Pain symptoms and physical performance in older adults: cross-sectional findings from the International Mobility in Aging Study (IMIAS).

PURPOSE: To analyze the associations between pain and physical performance in different aging contexts. METHODS: Data from 1725 older adults from Canada, Brazil, Colombia, and Albania from the 2014 wave of the IMIAS were used to assess the associations between Back Pain (BP) or Lower Limb Pain (LLP) and physical performance by the Short Physical Performance Battery (SPPB). Three binary logistic regression models adjusted for sex, age, study site, education, income sufficiency, BMI, depressive symptoms, and chronic conditions were used to estimate the associations between LLP or BP and SPPB. The SPPB was classified into good performance (8 points or more) and poor physical performance (< 8 points). RESULTS: The mean age of the older men was 71.2 (± 3.0) and the mean age of the women was 71.2 (± 2.8) years. Older men (72.8%, p < 0.05) and women (86.1%, p-value < 0.05) from Albania had the highest frequencies of self-reported general pain. Older women in Colombia had the highest frequencies of LLP or BP (33.5%, p-value < 0.05). In the fully adjusted logistic regression model, LLP or BP was significantly associated with poor SPPB (OR = 0.48, 0.35 to 0.66 95% CI, p < 0.01). CONCLUSIONS: Pain symptoms are associated with reduced physical performance in older people, even when adjusted for other clinical and sociodemographic factors. Protocols for aiming to increase the level of physical activity to manage pain should be incorporated into health care strategies.

Circumstances and Factors Associated With Falls Among Community-Dwelling Older Adults Diagnosed With Heart Disease Using the International Mobility in Aging Study (IMIAS).

BACKGROUND AND PURPOSE: To identify the circumstances of falls and the factors associated with falls among older adults with cardiovascular disease (CVD). METHODS: Baseline (2012) data from the International Mobility in Aging Study (IMIAS), a cross-sectional study, were used. Falling was measured by the subjective question, "Have you fallen in the last 12 months?" Several subjective questions were asked to obtain information about the circumstances of falls. Potential clinical factors associated with falling were cognitive status, depressive symptoms, physical performance, grip strength, visual acuity, and fear of falling (FOF). These clinical factors were measured respectively with the Leganes Cognitive Test, the Center for Epidemiological Studies Scales Depressive Symptoms, the Short Physical Performance Battery, a Jamar handgrip dynamometer, the Early Treatment Diabetic Retinopathy Study (ETDRS) tumbling E chart placed at 2 m, and the Falls Efficacy Scale-International. A χ 2 test was used to determine whether there were significant differences in fall circumstances among older adults with and without CVD. Two-sample t tests were used to test for any significant differences between older adults with and without CVD. Bonferroni correction was applied to limit type I errors and was corrected to .007. Simple and multiple logistic regressions identified which clinical factors were associated with falling. RESULTS: A total of 429 older adults with CVD (mean age 69.5 ± 2.9) and 431 older adults without CVD (69.2 ± 2.9) participated in the study. Approximately 53% of fallers with CVD had 2 or more falls compared with fallers without CVD (39%). The most common location for falling was at home (43%) for fallers with CVD or in the street (50%) for fallers without CVD. Approximately 9% of fallers with CVD needed to be hospitalized while only 3% of fallers without CVD were admitted to the hospital. Approximately 42% of fallers with CVD had some residual sequelae (eg, being unable to walk around the house or do housework) compared with only 27% of fallers without CVD. Fallers with CVD had significantly ( P value < .007) more depressive symptoms (mean ± SD, 14.7 ± 12.9) and poorer physical performance (8.4 ± 3.0) compared with fallers without CVD (10.1 ± 9.4 and 9.6 ± 2.5, respectively); however FOF was the only significant clinical factor ( P value < .05) associated with falling for older adults with CVD. CONCLUSIONS: Incidence of recurrent falls is higher among older adults with CVD than those without CVD. Circumstances of falls among fallers with CVD differ from those identified among fallers without CVD. Fear of falling was the only predictor of fall history among older adults with CVD. The results suggest the merit of considering FOF when designing prevention and intervention programs to reduce falls among older adults with CVD.

A Regression Tree Analysis to Identify Factors Predicting Frailty: The International Mobility in Aging Study.

INTRODUCTION: Frailty is a complex geriatric syndrome with a multifaceted etiology. We aimed to identify the best combinations of risk factors that predict the development of frailty using recursive partitioning models. METHODS: We analyzed reports from 1,724 community-dwelling men and women aged 65-74 years participating in the International Mobility in Aging Study (IMIAS). Frailty was measured using frailty phenotype scale that included five physical components: unintentional weight loss, weakness, slow gait, exhaustion, and low physical activity. Frailty was defined as presenting three of the above five conditions, having one or two conditions indicated prefrailty and showing none as robust. Socio-demographic, physical, lifestyle, psycho-social, and life-course factors were included in the analysis as potential predictors. RESULTS: 21% of pre-frail and robust participants showed a worse stage of frailty in 2014 compared to 2012. In addition to functioning variables, fear of falling (FOF), income, and research site (Canada vs. Latin America vs. Albania) were significant predictors of the development of frailty. Additional significant predictors after exclusion of functioning factors included education, self-rated health, and BMI. CONCLUSIONS: In addition to obvious risk factors for frailty (such as functioning), socio-economic factors and FOFs are also important predictors. Clinical assessment of frailty should include measurement of these factors to identify high-risk individuals.

Predicting restriction of life-space mobility: a machine learning analysis of the IMIAS study.

BACKGROUND: Some studies have employed machine learning (ML) methods for mobility prediction modeling in older adults. ML methods could be a helpful tool for life-space mobility (LSM) data analysis. AIM: This study aimed to evaluate the predictive value of ML algorithms for the restriction of life-space mobility (LSM) among elderly people and to identify the most important risk factors for that prediction model. METHODS: A 2-year LSM reduction prediction model was developed using the ML-based algorithms decision tree, random forest, and eXtreme gradient boosting (XGBoost), and tested on an independent validation cohort. The data were collected from the International Mobility in Aging Study (IMIAS) from 2012 to 2014, comprising 372 older patients (≥ 65 years of age). LSM was measured by the Life-Space Assessment questionnaire (LSA) with five levels of living space during the month before assessment. RESULTS: According to the XGBoost algorithm, the best model reached a mean absolute error (MAE) of 10.28 and root-mean-square error (RMSE) of 12.91 in the testing portion. The variables frailty (39.4%), mobility disability (25.4%), depression (21.9%), and female sex (13.3%) had the highest importance. CONCLUSION: The model identified risk factors through ML algorithms that could be used to predict LSM restriction; these risk factors could be used by practitioners to identify older adults with an increased risk of LSM reduction in the future. The XGBoost model offers benefits as a complementary method of traditional statistical approaches to understand the complexity of mobility.

Fear of Falling and Environmental Factors: A Scoping Review.

Fear of falling is a geriatric condition that must be understood from both a clinical perspective and from the environment in which older adults live. This review aimed to describe the scientific evidence reported in the last 5 years regarding the fear of falling in older adults and its relationship with environmental factors. The relationships between fear of falling and environmental factors are mainly evidenced in the built environment. Older adults with a fear of falling are described as perceiving the built environment as dangerous when they do not meet the requirements of safety, accessibility, and comfort; they also report the importance of living in communities with controlled crime levels and available social support for older adults to improve their insecurity and feelings of vulnerability.

Fear of Falling Among Community-Dwelling Older Adults with Heart Disease: Findings from an International Mobility in Aging Study (IMIAS).

BACKGROUND: Older adults with heart disease (HD) are more likely to report a higher prevalence of falls compared to those without HD. A knowledge gap currently exists regarding the factors associated with fear of falling (FOF) among older adults with HD. Therefore, this study aimed to estimate FOF and identify factors associated with FOF among older adults with HD. METHODS: Data came from a secondary analysis of the International Mobility in Aging Study (IMIAS) baseline (2012) data. FOF was measured using the Falls Efficacy Scale-International (FES-I). Stepwise linear regression was used to identify factors associated with FOF. RESULTS: A total of 429 participants identified themselves as having heart disease diagnosed by their physician (mean age 69.5 ± 2.9). Older adults with HD reported on average (25.6) higher FOF than those without HD. For older adults with HD, FES-I increased significantly by 1.3, 1.0, and 0.6 points, when the Short Physical Performance Battery, the Leganes Cognitive Test, and QOL total scores decreased by one point. FES-I also significantly increased by 3.2 when income was insufficient compared to sufficient or very sufficient income. DISCUSSION: FOF is multifactorial, and our findings provide a base for developing future management rehabilitation intervention programs aimed at decreasing FOF among older adults with HD.

Healthy aging determinants and disability among older adults: SABE Colombia.

OBJECTIVE: To identify the main factors associated with disability in older adults in Colombia, adjusted according to structural and intermediary determinants of healthy aging. METHODS: This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built environment, and health care systems. Data analysis employed multivariate logistic regression. RESULTS: The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activities of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low educational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability. CONCLUSIONS: Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.

Healthy aging determinants and disability among older adults: SABE Colombia

[ABSTRACT]. Objective. To identify the main factors associated with disability in older adults in Colombia, adjusted accord-ing to structural and intermediary determinants of healthy aging.Methods. This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built envi-ronment, and health care systems. Data analysis employed multivariate logistic regression.Results. The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activi-ties of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low edu-cational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability.Conclusions. Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.

[RESUMEN]. Objetivo. Determinar los principales factores asociados con la discapacidad en personas mayores en Colom-bia, ajustados según determinantes estructurales e intermediarios del envejecimiento saludable.Métodos. Este estudio empleó datos transversales de 23 694 adultos de más de 60 años provenientes de la encuesta nacional Colombia SABE. Se analizaron los determinantes estructurales como las variables demográficas y de situación socioeconómica. Las variables intermediarias se clasificaron en tres bloques: capacidad intrínseca, entorno físico y construido, y sistemas de atención de salud. El análisis de datos empleó la regresión logística con múltiples variables.Resultados. La prevalencia de la discapacidad general fue de 21% en la actividad cotidiana, 38% en la activi-dad cotidiana instrumental y 33% en la discapacidad relacionada con la movilidad. Se asoció la discapacidad con los determinantes estructurales sociodemográficos, como edad avanzada, sexo femenino, residencia en entornos rurales, estar soltero o divorciado, vivir solo, un nivel educativo bajo y tener etnicidad indígena o negra. Con respecto a los determinantes relativos a la situación socioeconómica, la principal influencia en la discapacidad fueron los ingresos netos bajos, la situación socioeconómica baja, una percepción insuficiente de ingresos y un plan de seguro de salud subsidiado. Los determinantes intermediarios de la capacidad intrínseca, como la mala salud informada por la propia persona, la multimorbilidad, la poca fuerza en el puño, un estilo de vida sedentario, las adversidades económicas desde la primera infancia, la carencia de apoyo social y la falta de participación en actividades se asociaron de manera significativa con la discapacidad.Conclusiones. Las medidas que tienen un efecto sobre los principales factores asociados con la discapaci-dad, como la reducción de las inequidades en materia de salud, mediante políticas, estrategias y actividades, pueden contribuir significativamente al bienestar y la calidad de vida de las personas mayores colombianas.

[RESUMO]. Objetivo. Identificar os principais fatores associados à incapacidade em idosos na Colômbia, ajustados de acordo com os determinantes estruturais e intermediários do envelhecimento saudável.Métodos. Este estudo usou dados transversais de 23.694 adultos com mais de 60 anos de idade que partic-iparam da pesquisa nacional SABE Colômbia. Determinantes estruturais, como variáveis demográficas e de condição socioeconômica, foram analisados. As variáveis intermediárias foram classificadas em três blocos: capacidade intrínseca, ambiente físico e construído, e sistemas de saúde. A análise dos dados empregou regressão logística multivariada.Resultados. A prevalência de incapacidade em geral foi de 21% para as atividades da vida diária, 38% para atividades instrumentais da vida diária e 33% para restrição de mobilidade. Constatou-se associação da incapacidade com determinantes estruturais sociodemográficos, como idade avançada, sexo feminino, residência em área rural, estado civil solteiro ou divorciado, viver sozinho, baixa escolaridade e etnia indígena/negra. Com relação aos determinantes da condição socioeconômica, baixa renda líquida, pertencimento ao estrato socioeconômico mais pobre, percepção de renda insuficiente e ter um plano de seguro-saúde sub-sidiado exerceram grande influência sobre a incapacidade. Determinantes intermediários da capacidade intrínseca, como autopercepção de saúde ruim, multimorbidade, força de preensão reduzida, estilo de vida sedentário, adversidade econômica na primeira infância, ausência de suporte social e não participação em atividades foram significativamente associados à incapacidade.Conclusões. Ações que afetem os principais fatores associados à incapacidade, como a redução das iniq-uidades em saúde por meio de políticas, estratégias e atividades, podem contribuir significativamente para o bem-estar e a qualidade de vida dos idosos colombianos.

Evaluación del desempeño de un analizador POCT con relación a los resultados de los métodos convencionales rutinarios del laboratorio clínico en un hogar de ancianos. Cali. 2014 / Performance evaluation of a POCT analyzer in relation to the results of routine conventional clinical laboratory methods in a nursing home. Cali. 2014

RESUMEN Introducción: Los análisis en el sitio de atención (POCT, por sus siglas en ingles Point-of-care testing) son pruebas de diagnóstico clínico llevadas a cabo fuera de los espacios específicamente diseñados para los análisis clínicos, que proporcionan resultados rápidos que mejoran la oportunidad en la toma de decisiones médicas. En Colombia no hay información sobre su uso y desempeño en grupos etarios específicos como los de los hogares de ancianos en Colombia. Objetivo: Evaluar el desempeño de un analizador POCT para perfil lipídico (CT, LDL-c, HDL-c, TG) y glicemia con relación a los resultados de los métodos convencionales rutinarios del laboratorio clínico en un hogar de ancianos. Materiales y métodos: Estudio descriptivo de corte transversal. Se tomaron 52 residentes a quienes se les tomaron muestras pareadas (punción venosa y digital). Se usó un instrumento estandarizado para la descripción de las características deseadas del POCT. Se aplicó estadística univariada y bivariada. Resultados: La edad promedio de los participantes fue de 78, rango 64-91 años. El POCT mostró un desempeño aceptable frente a los métodos convencionales del laboratorio clínico, especialmente TG y HDL-c. Sin embargo, se observaron diferencias estadísticamente significativas en los resultados de glicemia, CT y LDL-c entregados por el POCT en comparación con los del laboratorio clínico. Conclusiones: La POCT puede ser una opción importante para tamizaje y control de enfermedades crónicas en hogares de ancianos. Sin embargo, es necesario una estructura organizacional que garantice la calidad de las mediciones del POCT. MÉD.UIS.2021;34(2): 9-18.

ABSTRACT Introduction: Point-of-care testing (POCT) are clinical diagnostic tests carried out than laboratory analysts, outside of spaces specifically designed for clinical analysis, and they provide quick results that improve the timeliness of medical decision making. In Colombia there is no information on its use and performance in specific age groups such as those in nursing homes. Objective: To evaluate the performance of a POCT analyzer for lipid profile (CT, LDL-c, HDL-c, TG) and glycemia in relation to the results of routine conventional methods of the clinical laboratory in a nursing home. Materials and methods: Descriptive cross-sectional. 52 residents were taken to whom paired samples were applied. Glucose and lipid levels were determined. Samples collected by fingerstick were analyzed by POCT and venipuncture by conventional methods certified by the CDC in the laboratory. A standardized instrument was used to describe the desired characteristics of the POCT. Univariate and bivariate statistics were applied. The results issued by the clinical reference laboratory were compared with those of the POCT through the ICC. Results: The average age of the participants was 78, range 64-91 years. The POCT showed an acceptable performance compared to conventional clinical laboratory methods, especially TG and HDL-c. However, statistically significant differences were observed in the results of glycemia, CT and LDL-c delivered by the POCT compared to those of the clinical laboratory. Conclusions: POCT can be an important option for chronic disease screening and management in nursing homes. However, an organizational structure is necessary to ensure the quality of the POCT measurements. MÉD.UIS.2021;34(2): 9-18.

Prevalence and impact of potentially inappropriate medication on community-dwelling older adults. / Prevalencia e impacto de la medicación potencialmente inapropiada en ancianos que viven en comunidad

INTRODUCTION: Potentially inappropriate medication is associated with adverse health and functional outcomes, as well as increased health care costs. OBJECTIVE: To estimate the prevalence and types of potentially inappropriate medication according to the Beers criteria in community-dwelling older persons and to identify the major clinical and functional consequences of potentially inappropriate medication during two years of following. MATERIALS AND METHODS: We conducted a longitudinal, descriptive, and observational study that included 400 65-year or older community-dwelling people (48% women) selected by simple random sampling in 2012. In 2014, 372 people were re-evaluated and classified into two groups based on the presence or absence of potentially inappropriate medication through the follow-up period. RESULTS: In total, 31% had polypharmacy (5-9 medications) and 1,8% had excessive polypharmacy (10 or more medications). The mean of the number of medications was higher in the potentially inappropriate medication group (3 vs. 5.78; p<0.001) and 21.9% still had the potentially inappropriate medication status during the follow-up; of them, 75% had one potentially inappropriate medication and 23% two. The presence of potentially inappropriate medication was more frequent among frail and depressed male individuals with a bad health self-assessment and comorbidities, especially diabetes mellitus and chronic obstructive pulmonary disease. In the group with sustained potentially inappropriate medication, we found a worsening health self-assessment, increased frailty, a higher incidence of recurrent falls and prevalence of depression, as well as a higher hospital admission rate, ambulatory medical consultation, and more prescribed medications. We did not find an impact on functional capacity. CONCLUSIONS: We validated the negative effects of potentially inappropriate medication in the long run for the health of older people and, therefore, potentially inappropriate medications should be monitored in primary care services to avoid greater risks.

Introducción. La medicación potencialmente inapropiada se asocia con consecuencias clínicas, geriátricas, funcionales y farmacoeconómicas negativas. Objetivo. Estimar la prevalencia y los tipos de medicación potencialmente inapropiada según los criterios de Beers en ancianos que viven en comunidad y determinar las principales consecuencias clínicas y funcionales a lo largo de dos años de seguimiento. Materiales y métodos. Se hizo un estudio descriptivo, observacional y longitudinal que incluyó 400 mayores de 65 años (48 % mujeres) residentes en la comunidad seleccionados mediante muestreo aleatorio simple en el 2012. En el seguimiento del 2014 se reevaluaron 372 de ellos y se clasificaron en dos grupos: quienes a lo largo de los dos años siguieron tomando medicación potencialmente inapropiada y quienes no. Resultados. El 31 % de los ancianos estaban polimedicados, (5 a 9 medicamentos) y 1,8 % polimedicados de forma excesiva (10 o más medicamentos). El promedio de consumo de medicamentos era mayor en el grupo de medicación potencialmente inapropiada (3 Vs. 5,78; p<0,001), y el 21,9 % siguieron recibiendo medicación potencialmente inapropiada durante el seguimiento; de ellos, el 75 % recibía un medicamento de este tipo y el 23 %, dos. El uso de dicha medicación fue más frecuente en hombres frágiles con una mala percepción de la propia salud, depresión y un mayor número de comorbilidades, especialmente diabetes mellitus y enfermedad-pulmonar-obstructiva-crónica. En el grupo que siguió recibiendo medicación potencialmente inapropiada la percepción de la propia salud empeoró, con un incremento de la fragilidad, las caídas recurrentes y la depresión, así como en los ingresos hospitalarios y las consultas médicas y mayor cantidad de medicamentos formulados. No se evidenció un impacto en la capacidad funcional. Conclusiones. Se corroboran los efectos negativos a largo plazo de la medicación potencialmente inapropiada en la salud de los ancianos, por lo cual se la debe monitorizar en la atención primaria para evitar mayores riesgos.

Prevalence and impact of potentially inappropriate medication on community-dwelling older adults / Prevalencia e impacto de la medicación potencialmente inapropiada en ancianos que viven en comunidad

Abstract | Introduction: Potentially inappropriate medication is associated with adverse health and functional outcomes, as well as increased health care costs. Objective: To estimate the prevalence and types of potentially inappropriate medication according to the Beers criteria in community-dwelling older persons and to identify the major clinical and functional consequences of potentially inappropriate medication during two years of following. Materials and methods: We conducted a longitudinal, descriptive, and observational study that included 400 65-year or older community-dwelling people (48% women) selected by simple random sampling in 2012. In 2014, 372 people were re-evaluated and classified into two groups based on the presence or absence of potentially inappropriate medication through the follow-up period. Results: In total, 31% had polypharmacy (5-9 medications) and 1,8% had excessive polypharmacy (10 or more medications). The mean of the number of medications was higher in the potentially inappropriate medication group (3 vs. 5.78; p<0.001) and 21.9% still had the potentially inappropriate medication status during the follow-up; of them, 75% had one potentially inappropriate medication and 23% two. The presence of potentially inappropriate medication was more frequent among frail and depressed male individuals with a bad health self-assessment and comorbidities, especially diabetes mellitus and chronic obstructive pulmonary disease. In the group with sustained potentially inappropriate medication, we found a worsening health self-assessment, increased frailty, a higher incidence of recurrent falls and prevalence of depression, as well as a higher hospital admission rate, ambulatory medical consultation, and more prescribed medications. We did not find an impact on functional capacity. Conclusions: We validated the negative effects of potentially inappropriate medication in the long run for the health of older people and, therefore, potentially inappropriate medications should be monitored in primary care services to avoid greater risks.

Resumen | Introducción. La medicación potencialmente inapropiada se asocia con consecuencias clínicas, geriátricas, funcionales y farmacoeconómicas negativas. Objetivo. Estimar la prevalencia y los tipos de medicación potencialmente inapropiada según los criterios de Beers en ancianos que viven en comunidad y determinar las principales consecuencias clínicas y funcionales a lo largo de dos años de seguimiento. Materiales y métodos. Se hizo un estudio descriptivo, observacional y longitudinal que incluyó 400 mayores de 65 años (48 % mujeres) residentes en la comunidad seleccionados mediante muestreo aleatorio simple en el 2012. En el seguimiento del 2014 se reevaluaron 372 de ellos y se clasificaron en dos grupos: quienes a lo largo de los dos años siguieron tomando medicación potencialmente inapropiada y quienes no. Resultados. El 31 % de los ancianos estaban polimedicados, (5 a 9 medicamentos) y 1,8 % polimedicados de forma excesiva (10 o más medicamentos). El promedio de consumo de medicamentos era mayor en el grupo de medicación potencialmente inapropiada (3 Vs. 5,78; p<0,001), y el 21,9 % siguieron recibiendo medicación poitencialmente inapropiada durante el seguimiento; de ellos, el 75 % recibía un medicamento de este tipo y el 23 %, dos. El uso de dicha medicación fue más frecuente en hombres frágiles con una mala percepción de la propia salud, depresión y un mayor número de comorbilidades, especialmente diabetes mellitus y enfermedad-pulmonar-obstructiva-crónica. En el grupo que siguió recibiendo medicación potencialmente inapropiada la percepción de la propia salud empeoró, con un incremento de la fragilidad, las caídas recurrentes y la depresión, así como en los ingresos hospitalarios y las consultas médicas y mayor cantidad de medicamentos formulados. No se evidenció un impacto en la capacidad funcional. Conclusiones. Se corroboran los efectos negativos a largo plazo de la medicación potencialmente inapropiada en la salud de los ancianos, por lo cual se la debe monitorizar en la atención primaria para evitar mayores riesgos.

Frailty syndrome and risk of cardiovascular disease: Analysis from the International Mobility in Aging Study.

OBJECTIVE: To investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score, FRS) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS). MATERIAL AND METHODS: This cross-sectional study used data from the IMIAS, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). A total of 1724 older adults aged 65-74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. The FRS was calculated to estimate the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high-density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Confounders included measures of childhood social and economic adversity, as well as mid-life and adult adversity. RESULTS: After adjustment for adversities which occurred during in early, adult or current life, frail individuals presented higher FRS values (ß = 3.81, 95 %CI: 0.97-6.65, p-value <0.001) when compared to robust participants. A statistically significant relationship was also observed in prefrail participants with FRS (ß = 1.61, 95 % CI: 0.72-3.02, p-value <0.05). CONCLUSION: Frailty and prefrailty were associated to FRS, independent of life course adversities. Screening cardiovascular risk factors should be a target, mainly in those who present frailty syndrome.

Falls and life-space mobility: longitudinal analysis from The International Mobility in Aging Study.

OBJECTIVES: To investigate a 4-year longitudinal relationship between falls, recurrent falls, and injurious falls, according to different levels of life-space mobility (LSM). METHODS: Longitudinal analysis of an international cohort study. The participants were older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline. Three waves of data (2012, 2014, 2016) were used. Fall history during the past year was recorded. Recurrent fallers were identified as those who fell at least twice and injurious fallers as participants who required medical attention. LSM measurements included Total Life-Space (LS-C), Maximal Life-Space (LS-M), Assisted Life-Space (LS-A), Independent Life-Space (LS-I) and Restricted Life-space (LS-ID) scores. Generalized estimation equation (GEE) models were used to determine whether life-space mobility measures and their change over time differed between recurrence of falls and injurious falls. RESULTS: At baseline, the prevalence of falls in the last year was 28%. 11.8% reported recurrent falls and 2.6% had serious injurious falls in the last year preceding the assessments. Recurrent fallers were more likely to be female, with insufficient income and, with comorbidities. GEE models showed that life-space mobility was lower among those with recurrent falls or serious injurious falls compared to those who never fell, but the rate of change did not differ over the 4-year follow-up except for the LS-A and LS-I scores, where some improvements were observed over time. CONCLUSIONS AND IMPLICATIONS: Falls were independently associated with a decrease in LSM over 4 years. Targeting older adults with recurrent and injurious falls with appropriate interventions may improve community mobility and social participation.

The healthy aging phenotype in older people in Manizales / [Fenotipo de envejecimiento saludable de personas mayores en Manizales].

Introduction: The healthy aging phenotype is present in those individuals that age with low morbidity, no functional or cognitive deterioration, and retain an acceptable level of wellness and social participation. Objective: To establish the frequency of the healthy aging phenotype in older people in the community using a multidimensional, a biomedical, and a psychosocial model and to identify the predicting factors in each model. Materials and methods: We conducted a cross-sectional, observational and descriptive study. We assessed individuals (n= 402; 50.1% female) aged 65 years or older (69.2 years average) from the urban area of Manizales. The healthy aging phenotype included five domains: biomarkers of physiological and metabolic health, physical capability, cognitive function, and social and psychological wellbeing. We also analyzed sociodemographic- and health-related factors. Results: In the multidimensional model the prevalence of the healthy aging phenotype was 15.5% while in the biomedical model it was 12.3% and in the psychosocial one it was 63.3%. Good self-perceived health was an independent predictor of healthy aging in all the models assessed. Having enough income was a predictor in the biomedical and psychosocial models while being married was the only significant predictor in the psychosocial model. Conclusions: The prevalence of the healthy aging phenotype was low in the biological and multidimensional models (1 of every 10 individuals) and higher in the psychosocial one (6 of every 10 persons). However, independent predictor factors were the same in all models: Self-perceived good or very good health, having enough income and being married.

Introducción. El fenotipo de envejecimiento saludable está presente en aquellos individuos que envejecen con poca morbilidad, sin deterioro funcional ni cognitivo, y con un nivel aceptable de bienestar y de participación social. Objetivo. Establecer la frecuencia del fenotipo de envejecimiento saludable según un modelo multidimensional, uno biomédico y uno psicosocial, y determinar los factores de predicción en cada uno de ellos. Materiales y métodos. Se hizo un estudio de diseño transversal, observacional y descriptivo, que incluyó a 402 personas (50,1 % mujeres) de 65 años y más (promedio de edad, 69,2) en el área urbana de Manizales. El fenotipo de envejecimiento saludable se caracterizó en cinco dimensiones: salud metabólica y fisiológica, función física, función cognitiva, bienestar psicológico y bienestar social. Los factores asociados incluyeron aspectos sociodemográficos y de salud. Resultados. La prevalencia de envejecimiento saludable fue de 15,5 % en el modelo multidimensional, de 12,3 % en el biomédico y de 63,3 % en el psicosocial. El tener autopercepción de buena salud fue un factor de predicción independiente de envejecimiento saludable en los tres modelos, así como la satisfacción con los ingresos económicos en el modelo biomédico y en el psicosocial. Un tercer factor de predicción fue el estar casado, aunque fue significativo solamente en el modelo psicosocial. Conclusiones. La prevalencia del fenotipo de envejecimiento saludable fue baja en el modelo biológico y en el multidimensional (1 de cada 10 personas), y mayor en el modelo psicosocial (6 de cada 10). A pesar de ello, los factores predictores independientes fueron los mismos: la autopercepción de buena o muy buena salud, la satisfacción con los ingresos económicos y el estar casado.

Fenotipo de envejecimiento saludable de personas mayores en Manizales / The healthy aging phenotype in older people in Manizales

Introducción. El fenotipo de envejecimiento saludable está presente en aquellos individuos que envejecen con poca morbilidad, sin deterioro funcional ni cognitivo, y con un nivel aceptable de bienestar y de participación social. Objetivo. Establecer la frecuencia del fenotipo de envejecimiento saludable según un modelo multidimensional, uno biomédico y uno psicosocial, y determinar los factores de predicción en cada uno de ellos. Materiales y métodos. Se hizo un estudio de diseño transversal, observacional y descriptivo, que incluyó a 402 personas (50,1 % mujeres) de 65 años y más (promedio de edad, 69,2) en el área urbana de Manizales. El fenotipo de envejecimiento saludable se caracterizó en cinco dimensiones: salud metabólica y fisiológica, función física, función cognitiva, bienestar psicológico y bienestar social. Los factores asociados incluyeron aspectos sociodemográficos y de salud. Resultados. La prevalencia de envejecimiento saludable fue de 15,5 % en el modelo multidimensional, de 12,3 % en el biomédico y de 63,3 % en el psicosocial. El tener autopercepción de buena salud fue un factor de predicción independiente de envejecimiento saludable en los tres modelos, así como la satisfacción con los ingresos económicos en el modelo biomédico y en el psicosocial. Un tercer factor de predicción fue el estar casado, aunque fue significativo solamente en el modelo psicosocial. Conclusiones. La prevalencia del fenotipo de envejecimiento saludable fue baja en el modelo biológico y en el multidimensional (1 de cada 10 personas), y mayor en el modelo psicosocial (6 de cada 10). A pesar de ello, los factores predictores independientes fueron los mismos: la autopercepción de buena o muy buena salud, la satisfacción con los ingresos económicos y el estar casado.

Introduction: The healthy aging phenotype is present in those individuals that age with low morbidity, no functional or cognitive deterioration, and retain an acceptable level of wellness and social participation. Objective: To establish the frequency of the healthy aging phenotype in older people in the community using a multidimensional, a biomedical, and a psychosocial model and to identify the predicting factors in each model. Materials and methods: We conducted a cross-sectional, observational and descriptive study. We assessed individuals (n= 402; 50.1% female) aged 65 years or older (69.2 years average) from the urban area of Manizales. The healthy aging phenotype included five domains: biomarkers of physiological and metabolic health, physical capability, cognitive function, and social and psychological wellbeing. We also analyzed sociodemographic- and health-related factors. Results: In the multidimensional model the prevalence of the healthy aging phenotype was 15.5% while in the biomedical model it was 12.3% and in the psychosocial one it was 63.3%. Good self-perceived health was an independent predictor of healthy aging in all the models assessed. Having enough income was a predictor in the biomedical and psychosocial models while being married was the only significant predictor in the psychosocial model. Conclusions: The prevalence of the healthy aging phenotype was low in the biological and multidimensional models (1 of every 10 individuals) and higher in the psychosocial one (6 of every 10 persons). However, independent predictor factors were the same in all models: Self-perceived good or very good health, having enough income and being married.

Meeting Physical Activity Guidelines by Walking in Older Adults From Three Middle-Income Countries: A Cross-Sectional Analysis From the International Mobility in Aging Study.

Physical activity (PA) among older adults is understudied in middle-income countries. The authors examined the associations of factors across levels of the social ecological model (individual, interpersonal, organizational, and community) with older adults meeting guidelines of 150 min of moderate- to vigorous-intensity PA per week through walking in three middle-income countries: Albania (n = 387), Colombia (n = 404), and Brazil (n = 402). Using 2012 International Mobility in Aging Study data, multivariate logistic regression models identified the following significant associations with meeting PA guidelines through walking (a) individual level: depression (odds ratio [OR] = 0.62, 95% confidence interval, CI [0.45, 0.86]), being female (OR = 0.74, 95% CI [0.56, 0.998]), and high relative education (OR = 1.79, 95% CI [1.33, 2.41]) and (b) interpersonal level: high life partner (OR = 1.38, 95% CI [1.04, 1.83]) and friend social ties (OR = 1.39, 95% CI [1.05, 1.83]). While individual and interpersonal variables were associated with meeting PA guidelines, community-level social and environmental variables were not.

Fear of falling in community-dwelling older adults diagnosed with cancer: A report from the International Mobility in Aging Study (IMIAS).

BACKGROUND: The incidence of fear of falling (FOF) is high among people with cancer. However, factors that are associated with FOF in people with cancer has not yet been investigated. Therefore, the objective of this study was to identify the associated factors with FOF in people with cancer. METHOD: This is a secondary analysis of the International Mobility in Aging Study (IMIAS) study. A total of 175 people self-identified as patients with cancer (mean age: 69.3 years, women: 50.2%) and 177 healthy age-matched group. FOF measured using the Falls Efficacy Scale-International (FES-I) was the primary outcome. Potential variables/factors for consistency known to be associated with FOF (cognitive status, depression, physical performance, the number of falls in the last year, visual acuity and grip strength) were assessed. Simple linear regression was used to identify factors associated with FOF. Variables with p-value <0.05 were then included in a multiple linear regression adjusted for the study confounders (study site, sex, and age). RESULTS: For people with cancer, FES-I was significantly associated with the Leganes Cognitive Test, The Short Physical Performance Battery (SPPB) total scores and the number of falls reported in the past 12 months (P-value <0.05). For the healthy group, FOF was only associated with depression and SPPEB. CONCLUSION: FOF is multifactorial in people with cancer and it is associated with cognitive status, physical performance and number of falls in the last year. Healthcare providers for patients with cancer should evaluate all potential factors associated with FOF and manage it.

A Regression Tree for Identifying Risk Factors for Fear of Falling: The International Mobility in Aging Study (IMIAS).

BACKGROUND: We determine the best combination of factors for predicting the risk of developing fear of falling (FOF) in older people via Classification Regression Tree (CaRT) analysis. METHODS: Community-dwelling older adults living in Canada, Albania, Brazil, and Colombia were from International Mobility in Aging Study (IMIAS). In 2014, 1,725 participants (aged 65-74) were assessed. With a retention rate of 81%, in 2016, 1,409 individuals were reassessed. Risk factors for FOF were entered into the CaRT: age, sex, education, self-rated health, comorbidity, medication, visual impairment, frailty, cognitive deficit, depression, fall history, Short Physical Performance Battery (SPPB), walking aid use, and mobility disability measured by the Nagi questionnaire. RESULTS: The classification tree included 12 end groups representing differential risks of FOF with a minimum of two and a maximum of five predictors. The first split in the tree involved impaired physical function (SPPB scores). Respondents with less than 8 in SPPB score and mobility disability had 82% risk of developing FOF at the end of 2-year follow-up. Between 23.2% and 82.3% of the risk of developing FOF in 2 years of follow-up were explained by only five variables: age, sex, self-rated health, functional impairment measured by SPPB, and mobility disability. In those with no functional impairment or mobility disability, levels of education, sex, and self-rated health were important predictors of FOF in the future. CONCLUSION: This classification tree included different groups based on specific combinations of a maximum of five easily measurable predictors with emphasis on impaired physical functioning risk factors for developing FOF.

Estimation equations for the height of Colombian elders using knee height / Ecuaciones para estimar la talla de ancianos colombianos mediante la altura de la rodilla

Introduction: The height in the elderly does not reflect their real size as young adults due to the aging of their spine, among other aspects. Objective: To estimate the equations to predict the height in Colombian elders according to their ethnic group and sex using the knee height measurement. Materials and methods: We conducted a secondary analysis of the SABE, 2015, crosssectional study using a multistage probabilistic sampling design in people aged 60 years and over in Colombia. We randomly selected two groups from the study's database: A development group and a validation group of the equations. Age and anthropometric characteristics were similar in both groups. We performed a multiple linear regression analysis to predict the height using knee height measurement in the different ethnic groups (Indigenous, Afro-descendant, and white-mestizo groups) by age and sex; the results were validated in each selected subgroup. Results: We designed six equations by sex (men=3,665; women=3,019) and ethnic group. The adjusted R2 of the equations in men from the three ethnic groups oscillated between 64% and 75% and the standard errors, between 3,09 and 3,93 cm while in women, the R2s of the three equations ranged between 53% and 73% and the EEs, between 2,96 and 3,90 cm. Conclusion: The equation with the best predictive capacity of the height of Colombian elders was obtained for African descendants of both sexes. The lowest coefficients of determination were obtained for the indigenous population.

Introducción. La estatura en el anciano no refleja su talla real de adulto joven debido al envejecimiento de su columna vertebral, entre otros aspectos. Objetivo. Proponer ecuaciones para estimar la talla de los ancianos colombianos mediante la altura de la rodilla, según el grupo étnico y el sexo. Materiales y métodos. Se hizo un análisis secundario del estudio transversal SABE 2015, utilizando un diseño muestral probabilístico y multietápico en personas colombianas de 60 o más años. Se seleccionaron aleatoriamente dos grupos de la base de datos del estudio SABE: el grupo para el desarrollo de las ecuaciones y el grupo para su validación. Se hizo un análisis de regresión lineal múltiple para estimar la estatura mediante la altura de la rodilla en los grupos étnicos (indígenas, afrodescendientes y blancos-mestizos) por edad y sexo; los resultados se validaron en cada subgrupo de estudio. Resultados. Se diseñaron seis ecuaciones por sexo (hombres=3.665, mujeres=3.019) y etnia; los coeficientes de determinación ajustados (R2) de las ecuaciones en hombres de los tres grupos étnicos oscilaron entre 64 y 75 % y, los errores estándar, entre 3,09 y 3,93 cm. En las mujeres, los R2 de las tres ecuaciones fluctuaron entre 53 y 73 % y los EE, entre 2,96 y 3,90 cm. Conclusión. La ecuación con mejor capacidad para estimar la talla del anciano colombiano fue la obtenida para los afrodescendientes de ambos sexos, en tanto que en la población indígena se presentaron los menores coeficientes de determinación.

Ecuaciones para estimar la talla de ancianos colombianos mediante la altura de la rodilla / Estimation equations for the height of Colombian elders using knee height

Introducción. La estatura en el anciano no refleja su talla real de adulto joven debido al envejecimiento de su columna vertebral, entre otros aspectos. Objetivo. Proponer ecuaciones para estimar la talla de los ancianos colombianos mediante la altura de la rodilla, según el grupo étnico y el sexo. Materiales y métodos. Se hizo un análisis secundario del estudio transversal SABE 2015, utilizando un diseño muestral probabilístico y multietápico en personas colombianas de 60 o más años. Se seleccionaron aleatoriamente dos grupos de la base de datos del estudio SABE: el grupo para el desarrollo de las ecuaciones y el grupo para su validación. Se hizo un análisis de regresión lineal múltiple para estimar la estatura mediante la altura de la rodilla en los grupos étnicos (indígenas, afrodescendientes y blancos-mestizos) por edad y sexo; los resultados se validaron en cada subgrupo de estudio. Resultados. Se diseñaron seis ecuaciones por sexo (hombres=3.665, mujeres=3.019) y etnia; los coeficientes de determinación ajustados (R2 ) de las ecuaciones en hombres de los tres grupos étnicos oscilaron entre 64 y 75 % y, los errores estándar, entre 3,09 y 3,93 cm. En las mujeres, los R2 de las tres ecuaciones fluctuaron entre 53 y 73 % y los EE, entre 2,96 y 3,90 cm. Conclusión. La ecuación con mejor capacidad para estimar la talla del anciano colombiano fue la obtenida para los afrodescendientes de ambos sexos, en tanto que en la población indígena se presentaron los menores coeficientes de determinación.

Introduction: The height in the elderly does not reflect their real size as young adults due to the aging of their spine, among other aspects. Objective: To estimate the equations to predict the height in Colombian elders according to their ethnic group and sex using the knee height measurement. Materials and methods: We conducted a secondary analysis of the SABE, 2015, crosssectional study using a multistage probabilistic sampling design in people aged 60 years and over in Colombia. We randomly selected two groups from the study's database: A development group and a validation group of the equations. Age and anthropometric characteristics were similar in both groups. We performed a multiple linear regression analysis to predict the height using knee height measurement in the different ethnic groups (Indigenous, Afro-descendant, and white-mestizo groups) by age and sex; the results were validated in each selected subgroup. Results: We designed six equations by sex (men=3,665; women=3,019) and ethnic group. The adjusted R2 of the equations in men from the three ethnic groups oscillated between 64% and 75% and the standard errors, between 3,09 and 3,93 cm while in women, the R2 s of the three equations ranged between 53% and 73% and the EEs, between 2,96 and 3,90 cm. Conclusion: The equation with the best predictive capacity of the height of Colombian elders was obtained for African descendants of both sexes. The lowest coefficients of determination were obtained for the indigenous population.