzed, the only one in which the statistical analysis presented a significant difference between the groups was the complaint of heartburn, which occurred more often in the group GI-- eight patients (22.2%) and GII--one patient (2.9%). In the study of videofluoroscopy, it was observed a higher incidence in the oropharyngeal disorder in group GII--41.2% while in group GI--13.9%. As for the esophageal disorder, the incidence was similar in both groups GI - 35.3% and GII--33.3%. Nineteen patients (52.8%) in GI and 23 (67.6%) in GII had their complaints clarified through the videofluoroscopy. CONCLUSIONS: Under the conditions of this study, it can be concluded that: 1. The clinical complaints associated with the difficulty of deglutition occur at a similar frequency in adults and older people, with the exception of heartburn that occurs in larger number among adults; 2. Older people present a higher incidence of oropharyngeal deglutition problems; 3. The videofluoroscopy of the deglutition represents a method of great importance for the diagnosis, because it allows the identification of morphofunctional disorders that cannot be adequately identified by anamnesis; 4. The capacity of clarifying diagnosis of the videofluoroscopy of the deglutition is higher in the older people group.

Avaliação clínica e videofluoroscópica de pacientes com distúrbios da deglutição - estudo comparativo em dois grupos etários: adultos e idosos / Clinical and radiological study of swallowing in patients with deglutition disorders, classified into two age groups: adults and older people / Clinical and radiological study of swallowing in patients with deglutition disorders, classified into two age groups: adults and older people

RACIONAL: As anomalias do processo da deglutição têm etiologia multifatorial e complexa. A videofluoroscopia da deglutição tem sido apontada como o exame de maior utilidade na investigação diagnóstica desses casos. Tal método, quando precedido de anamnese clínica adequada, consegue caracterizar convenientemente o grau de disfunção e, freqüentemente, identificar a causa da anomalia com grande precisão. OBJETIVOS: Estudar as queixas clínicas e os achados da videofluoroscopia em pacientes com distúrbios da deglutição, sem evidências clínicas de afecções neurológicas associadas, distribuídos em duas faixas etárias - adultos e idosos - e analisar as manifestações sintomáticas, o tipo de disfunção (orofaríngea ou esofágica) e a capacidade de elucidação da queixa clínica pelo método de imagem. MATERIAL E MÉTODOS: Foram analisados 70 pacientes com queixa de alteração na capacidade de deglutição, sem evidências clínicas de afecções neurológicas associadas, distribuídos em dois grupos: adultos (GI) - idade inferior ou igual a 65 anos (n = 36) e idosos (GII) - idade superior a 65 anos (n = 34). Todos foram submetidos a anamnese para obtenção de informações sobre queixas em relação à deglutição; as queixas foram caracterizadas como altas ou baixas, de acordo com o local predominante de manifestação. Todos os pacientes foram submetidos a videofluoroscopia da deglutição; as alterações observadas com esse exame foram caracterizadas como orofaríngeas ou esofágicas. Avaliou-se a capacidade de elucidação da queixa clínica pela videofluoroscopia nos dois grupos. RESULTADOS: Dentre as queixas analisadas, a única cuja análise estatística demonstrou diferença significante entre os grupos, foi a de pirose, que ocorreu com maior freqüência no grupo de adultos (oito pacientes (22,2 por cento) do GI e um (2,9 por cento) do GII referiam tal queixa). Ao estudo videofluoroscópico, observou-se maior ocorrência de disfunção orofaríngea no grupo de pacientes idosos (41,2 por cento GII x 13,9 por cento GI)...

BACKGROUND: The abnormalities of swallowing process have multifactor and complex etiologies. The videofluoroscopy has been pointed as the exam of greater utility in diagnostic investigation for these cases. This method, when preceded of an adequate anamnesis, can characterize conveniently the level of the dysfunction and usually identify the cause of abnormality with great precision. AIMS: To study the clinical complaints and findings of the videofluoroscopy examination in patients with deglutition disorders and no clinical evidence associated with neurological disorder, classified into two age groups: adults and older people, and to analyze: symptomatic manifestations, kinds of disorders (oropharyngeal or esophageal) and the capacity of clarifying the clinical complaints through the method of images. MATERIALS AND METHODS: Seventy patients with complaint of the capacity of deglutition were analyzed. They had no clinical evidence of associated neurological syndromes or disorders and were classified into two age groups: adults (GI) - £65 years (n = 36) and older (GII) >65 years (n = 34). All patients were submitted to anamnesis to obtain the information about their complaints concerning deglutition. The complaints were characterized as high or low, according to their predominant location of manifestation. All the patients were submitted to videofluoroscopy of the deglutition; these alterations were characterized as oropharyngeal or esophageal. The capacity of clarifying the clinical complaints by videofluoroscopy was evaluated in both groups. RESULTS: Among the complaints analyzed, the only one in which the statistical analysis presented a significant difference between the groups was the complaint of heartburn, which occurred more often in the group GI - eight patients (22.2 percent) and GII - one patient (2.9 percent). In the study of videofluoroscopy, it was observed a higher incidence in the oropharyngeal disorder in group GII - 41.2 percent while in...

Estudo das alterações de maior ocorrência nas fases oral e faríngea da deglutição, entre 20 e 93 anos de idade, avaliadas pela videofluoroscopia / Description of the most prevalent dysfunction in the oral and pharyngeal stages of swallowing among 20 to 93 years old subjects evaluated through videofluoroscopy

Objetiva descrever e comparar as alterações de maior ocorrência, nas fases oral e faríngea da deglutição, de dois grupos etários distintos, avaliados pela videofluoroscopia

Estrutura e conteúdo do discurso de idosas residentes em instituição de longa permanência portadoras e não-portadoras de déficit cognitivo e de depressão / Oral discourse structural and content of institucionalized elderly women with and without cognitive deficit and depression

Foi analisado o discurso oral de idosas quanto à estrutura e ao conteúdo em duas situações de auto-relatos

Avaliação de linguagem e de deglutição de pacientes hospitalizados após acidente vascular cerebral / Language and swallowing evaluation of hospitalized pacients after stroke

Objetiva realizar avaliação clínica de linguagem e de deglutição em idosos hospitalizados após AVC e elaborar propostas terapêuticas para as alterações identificadas. Foram avaliados 14 pacientes, de ambos os sexos, com idade entre 48 e 84 anos

Estudo da alimentaçäo e deglutiçäo de idosos com doença de Alzheimer leve e moderada / Feeding and swallowing in senior citizens diagnosed with mild or moderate Alzheimer disease

Descreve questöes relacionadas à dependência no momento da alimentaçäo , os comportamentos associados e a dinämica da deglutiçäo de idosos com doença de Alzheimer, além de comparar os grupos com demência leve e moderada, quanto aos aspectos acima.

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