Are quality of life, functional capacity, and urinary incontinence associated with fecal incontinence? The Fibra-BR Study / Cuidados de saúde, capacidade funcional e incontinência urinária estão associados à incontinência fecal? Estudo Fibra-BR

OBJECTIVE: To assess the prevalence of fecal incontinence and its association with clinical, functional, and cognitive-behavioral variables, medication use, frailty, falls, and quality of life in community-dwelling older adults (aged 65 years or older). METHODS: Cross-sectional, multicenter study carried out across 16 Brazilian cities. The question "In the last 12 months, did you experience fecal incontinence or involuntary passage of stool?" was defined as the indicator variable for fecal incontinence. Bivariate analyses were carried out to assess the prevalence of fecal incontinence and sociodemographic characteristics, comorbidities, cognition, functional capacity, depression, frailty, quality of life, and falls. Logistic regression analysis was also performed, with fecal incontinence as the dependent variable. RESULTS: Overall, 6855 subjects were evaluated; 66.56% were female, 52.93% white, and the mean age was 73.51 years. The prevalence of fecal incontinence was 5.93%. It was associated with worse self-care (OR 1.78 [1.08­2.96]), dependence for basic activities of daily living (OR 1.29 [1.01­1.95]), and urinary incontinence (OR 4.22 [3.28­5.41]). Furthermore, the absence of polypharmacy was identified as a protective factor (OR 0.61 [0.44­0.85]). CONCLUSION: The overall prevalence of fecal incontinence was 5.93%. On logistic regression, one quality of life variable, dependence for basic activities of daily living, and polypharmacy were significantly associated with fecal incontinence

OBJETIVO: Avaliar a prevalência de incontinência fecal e sua associação com variáveis clínicas, funcionais, cognitivo-comportamentais, uso de fármacos, fragilidade, quedas e qualidade de vida em indivíduos com 65 anos ou mais que vivem na comunidade. METODOLOGIA: Estudo transversal e multicêntrico, realizado em 16 cidades brasileiras. A pergunta "Nos últimos 12 meses o(a) senhor(a) apresentou incontinência fecal ou perda de fezes de forma involuntária?'' foi a variável indicadora de incontinência fecal. Análises bivariadas avaliaram a prevalência de incontinência fecal e suas características sociodemográficas, comorbidades, cognição, funcionalidade, depressão, fragilidade, qualidade de vida e quedas. Também realizou-se análise de regressão logística tendo a incontinência fecal como variável dependente. RESULTADOS: No total, 6855 indivíduos foram avaliados; 66,56% eram do sexo feminino, 52,93% brancos e a média de idade de 73,51 anos. A prevalência de incontinência fecal foi de 5,93% e estava associada com pior cuidado com a própria saúde [OR 1,78 (1,08­2,96)], dependência para as atividades básicas de vida diária [OR 1,29 (1,01­1,95)] e incontinência urinária [OR 4,22 (3,28­5,41)]. Além disso, observou-se que a ausência de polifarmácia [OR 0,61 (0,44­0,85)] foi identificada como associação de proteção. CONCLUSÃO: A prevalência de incontinência fecal foi de 5,93%. Na regressão logística, uma variável de qualidade de vida, dependência para atividades básicas de vida diária e polifarmácia mostrou-se significativamente associada à incontinência fecal

Correction: Normative reference values of handgrip strength for Brazilian older people aged 65 to 90 years: Evidence from the multicenter Fibra­BR study.

[This corrects the article DOI: 10.1371/journal.pone.0250925.].

Methodological Description of Mapping Brazilian Long-Term Care Facilities for Older Adults / Descrição Metodológica do Mapeamento das Instituições de Longa-Permanência para Idosos no Brasil

Aim: describe the methodological approach adopted to build a Brazilian database of LCTFs in the country. Methods: This exploratory research was conducted between August 2020 and 2021 based on primarily publicly accessible data. First, the database of the Sistema Único de Assistência Social for 2019 was adopted as the primary source of information. In addition, public agencies and managers were consulted and invited to share their databases. Likewise, researchers and private entities also collaborated by making their spreadsheets available. The information collected was placed in individual spreadsheets for each Brazilian state. LTCFs not catering to older adults (aged 60 and over) were excluded. Duplicate data were excluded when overlaps were identified for each new aggregated source. Results & Discussion: This brief communication describes the methodology adopted for mapping the current status of Brazilian LTCFs. Despite its caveats, this study represents an important advance in the identification, characterization, and monitoring of these services nationwide. A total of 5769 facilities were found in the 2019 SUAS census. After excluding facilities not caring for residents aged 60 or over, this total decreased to 2381 LTCFs. Consolidating and filtering the information from multiple data sources led to the identification of 7029 LTCFs for the country as a whole.

Normative reference values of handgrip strength for Brazilian older people aged 65 to 90 years: Evidence from the multicenter Fibra­BR study.

BACKGROUND: Handgrip strength (HGS) is an indicator of muscle strength, suited for evaluating the aging process. Its use depends on the availability of reliable normative reference values (NRV). The main objective of this study is to provide NRV of HGS for Brazilians aged 65 to 90 years. METHODS: Participants were from the Frailty in Brazilian Older People research. 2,999 successful aging (SA) participants comprised the development sample. HGS was measured using a hydraulic dynamometer. Obtaining NRV involved regressing HGS on age per sex-height strata, fitting separate fractional polynomial (FP) models for the mean and coefficient of variation. Model fit was assessed via standardized residuals, probability/quantile plots, and comparing observed to normal expected percentages of participants falling within specified centile intervals. For validation, the latter procedure was applied to 2,369 unsuccessfully aging (UA) participants. RESULTS: Across strata, the best-fitting models for the means were FP of power 1. FP models for the CV indicated age invariance, entailing steady heteroscedastic age decline in SD since coefficients for the means were negative and SD = CV×mean. All models adjusted well. Centiles distributions for the SA and UA populations showed anticipated patterns, respectively falling on and below the normative expected centile references. Results (NRV) are presented in tables and centile charts. Equations are also provided. CONCLUSION: NRV/charts may be endorsed for routine use, while still tested further. They would aid professionals caring for older people, not only to identify those at risk and eligible for immediate provisions, but also in planning prevention and rehabilitation measures.

Methodological description of the mapping of Brazilian long-term care facilities for older adults / Descrição metodológica do mapeamento das instituições de longa permanência para idosos no Brasil

OBJECTIVE: To describe the methodological approach adopted to build a database of long-term care facilities (LCTFs) in Brazil. METHODS: This exploratory research was conducted for 12 months, between August 2020 and July 2021, based on primarily publicly accessible data. First, the Unified Social Assistance System (Sistema Único de Assistência Social [SUAS]) database from 2019 was adopted as the primary source of information. In addition, public agencies and managers were consulted and invited to share their databases, while researchers and private entities collaborated by making their spreadsheets available. Data were organized in spreadsheets for each Brazilian state. LTCFs not catering to older adults (aged 60 years and over) were excluded. Duplicate data were excluded when overlaps were identified. RESULTS: This brief communication describes the methodology adopted for mapping the current status of Brazilian LTCFs. Despite its caveats, this study represents an important advance in the identification, characterization, and monitoring of these services nationwide. A total of 5769 facilities were found in the 2019 SUAS census. After excluding facilities not caring for residents aged 60 years or over, this number decreased to 2381 LTCFs. The consolidation and filtering of information from multiple data sources led to the identification of 7029 LTCFs throughout the country. CONCLUSION: Building a solid database was paramount to devising a national policy on long-term care. By including multiple sources, the scope of this survey was wider than all previous efforts and constituted an unprecedented collaborative experience in the country, including the potential to become the first national dataset for the Brazilian LTC secto

OBJETIVO: Descrever a abordagem metodológica adotada para a construção de um banco de dados brasileiro de instituições de longa permanência (ILPIs) no país. METODOLOGIA: Esta pesquisa exploratória foi realizada durante 12 meses, entre agosto de 2020 ­ 2021, com base principalmente em dados acessíveis ao público. Em primeiro lugar, o banco de dados do Sistema Único de Assistência Social para 2019 foi adotado como principal fonte de informação. Além disso, órgãos públicos e gestores foram consultados e convidados a compartilhar seus bancos de dados. Da mesma forma, pesquisadores e entidades privadas colaboraram disponibilizando suas planilhas. Os dados foram colocados em planilhas para cada estado brasileiro. Excluíram-se as ILPIs que não atendiam a idosos (60 anos ou mais). Dados duplicados foram excluídos quando as sobreposições foram identificadas. RESULTADOS: Esta comunicação breve descreve a metodologia adotada para mapear a situação atual das ILPIs brasileiras. Apesar de suas ressalvas, este estudo representa um importante avanço na identificação, caracterização e monitoramento desses serviços em âmbito nacional. Um total de 5769 instalações foram encontradas no censo do SUAS de 2019. Após a exclusão dos estabelecimentos que não atendiam residentes idosos, esse total passou para 2381. A consolidação e filtragem das informações de múltiplas fontes de dados levaram à identificação de 7029 ILPIs para o país como um todo. CONCLUSÃO: A construção de um banco de dados sólido é fundamental para a formulação de uma Política Nacional de Cuidados de Longa Duração. Por incluir fontes múltiplas, o escopo desta pesquisa é muito maior do que todos os esforços anteriores e constitui uma experiência colaborativa sem precedentes no país, incluindo o potencial de se tornar o primeiro conjunto de dados nacional para o setor.

Estimates of infection and mortality from COVID-19 in care homes for older people in Brazil / Estimativas de infecção e mortalidade por COVID-19 em lares de idosos no Brasil

OBJECTIVE: To describe infection and mortality rates associated with COVID-19 in older people living in Brazilian care homes. METHODS: A descriptive cross-sectional study was conducted using primary and secondary data sources. Nationwide care home administrators were invited to report, via an online questionnaire, the occurrence of infection and mortality associated with COVID-19 from April to August 2020. State Public Prosecutor Offices, State Health Departments, and the Unified Social Security System were also contacted for information. Data were analyzed using descriptive statistics. RESULTS: Data were collected from 2154 care homes located in 14 states, covering 59878 older residents. The incidence rate of COVID-19 was 6.57%, and 883 deaths were recorded in the period, with a case-fatality rate of 22.44%. CONCLUSIONS: The incidence and mortality rates observed in this study were lower than those observed in other (high-income) countries. Data sources related to COVID-19 outbreaks in Brazilian care homes are currently limited to self-report. Structuring and systematizing data recording and reporting in these settings is essential to better understand the spread of the virus and to protect care home residents in Brazil.

OBJETIVO: Descrever as taxas de infecção e mortalidade associadas a COVID-19 em idosos residentes em lares geriátricos brasileiros. MÉTODOS: Foi realizado um estudo transversal descritivo, utilizando fontes primárias e secundárias de dados. Os administradores de lares geriátricos em todo o país foram convidados a relatar, por meio de um questionário online, a ocorrência de infecção e mortalidade associadas a COVID-19 de abril a agosto de 2020. Os gabinetes dos Procuradores Regionais da República, as Secretarias Estaduais de Saúde e o Sistema Único de Assistência Social também foram contatados para informações. Os dados foram analisados por meio de estatística descritiva. RESULTADOS: Foram coletados os dados de 2154 lares de idosos localizados em 14 estados, cobrindo 59 878 idosos residentes. A taxa de incidência de COVID-19 foi de 6,57%, e foram registrados 883 óbitos no período, com uma taxa de letalidade dos casos de 22,44%. CONCLUSÕES: As taxas de incidência e mortalidade observadas neste estudo foram inferiores às observadas em outros países (de alta renda). As fontes de dados relacionadas a surtos de COVID-19 em lares geriátricos brasileiros são atualmente limitadas a autorrelato. Estruturar e sistematizar o registro e a notificação de dados nesses locais é essencial para um melhor entendimento da disseminação do vírus e para a proteção dos residentes de lares geriátricos no Brasil.

OCCURRENCE OF INFECTION AND MORTALITY BY COVID-19 IN CARE HOMES FOR OLDER PEOPLE IN BRAZIL / OCORRÊNCIA DE INFECÇÃO E MORTALIDADE POR COVID-19 EM RESIDENCIAIS PARA IDOSOS NO BRASIL

Introduction: Mortality rates due to COVID-19 in older people living in long-term care homes reach 80% in some countries. In Brazil, little is known about the incidence and mortality in this population. Objective: To describe the occurrence of COVID-19 infection and mortality in care homes for the older people in Brazil. Methods: Cross-sectional and descriptive study using primary and secondary sources and non-probabilistic sampling. Between April and June 2020, through an electronic questionnaire, care homes administrators from all over Brazil were invited to report the occurrence of infection and mortality of residents by COVID-19. In addition, an active search for data was carried out with the services of the State Public Prosecutor Offices, State Health Departments and the Unified Social Assistance System. The data were analyzed using descriptive statistics. Results: Information from 1,802 care homes from 11 states was analyzed, where 42,216 older people lived. The incidence rate of COVID-19 was 6.14%, and 458 deaths were recorded in the period, with a case-fatality rate of 17.65%. Conclusion: The incidence and fatality observed in this study were lower than the rates observed in other countries. However, given the limitations regarding the collection of information and other barriers to the study, new structured data sources are essential for understanding the spread of the virus in care homes in the country.

Introdução: As taxas de mortalidade pela COVID-19 em idosos que vivem em Residenciais de Cuidado de Longa Duração (RCLD) chegam a 80% em alguns países. No Brasil, pouco se conhece sobre a incidência e mortalidade nesta população. Objetivo: Descrever a ocorrência da infecção e mortalidade por COVID-19 em RCLD para idosos no Brasil. Metodologia: Estudo transversal e descritivo com uso de fontes primárias e secundárias e amostragem não probabilística. Entre abril e junho de 2020, por meio de um questionário eletrônico, administradores de RCLD de todo o Brasil foram convidados a informar a ocorrência de infecção e mortalidade de residentes por COVID-19. Além disso, foi realizada busca ativa de dados junto aos serviços do Ministério Público Estadual, Secretarias de Saúde e Sistema Único de Assistência Social. Os dados foram analisados através de estatística descritiva Resultados: Foram analisadas as informações de 1,802 RCLD de 11 estados, onde residiam 42,216 idosos. A taxa de incidência de COVID-19 foi de 6,14%. Foram registrados no período 458 óbitos, com uma taxa de letalidade de 17,65%. Conclusão: A incidência e letalidade observados neste estudo foram menores do que as taxas observadas em outros países. Entretanto, dadas as limitações quanto a coleta de informações e outras barreiras para o estudo, novas fontes estruturadas de dados são fundamentais para o conhecimento da propagação do vírus nos RCLD no país.

Prevalence of falls and associated factors among older adults in Rio de Janeiro, Brazil: the FIBRA-RJ study / Prevalência de quedas e fatores associados em idosos do Rio de Janeiro, Brasil: Estudo FIBRA-RJ

OBJECTIVE: The prevalence of falls and associated factors were determined in a large cohort of community-dwelling older adults. METHODS: The sample included adults at least 65 years old who resided in the city of Rio de Janeiro, Brazil. A total of 742 individuals were investigated by inverse random sampling and were stratified by gender and age. The prevalence of falls was calculated by the history of falls in the last year. Data on clinical, psychosocial, sociodemographic and functional characteristics were also gathered. After bivariate analysis, statistically relevant variables were included in groups in 4 models for multivariate analyses. RESULTS: The prevalence of falls was 29%. The mean age was 76.7; 70.2% were female; 43.4% were married; 80.3% had ≥ 5 years of education; 48.3% had an income, of which ≥ 5.1 were minimum wage. All of the variables were associated with falls, except fair self-rated health. In contrast, when all these variables were adjusted (model 2), almost all lost the statistical significance, except for functional dependency-IADL (OR = 1.51; 95%CI 1.02­2.21) and poor/very poor self-rated health (OR = 2.36; 95%CI 1.06­5.25). For psychosocial variables in model 1, only fear of falling and activity level were significantly associated with falls. However, when these variables were adjusted (model 3), only fear of falling remained significant. In the final model, functional dependency (OR = 1.48; 95%CI 1.01­2.17), poor/very poor self-rated health (OR = 2.33; 95%CI 1.05­5.21) and fear of falling (OR = 2.14; 95%CI = 1.47­3.12) were associated with falls. CONCLUSION: The prevalence of falls is high among community-dwelling older adults. Associations with socio-demographic and biological factors have been identified and confirmed in the literature. Social activities were considered a protective factor.

OBJETIVO: Analisar a prevalência de quedas e fatores associados em uma ampla coorte de idosos na comunidade. MÉTODO: Indivíduos com 65 anos de idade ou mais, residentes na cidade do Rio de Janeiro, Brasil. Um total de 742 indivíduos foram investigados e estratificados por sexo e idade em uma amostra aleatória inversa. A prevalência de quedas foi calculada pelo histórico de quedas no último ano. Também foram coletadas outras variáveis como: características clínicas, psicossociais, sociodemográficas e funcionais. Após análise bivariada, aqueles estatisticamente relevantes foram incluídos nos grupos em 4 modelos para análises multivariadas. RESULTADOS: A prevalência de quedas foi de 29%. A idade média foi de 76,7; 70,2% do sexo feminino; 43,4% eram casados; 80,3% tinham ≥ 5 anos de estudo; 48,3% tinham renda ≥ 5,1 salários mínimos. Todas as variáveis foram associadas a quedas, com exceção da categoria de autoavaliação de saúde. Por outro lado, quando todas essas variáveis foram ajustadas (modelo 2), quase todas perderam a significância estatística, exceto a AIVD (OR = 1,51; IC95% 1,02­2,21) e a avaliação de saúde ruim/muito ruim (OR = 2,36; IC95% 1,06­5,25). Para as variáveis psicossociais, no modelo 1, apenas o medo de cair e o nível de atividade foram associados significativamente. Porém, quando essas variáveis foram ajustadas (modelo 3), o medo de cair persistiu de forma significativa. No modelo final, a dependência em AIVD (OR = 1,48; IC95% 1,01­2,17), a autoavaliação de saúde ruim/muito ruim (OR = 2,33; IC95% 1,05­5,21) e o medo de cair (OR = 2,14; IC95% 1,47­3,12) foram associados a quedas. CONCLUSÃO: A prevalência de queda é alta nos idosos que vivem em comunidade. A associação com fatores sociodemográficos e biológicos foi identificada e confirmada pela literatura. As atividades sociais foram consideradas um fator de proteção.

Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies.

OBJECTIVES: Sarcopenia is a common treatable geriatric condition. The aim of this study was to estimate the prevalence of sarcopenia and its associated factors in community-dwelling elderly living in Rio de Janeiro, Brazil, and to discuss the impact of different muscle mass, handgrip strength and gait speed cut-off values on the reported frequency of sarcopenia. METHODS: The health habits, functional capacity, and anthropometric measurements of 745 individuals aged ≥65 years from the Frailty in Brazilian Older People study were analyzed. The participants were classified into the following four groups: no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia. Univariate and multivariate regression analyses were performed. Muscle mass, handgrip strength and gait speed cut-off thresholds tailored to the sample and those proposed by the European Working Group on Sarcopenia in Older People were used to compare the prevalence rates of sarcopenia. RESULTS: Seventy-three percent of the participants were female, 61.9% were Caucasian, and the mean age was 76.6 years. The prevalence rates of sarcopenia were 10.8% and 18% using the sample-tailored and European consensus cut-off values, respectively. Sarcopenia was associated with advanced age (OR: 37.2; CI95%12.35-112.48), Caucasian race (OR: 1.89; CI 95% 1.02-3.52), single marital status (OR:6; CI95% 2.2-16.39), low income (OR:3.64; CI 95% 1.58-8.39), and the presence of comorbidities (OR:3.26; CI 95%1.28-8.3). CONCLUSION: In this study, the estimated prevalence of sarcopenia was similar to that reported in most studies after the tailored handgrip strength and gait speed cut-off values were adopted. A higher prevalence was observed when the cut-off values suggested by the European consensus were used. This indicates that the prevalence of sarcopenia must be estimated using population-specific reference values.

Prevalence of frailty and associated factors in a community-dwelling older people cohort living in Juiz de Fora, Minas Gerais, Brazil: Fibra-JF Study. / Prevalência e fatores associados à fragilidade em uma amostra de idosos que vivem na comunidade da cidade de Juiz de Fora, Minas Gerais, Brasil: estudo FIBRA-JF.

Frailty is a state of multisystem physiological vulnerability related to aging and an increased risk of adverse outcomes. This study aimed to evaluate the prevalence and associated factors of frailty in the Fibra-JF Study, Minas Gerais, Brazil. We selected a random sample of 461 individuals aged 65 years or more stratified by territorial unit, gender and age. The frailty syndrome was established by the presence of three or more of five items: a feeling of exhaustion, low handgrip strength, slow gait speed, weight loss, and low caloric expenditure. The mean age was 74.4 (SD ± 6.8) years, 69.6% were women and 71.9% white. The prevalence of frailty was 5.2%; 49.9% was from pre-frail subjects. Advanced age (OR: 6.4; CI 1.76-23.8), impairment of the basic activities of daily living (OR: 5.2, CI 1.1-23.1) and self-perception of poor health (OR: 0.13, CI 0.03-0.4) were associated with frailty. In this study, a substantial number of individuals was classified as frail, while half of the sample was at risk of progression towards this condition, suggesting that it is urgent to adopt public health measures focused on frailty prevention and reduction of associated adverse health outcomes.

Fragilidade é um estado de vulnerabilidade fisiológica multissistêmica relacionada à idade e a um risco aumentado de desfechos adversos. O objetivo do presente estudo foi avaliar a prevalência e os fatores associados à fragilidade no estudo FIBRA em Minas Gerais, Brasil. Selecionou-se uma amostra aleatória, estratificada por unidade territorial, sexo e idade, de 461 indivíduos, com 65 anos ou mais. A fragilidade foi estabelecida pela presença de três ou mais de cinco itens: sensação de exaustão, baixa força de preensão manual, velocidade da marcha lenta, perda de peso e baixo gasto calórico. A média de idade foi de 74,4 anos (DP± 6,8), 69,6% eram mulheres e 71,9% brancos. A prevalência de fragilidade foi de 5,2%; 49,9% foram de indivíduos pré-frágeis. Idade avançada (OR: 6,4; IC 1,76-23,8), comprometimento das atividades básicas de vida diária (OR: 5,2; IC 1,1-23,1) e auto percepção de saúde ruim (OR: 0,13; IC 0,03-0,4), foram associados à fragilidade. No presente estudo, um número substancial de indivíduos apresentou-se frágil, enquanto que metade da amostra estava sob risco de progressão para esta condição, sugerindo que é urgente a adoção de medidas de saúde pública com objetivo de prevenção e redução de complicações.

Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies

OBJECTIVES: Sarcopenia is a common treatable geriatric condition. The aim of this study was to estimate the prevalence of sarcopenia and its associated factors in community-dwelling elderly living in Rio de Janeiro, Brazil, and to discuss the impact of different muscle mass, handgrip strength and gait speed cut-off values on the reported frequency of sarcopenia. METHODS: The health habits, functional capacity, and anthropometric measurements of 745 individuals aged ≥65 years from the Frailty in Brazilian Older People study were analyzed. The participants were classified into the following four groups: no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia. Univariate and multivariate regression analyses were performed. Muscle mass, handgrip strength and gait speed cut-off thresholds tailored to the sample and those proposed by the European Working Group on Sarcopenia in Older People were used to compare the prevalence rates of sarcopenia. RESULTS: Seventy-three percent of the participants were female, 61.9% were Caucasian, and the mean age was 76.6 years. The prevalence rates of sarcopenia were 10.8% and 18% using the sample-tailored and European consensus cut-off values, respectively. Sarcopenia was associated with advanced age (OR: 37.2; CI95%12.35-112.48), Caucasian race (OR: 1.89; CI 95% 1.02-3.52), single marital status (OR:6; CI95% 2.2-16.39), low income (OR:3.64; CI 95% 1.58-8.39), and the presence of comorbidities (OR:3.26; CI 95%1.28-8.3). CONCLUSION: In this study, the estimated prevalence of sarcopenia was similar to that reported in most studies after the tailored handgrip strength and gait speed cut-off values were adopted. A higher prevalence was observed when the cut-off values suggested by the European consensus were used. This indicates that the prevalence of sarcopenia must be estimated using population-specific reference values.

Prevalência e fatores associados à fragilidade em uma amostra de idosos que vivem na comunidade da cidade de Juiz de Fora, Minas Gerais, Brasil: estudo FIBRA-JF / Prevalence of frailty and associated factors in a community-dwelling older people cohort living in Juiz de Fora, Minas Gerais, Brazil: Fibra-JF Study

Resumo Fragilidade é um estado de vulnerabilidade fisiológica multissistêmica relacionada à idade e a um risco aumentado de desfechos adversos. O objetivo do presente estudo foi avaliar a prevalência e os fatores associados à fragilidade no estudo FIBRA em Minas Gerais, Brasil. Selecionou-se uma amostra aleatória, estratificada por unidade territorial, sexo e idade, de 461 indivíduos, com 65 anos ou mais. A fragilidade foi estabelecida pela presença de três ou mais de cinco itens: sensação de exaustão, baixa força de preensão manual, velocidade da marcha lenta, perda de peso e baixo gasto calórico. A média de idade foi de 74,4 anos (DP± 6,8), 69,6% eram mulheres e 71,9% brancos. A prevalência de fragilidade foi de 5,2%; 49,9% foram de indivíduos pré-frágeis. Idade avançada (OR: 6,4; IC 1,76-23,8), comprometimento das atividades básicas de vida diária (OR: 5,2; IC 1,1-23,1) e auto percepção de saúde ruim (OR: 0,13; IC 0,03-0,4), foram associados à fragilidade. No presente estudo, um número substancial de indivíduos apresentou-se frágil, enquanto que metade da amostra estava sob risco de progressão para esta condição, sugerindo que é urgente a adoção de medidas de saúde pública com objetivo de prevenção e redução de complicações.

Abstract Frailty is a state of multisystem physiological vulnerability related to aging and an increased risk of adverse outcomes. This study aimed to evaluate the prevalence and associated factors of frailty in the Fibra-JF Study, Minas Gerais, Brazil. We selected a random sample of 461 individuals aged 65 years or more stratified by territorial unit, gender and age. The frailty syndrome was established by the presence of three or more of five items: a feeling of exhaustion, low handgrip strength, slow gait speed, weight loss, and low caloric expenditure. The mean age was 74.4 (SD ± 6.8) years, 69.6% were women and 71.9% white. The prevalence of frailty was 5.2%; 49.9% was from pre-frail subjects. Advanced age (OR: 6.4; CI 1.76-23.8), impairment of the basic activities of daily living (OR: 5.2, CI 1.1-23.1) and self-perception of poor health (OR: 0.13, CI 0.03-0.4) were associated with frailty. In this study, a substantial number of individuals was classified as frail, while half of the sample was at risk of progression towards this condition, suggesting that it is urgent to adopt public health measures focused on frailty prevention and reduction of associated adverse health outcomes.

Consenso brasileiro de fragilidade em idosos: conceitos, epidemiologia e instrumentos de avaliação / Brazilian consensus on frailty in older people: concepts, epidemiology and evaluation instruments

O objetivo do presente trabalho foi descrever as definições conceitual e operacional da síndrome de fragilidade recomendadas pelo Consenso Brasileiro de Fragilidade em Idosos. Em 2015, uma força-tarefa composta de especialistas brasileiros em envelhecimento humano conduziu uma revisão bibliográfica sobre fragilidade em idosos no Brasil e estabeleceu um consenso acerca dos principais achados por meio de reuniões periódicas. No total, 72 artigos foram incluídos para análise, entre os quais, uma revisão sistemática, duas discussões conceituais, duas descrições metodológicas, quatro estudos longitudinais focando mortalidade e piora do perfil de fragilidade, oito estudos de adaptação transcultural e 55 estudos transversais ou de prevalência. Quarenta e cinco estudos (62,5%) utilizaram a escala de fragilidade do Cardiovascular Health Study (EFCHS), dos quais sete (15,2%) usaram pontos de corte não ajustados para a amostra e 17 (36,9%) modificaram pelo menos um dos cinco itens que compõem o instrumento. A prevalência de fragilidade variou entre 6,7 e 74,1%. Quando utilizada a EFCHS, a ampla variação de prevalência ­ de 8 a 49,3% ­ dependeu dos pontos de corte empregados para classificar as alterações na velocidade de marcha e na força de preensão palmar, bem como do cenário de investigação. Os estudos foram baseados em quatro grandes modelos conceituais de fragilidade. A fragilidade em idosos representa um estado de vulnerabilidade fisiológica e não deve ser confundida com incapacidades ou multimorbidades. Na população brasileira, a prevalência de fragilidade ainda não está adequadamente estimada, e os pontos de corte dos itens que compõem as escalas de fragilidade devem ser adaptados aos parâmetros dessa população.

The aim of the present study was to describe the conceptual and operational definitions of the frailty syndrome recommended by the Brazilian Consensus on Frailty in Older People. In 2015, a task force consisting of Brazilian specialists on human aging conducted a bibliographical review on frailty among older people in Brazil and established a consensus on the main findings through periodic meetings. A total of 72 articles were included in the analysis, comprising one systematic review, two conceptual discussions, two methodological descriptions, four longitudinal studies focusing on mortality and worsening of the frailty profile, eight cross-cultural adaptation studies, and 55 cross-sectional or prevalence studies. Forty-five studies (62.5%) used the Cardiovascular Health Study (CHS) frailty scale, of which seven (15.2%) used unadjusted cut-off points for their samples and 17 (36.9%) modified at least one of the five items of the instrument. The prevalence of frailty varied between 6.7 and 74.1%. When the CHS frailty scale was used, the wide range of prevalence ­ from 8 to 49.3% ­ depended on the cut-off points used to classify changes in gait speed and handgrip strength, as well as the research setting. The studies were based on four major conceptual models of frailty. Frailty in older people represents a state of physiological vulnerability and should not be confused with disabilities or multi-morbidities. In the Brazilian population, the prevalence of frailty has not yet been adequately estimated, and the cut-off points of the items of the frailty scales should be adapted to the parameters of this population.

Body composition and frailty profiles in Brazilian older people: Frailty in Brazilian Older People Study-FIBRA-BR.

OBJECTIVE: To determine the association between body composition and frailty in older Brazilian subjects. MATERIAL AND METHODS: This is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n=5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio. RESULTS: The lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9kg/m2. Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR)=3.10; 95% CI: 2.06-4.67) and (OR=1.15; 95% CI: 1.03-1.27), respectively. Being overweight was protective for pre-frailty (OR=0.48; 95% CI: 0.4-0.58) and frailty (OR=0.77; 95% CI: 0.67-0.9). Obese older people presented a higher risk of pre-frailty only (OR=1.29; 95% CI: 1.09-1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range. CONCLUSION: Undernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI.

Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis.

Frailty is common and associated with poorer outcomes in the elderly, but its role as potential cardiovascular disease (CVD) risk factor requires clarification. We thus aimed to meta-analytically evaluate the evidence of frailty and pre-frailty as risk factors for CVD. Two reviewers selected all studies comparing data about CVD prevalence or incidence rates between frail/pre-frail vs. robust. The association between frailty status and CVD in cross-sectional studies was explored by calculating and pooling crude and adjusted odds ratios (ORs) ±95% confidence intervals (CIs); the data from longitudinal studies were pooled using the adjusted hazard ratios (HRs). Eighteen cohorts with a total of 31,343 participants were meta-analyzed. Using estimates from 10 cross-sectional cohorts, both frailty and pre-frailty were associated with higher odds of CVD than robust participants. Longitudinal data were obtained from 6 prospective cohort studies. After a median follow-up of 4.4 years, we identified an increased risk for faster onset of any-type CVD in the frail (HR=1.70 [95%CI, 1.18-2.45]; I2=66%) and pre-frail (HR=1.23 [95%CI, 1.07-1.36]; I2=67%) vs. robust groups. Similar results were apparent for time to CVD mortality in the frail and pre-frail groups. In conclusion, frailty and pre-frailty constitute addressable and independent risk factors for CVD in older adults.

Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study.

OBJECTIVE: Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual's capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan. METHODS: We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis. RESULTS: The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3); 43.6% (95% CI, 40.3-47) of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8) were considered pre-frail (p<0.001). The frail individuals tended to be older (odds ratio [OR] 13.2, 95% CI, 8.7-20) and have lower education levels (OR 2.1, 95% CI, 1-4.6), lower cognitive performance (OR 0.76, 95% CI, 0.73-0.79) and reduced health perception (OR 65.8, 95% CI, 39.1-110.8). Frail individuals also had a greater number of comorbidities (OR 6.6, 95% CI, 4.4-9.9) and worse functional capacity (OR 3.8, 95% CI, 2.9-5). CONCLUSION: The prevalence of frailty was similar to that seen in other international studies and was significantly associated with educational level, cognition, comorbidities, functional capacity, perception of health and old age.

Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study

OBJECTIVE: Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual's capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan. METHODS: We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis. RESULTS: The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3); 43.6% (95% CI, 40.3-47) of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8) were considered pre-frail (p<0.001). The frail individuals tended to be older (odds ratio [OR] 13.2, 95% CI, 8.7-20) and have lower education levels (OR 2.1, 95% CI, 1-4.6), lower cognitive performance (OR 0.76, 95% CI, 0.73-0.79) and reduced health perception (OR 65.8, 95% CI, 39.1-110.8). Frail individuals also had a greater number of comorbidities (OR 6.6, 95% CI, 4.4-9.9) and worse functional capacity (OR 3.8, 95% CI, 2.9-5). CONCLUSION: The prevalence ...

Saúde da Pessoa Idosa

O objetivo geral deste módulo é fornecer ao profissional os conhecimentos necessários para executar ações de prevenção e promoção da saúde, hierarquização da demanda e do cuidado e abordagem dos principais problemas que afligem os idosos, considerando as ações da Atenção Básica. O módulo é composto por 4 unidades e aborda as seguintes temáticas: Promoção da Saúde no Envelhecimento; Prevenção de doenças no Envelhecimento; Nutrição, perda de peso Involuntária; Avaliação da estabilidade postural e prevenção de quedas; Avaliação Multidimensional da Pessoa Idosa I; Avaliação Multidimensional da Pessoa Idosa II; Farmacologia no Envelhecimento; Incontinência Urinária; Doença de Parkinson e Tremor; Osteoporose; Avaliação e manejo do declínio cognitivo 1; Avaliação e manejo do declínio cognitivo 2; Depressão; Desequilíbrio e Vertigem; Avaliação dos cuidadores e contexto familiar dos idosos; Violência e maus tratos contra idosos; Cuidados Paliativos.