Relationship between Pain, Fear of Falling and Physical Performance in Older People Residents in Long-Stay Institutions: A Cross-Sectional Study.

Introduction: To analyze the relationship between pain, the fear of falling and functional performance in older people living in a long-stay institution (LSI) in the interior of northeastern Brazil. Methods: A cross-sectional study was conducted with 133 older residents in an LSI in the State of Paraíba. The instruments used for data collection were the Geriatric Pain Measure (GPM), the Falls Efficacy Scale-International (FES-I) and the Short Physical Performance Battery (SPPB). Results: Pain was reported by 57.5% of those evaluated, 48% being classified as chronic pain and presenting an average of 25.2 in the GPM. As for physical performance, assessed using the SPPB, the 133 older residents showed moderate to poor performance, with an average of 6.43 (±2.96) on the scale. By correlating the adjusted GPM values with the FES-I, a weak and statistically significant positive correlation was obtained (ρ = 0.31: p < 0.001). Conclusions: It can be concluded that those who reported pain had a worse performance in the applied tests, in addition to having higher scores on the scale referring to a fear of falling.

Physical performance as a predictor of mortality in nursing home residents: A five-year survival analysis.

This study developed a five-year survival analysis to verify the relationship between the Short Physical Performance Battery (SPPB) and death in older adults residing in nursing homes (NHs). A total of 114 residents of NHs in Northeast Brazil participated in the follow-up. In addition to the SPPB, the older adults answered questions about sociodemographic and health condition information. The relationship between physical performance and mortality was evaluated using the Kaplan Meier survival curves and Cox proportional regression. As a result, 61.40% of the participants presented low performance and 41.22% died. Low physical performance increased the chance of death by 2.77 times in five years (adjusted Hazard Ratio 2.77; 95% CI 1.40-5.50; p < 0.01). Low SPPB Gait Speed Test also represented a 2.58-fold increased risk of dying (adjusted HR 2.58; 95% CI 1.38-4.83; p < 0.01). The results of this study showed that low physical performance can predict the mortality of older adults residing in NHs over five years.

Uso de prótese total e síndrome da fragilidade em idosos institucionalizados / Total prosthesis use and frailty syndrome in institutionalized elderly

Introdução: Perda dentária constitui indicador prévio de envelhecimento acelerado, em particular nos idosos institucionalizados, sendo preferencialmente tratada com reabilitações protéticas. Uma das manifestações patológicas do envelhecer que compartilha características com perdas dentárias é a síndrome da fragilidade. Objetivo: Avaliar relação entre uso de prótese total e síndrome da fragilidade em idosos institucionalizados. Métodos: Estudo transversal, com 69 idosos institucionalizados, realizado em João Pessoa-PB, Brasil. Foram utilizados formulário para avaliar saúde bucal, condição protética e testes específicos para variáveis do fenótipo de fragilidade. Na análise estatística foram aplicados testes t-Student e Qui-Quadrado. Resultados: A amostra caracterizou-se pelo predomínio de frágeis (49,3%) e usuários de prótese total (50,7%). Os pré-frágeis e frágeis apresentaram maior prevalência de edentulismo e de uso de prótese total (56,3% e 39,4%, respectivamente). Contudo, não foram encontradas diferenças significativas entre os grupos (p = 0,05). Conclusão: É sugerido que o uso de prótese total não influencia a fragilidade em idosos institucionalizados. (AU)

Background: Tooth loss is an early indicator of accelerated aging, in institutionalized elderly in particular, being preferentially treated with prosthetics rehabilitation. One of the pathological displays of to age, that share characteristics with tooth loss, is the frailty syndrome. Objective: Evaluate relationship between total prosthesis use, and frailty syndrome in institutionalized elderly. Methods: Cross-sectional study of 69 institutionalized elderly in the city of João Pessoa, Brazil. A form to assess oral, and dental health data, and specific tests for frailty phenotype variables were used t Student's and chi-square test was applied in statistical analysis. Results: The sample was characterized as predominantly denture complete use (50,7%), and frail (49,3%). Pre-frail, and frail exhibited highest prevalence of edentulous, and complete denture use (56,3% e 39,4%, respectively). However, no significant differences were found between groups (p = 0,05). Conclusion: It is suggested that complete denture use wasn't related to frailty in institutionalized elderly. (AU)

Support networks and people with physical disabilities: social inclusion and access to health services.

This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these individuals predominantly consist of family members (parents, siblings, children, spouses) and people outside the family (friends and neighbors). However, 50% of the interviewees declared that they could not count on any support from outside the family. It was observed that the support network contributes to access to the services and participation in social groups. However, reduced social inclusion was detected, due to locomotion difficulties, this being the main barrier to social interaction. Among those individuals who began to interact in society, the part played by social support was fundamental.

Support networks and people with physical disabilities: social inclusion and access to health services / Redes de apoio e pessoas com deficiência física: inserção social e acesso aos serviços de saúde

This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these individuals predominantly consist of family members (parents, siblings, children, spouses) and people outside the family (friends and neighbors). However, 50% of the interviewees declared that they could not count on any support from outside the family. It was observed that the support network contributes to access to the services and participation in social groups. However, reduced social inclusion was detected, due to locomotion difficulties, this being the main barrier to social interaction. Among those individuals who began to interact in society, the part played by social support was fundamental.

Este estudo objetiva identificar a constituição das redes de apoio social das pessoas com deficiência física e como estas podem contribuir para facilitar o acesso aos serviços de saúde e a inclusão social das mesmas. Trata-se de um estudo transversal, com dados coletados através de um formulário, aplicado em pessoas com deficiência física maiores de dezoito anos, cadastradas nas Equipes de Saúde da Família do município de João Pessoa (PB). Constatou-se que as redes de apoio dessas pessoas estão constituídas principalmente pelos componentes da dimensão familiar (pais, irmãos, filhos, cônjuges) e extrafamiliar (amigos e vizinhos). No entanto, 50% dos entrevistados relataram não contar com qualquer apoio fora da família. Verificou-se que a rede de apoio contribui para o acesso aos serviços e para a participação em grupos sociais. Evidenciou-se, porém, uma reduzida inserção social, decorrente da dificuldade de locomoção, sendo esta a principal barreira para a interação social. Entre as pessoas que começaram a interagir na sociedade o apoio social foi fundamental.

[Accessibility for people with disabilities or permanent mobility restrictions to the Unified Health System]. / Acessibilidade de pessoas com deficiência ou restrição permanente de mobilidade ao SUS.

The scope of this study was to monitor the access of persons with disabilities and permanent mobility restrictions to the Unified Health System in João Pessoa, State of Pernambuco. This is a descriptive field study, consisting of a random sample of 523 people with disabilities or permanent mobility restrictions. Data collection occurred between August 2007 and December 2008 and consisted of home interviews. The neuromusculoskeletal functions and those related to movement (52%) were among the most affected body functions, with a higher incidence among body structures related to movement (44.2%) and those of the nervous system (39.2%), with special emphasis on the high number of cases (14%) due to the sequelae from strokes. Among the respondents, 63.9% stated that there had not been sufficient and appropriate means to lessen the physical obstacles between their homes and the places where they received healthcare, and 41.7% claimed that there were no special facilities for the handicapped in the healthcare offices. Brazilian law ensures rights for people with disabilities, which were not broadly respected. Action is necessary to prevent the development of disabilities, especially those resulting from the sequelae from strokes.

Acessibilidade de pessoas com deficiência ou restrição permanente de mobilidade ao SUS / Accessibility for people with disabilities or permanent mobility restrictions to the Unified Health System

The scope of this study was to monitor the access of persons with disabilities and permanent mobility restrictions to the Unified Health System in João Pessoa, State of Pernambuco. This is a descriptive field study, consisting of a random sample of 523 people with disabilities or permanent mobility restrictions. Data collection occurred between August 2007 and December 2008 and consisted of home interviews. The neuromusculoskeletal functions and those related to movement (52%) were among the most affected body functions, with a higher incidence among body structures related to movement (44.2%) and those of the nervous system (39.2%), with special emphasis on the high number of cases (14%) due to the sequelae from strokes. Among the respondents, 63.9% stated that there had not been sufficient and appropriate means to lessen the physical obstacles between their homes and the places where they received healthcare, and 41.7% claimed that there were no special facilities for the handicapped in the healthcare offices. Brazilian law ensures rights for people with disabilities, which were not broadly respected. Action is necessary to prevent the development of disabilities, especially those resulting from the sequelae from strokes.

Objetivou-se avaliar a acessibilidade de pessoas com deficiência e restrição de mobilidade permanente ao SUS em João Pessoa (PB). Trata-se de estudo descritivo de campo, composto por amostra aleatória de 523 pessoas com deficiência ou restrição permanente de mobilidade. A coleta de dados ocorreu no período de agosto de 2007 à dezembro de 2008 e consistiu de entrevistas domiciliares. As funções neuromusculoesqueléticas e relacionadas ao movimento foram as mais prejudicadas (52%), havendo maior acometimento das estruturas corporais relacionadas ao movimento (44,2%) e as do Sistema Nervoso (39,2%), com destaque para o elevado número de casos (14%) decorrentes de sequela de Acidente Vascular Cerebral (AVC). Entre os entrevistados, 63,9% afirmam que de suas residências aos locais onde recebiam atendimento à Saúde não haviam meios suficientes e apropriados para diminuir os obstáculos físicos e 41,7% que não existiam adaptações nos locais de atendimento. A legislação brasileira garante direitos às pessoas com deficiência que não foram amplamente respeitados. São necessárias ações que previnam o desenvolvimento de deficiências, em especial aquelas decorrentes de sequelas de AVC.

Salivary cortisol and frailty syndrome in elderly residents of long-stay institutions: a cross-sectional study.

Analyze the relationship between frailty and cortisol in elderly residents of long-stay institutions. A cross-sectional study was conducted in the city of João Pessoa-PB-Brazil, on a sample of residents of long-stay institutions. Data were collected on frailty phenotype (weight loss, fatigue, slowness, weakness and low physical activity) and salivary cortisol (first measurement between 6 and 7a.m.; second measurement between 11 and 12a.m.; third measurement between 4 and 5p.m.). Statistical analysis applied Pearson's correlation test, Chi-square test, ANOVA and linear regression. The sample was composed of 69 elderly subjects, 37.7% men and 62.3% women, with a mean age of 77.5 (±7.8) years. The percentage of frail elderly was 45.8%. Frail aged subjects achieved higher cortisol values on the third measurement (p=0.04) and frailty load was significantly associated to the first measurement (r=0.25, p=0.04). Simple linear regression analysis showed a rate of determination (R(2)=0.05) between frailty load and the first cortisol measurement. Greater cortisol values in the morning and before bed among frail aged individuals suggest a positive correlation may exist between cortisol levels and frailty in elderly residents of long-stay institutions.