Weight loss severity and functional decline among the oldest old in a middle-income country: The FIBRA study longitudinal findings.

BACKGROUND AND AIMS: Nutritional status is a key modifiable risk factor associated with disability, and further evidence suggests that weight change is also linked to this adverse outcome. Thus, this study aims to evaluate weight loss severity and functional decline in instrumental activities of daily living (IADL) in a seven-year period among a sample of Brazilian oldest-old adults. METHODS: Longitudinal prospective study using data from the FIBRA study (Frailty in Older Brazilians), a population-based investigation carried out in 2008/2009, with follow-up data collected in 2016/2017 from participants who were 80 years and older in the follow-up in Campinas, Brazil. Of the 167 participants with complete data in 2016-2017, 16 had improved their functional status and were excluded, so the final sample was restricted to 151 participants who maintained or declined functional status. We considered functional decline when a subject had greater IADL dependencies at follow-up than baseline. Logistic regression was performed to assess the effect of weight loss, according to severity (moderate weight loss: 5-10% of body weight; severe weight loss >10%) in increasing the number of disabilities than the group with stable weight, controlling for covariates (gender, age, education, and morbidity). An alpha level of <5% was adopted. RESULTS: During the follow-up period, 60.3% of the participants kept stable weight, 21.8% had moderate weight loss, and 17.9% had severe weight loss. During the follow-up, only severe weight loss was associated with a higher risk of functional decline (OR = 2.74; p = 0.032). CONCLUSIONS: Severe weight loss was associated with functional decline. This finding reinforces the importance of early identification of weight loss among older adults.

Meaning and Purpose in Life in Aging: A Scoping Review / Sentido e Propósito de Vida na Velhice: Uma Revisão de Escopo

ABSTRACT The feeling that life has meaning or purpose is essential for human beings. Absence of meaning can lead to an existential vacuum. Purpose in life, akin to meaning in life, derives from the humanistic psychology theory of Frankl, and they are considered synonymous. Other scholars, however, regard the two constructs as distinct. The objective of the review was to map both concepts in the gerontological literature, examining how they manifest in aging. The review of the databases was carried out between January 2019 and March 2020. Thirty articles were included. In the context of aging, results were conflicting. The literature review yielded evidence to affirm that meaning and purpose in life are distinct concepts, despite sharing the same existential-philosophical roots.

RESUMO O sentimento de que a vida tem sentido ou propósito é essencial ao ser humano. A ausência de sentido pode levar a um vácuo existencial. Propósito de vida, a exemplo de sentido, também deriva da psicologia humanística de Frankl, sendo considerados sinônimos. No entanto, há estudos que propõem distinção entre os dois construtos. A revisão tem por objetivos mapear ambos os conceitos na literatura gerontológica, examinando-os à luz do envelhecimento. O levantamento nas bases de dados foi realizado de janeiro de 2019 a março de 2020. Foram incluídos 30 artigos. No contexto do envelhecimento, os resultados foram controversos. A literatura revista apresentou evidências para afirmar que sentido de vida e propósito são conceitos distintos, apesar da origem filosófico-existencialista comum.

Association of dynapenia, obesity and chronic diseases with all-cause mortality of community-dwelling older adults: A path analysis.

AIM: The objective of the present study was to evaluate the effect of dynapenia, central obesity and the presence of chronic diseases in 8-year mortality of community-dwelling older adults. METHODS: Participants comprised 610 older adults, aged ≥65 years at baseline, who participated in the "Frailty in Brazilian Older People" study carried out in 2008. Baseline data, such as weight, height, waist circumference, muscle strength, sex, self-reported diseases and physical activity, were assessed. Vital status in 2016 was assessed by Mortality Information System database of Campinas. The χ2 -test and Mann-Whitney U-test were used to compare categorical and continuous variables, respectively. Path analysis was carried out to study the factors associated with mortality. RESULTS: There was a statistical difference between alive and deceased groups for the variables sex, age group, physical activity, waist circumference and dynapenia. Path analysis explored the relationship among the studied variables. Direct paths showed a positive association to mortality for those who presented the combination of more diseases (ß = 0.105), male sex (ß = 0.108), low physical activity (ß = 0.121), low handgrip strength (ß = 0.090) and no central obesity (ß = -0.143). When indirect paths were concerned, variables "central obesity", the presence of "more diseases" and dynapenia had a mediator role. CONCLUSIONS: Central obesity was not positively associated with higher mortality, unless it was associated with the presence of chronic diseases. Dynapenia showed a direct effect on mortality, but not combined with central obesity. The findings of this study shed light on complex relationships between nutritional status and elderly mortality through the use of simple measurements. Geriatr Gerontol Int 2019; 19: 108-112.

Path analysis of caregiver characteristics and neuropsychiatric symptoms in Alzheimer's disease patients.

AIM: To determine the direct and indirect relationships of sociodemographic, emotional and behavioral characteristics of family caregivers of Alzheimer's disease patients who have neuropsychiatric symptoms. METHODS: A total of 134 family caregivers answered a questionnaire with sociodemographic data, and questions regarding the context of care, Neuropsychiatric Inventory, Zarit Burden Interview, Dementia Management Strategies Scale and the Beck Depression Inventory. A path analysis was used to model the direct and indirect relationships among the selected variables. RESULTS: Being a female caregiver, presenting high levels of burden, a moderate degree of depressive symptoms, distress (Neuropsychiatric Inventory total distress score), active management strategies and criticism management strategies were significantly associated with the total score of neuropsychiatric symptoms. The caregiver burden and use of criticism management strategies were directly related to neuropsychiatric symptoms in older adults with Alzheimer's disease. The use of active management strategies and depressive symptoms of caregivers had indirect relationships with neuropsychiatric symptoms through caregiver burden. CONCLUSIONS: Overburdened caregivers and the use of dysfunctional management strategies are associated with a greater presence of neuropsychiatric symptoms in Alzheimer's disease patients. These aspects should be considered when developing interventions for caregivers to manage neuropsychiatric symptoms and overall treatment of patients with dementia. Geriatr Gerontol Int 2018; 18: 1177-1182.

Influence of muscle mass and bone mass on the mobility of elderly women: an observational study.

BACKGROUND: The purpose of this study was to investigate the influence of muscle mass and bone mineral density on markers of mobility in dwelling elderly women. METHODS: This cross-sectional study included 99 elderly women, who were 65 years old or above, in Campinas-SP, Brazil. To collect data, we used sociodemographic data, the body mass index (BMI), health status, comorbidities, use of medications, mobility tests (TUG and gait speed) and examinations of the body composition (densitometry with dual-emission X-ray absorptiometry "DXA"). In order to examine the relationship between muscle and bone mass with mobility (gait speed and TUG), we applied the Spearman correlation coefficient.Also was applied the analysis of covariance (ANCOVA) adjusted for age and comorbidities. To identify the factors associated with mobility, we used the univariate and multivariate logistic regression analysis. The level of significance for statistical tests was P < 0.05. RESULTS: The correlation between sarcopenia and bone mineral density with mobility tests showed a significant relationship only between sarcopenia and TUG (r = 0.277, P = 0.006) in Spearman correlation coefficient. The result of the correlation analysis (ANCOVA) showed that sarcopenia was associated with gait speed (r2 = 0.0636, P = 0.0018) and TUG (r2 = 0.0898, P = 0.0027). The results of the multivariate analysis showed that age (P = 0.034, OR = 1.081) was associated with worse performance on gait speed. By highlighting the TUG test, the results of the multivariate analysis showed that the age (P = 0.004, OR = 1.111) and BMI in overweight (P = 0.011, OR = 7.83) and obese (P < 0.001, OR = 7.84) women were associated with lower performance of the functionality of the lower limbs. CONCLUSION: The findings with regard to mobility tests which were analyzed in this study indicate the association of variables related to the aging process that contribute to the decline in physical performance, for example, age, BMI and sarcopenia.

[Relationship between subjective well-being and the functionality of elderly outpatients]. / Relações entre o bem-estar subjetivo e a funcionalidade em idosos em seguimento ambulatorial.

OBJECTIVE: The aim of this study was to investigate the relationship between subjective well-being, functional independence and lower-limb performance (muscle strength, gait velocity and balance) among elderly people undergoing outpatient follow-up, stratified by sex and age groups. METHODS: We evaluated 125 elderly people, aged 60 years and over, who received care at a geriatric outpatient clinic. The instruments used were: 1) Functional Independence Measure (FIM) to evaluate functional dependence; 2) Short Physical Performance Battery (SPPB) to measure physical performance; and 3) Subjective Well-Being (SWB) with questions about health and satisfaction with life. RESULTS: A convenience sample was used, with predominance of females (who had greater functional impairment). The Spearman correlation coefficients for subjective well-being and the performance tests varied from -0.16 to 0.31 for men and -0.09 to 0.29 for women, therefore there were no differences between the sexes. However, the older participants had a higher level of satisfaction than the younger participants. Perceived health was also more satisfactory among the older participants, however comparative perceived health was better among the elderly participants with moderate to good physical performance. CONCLUSION: The results suggest that older individuals have greater satisfaction with life and better perceived health. Moreover, good physical performance was an important variable for better perceived health when compared to other people.

Relações entre o bem-estar subjetivo e a funcionalidade em idosos em seguimento ambulatorial / Relationship between subjective well-being and the functionality of elderly outpatients

OBJETIVO: Este estudo teve como objetivo verificar a relação entre o bem-estar subjetivo, independência funcional e desempenho de membros inferiores (força muscular, velocidade de marcha e equilíbrio) de idosos em seguimento ambulatorial, em relação ao sexo e a grupos etários. MÉTODOS: Foram avaliados 125 idosos de ambos os sexos com idade mínima de 60 anos, atendidos em um ambulatório de geriatria. Os instrumentos utilizados foram: 1) Medida da Independência Funcional (MIF) para avaliar a dependência funcional; 2) Short Physical Performance Battery (SPPB) para medir o desempenho físico; 3) Bem-Estar Subjetivo (BES): questões sobre a saúde e satisfação com a vida. RESULTADOS: A amostra utilizada foi de conveniência, com predomínio do sexo feminino, que apresentou maior comprometimento funcional. As correlações do bem-estar subjetivo com o teste de desempenho não demonstraram diferenças entre os sexos, contudo os idosos mais velhos apresentaram maior nível de satisfação que os idosos mais jovens. A saúde percebida também foi mais satisfatória entre os idosos mais velhos. Entretanto, a saúde percebida comparada mostrou melhores resultados nos idosos com moderado a bom desempenho físico. CONCLUSÃO: Os resultados sugerem que indivíduos mais velhos apresentam maior satisfação com a vida e melhor saúde percebida. Além disso, o bom desempenho físico foi uma variável de relevância para melhor saúde percebida quando comparada a outras pessoas.

OBJECTIVE: The aim of this study was to investigate the relationship between subjective well-being, functional independence and lower-limb performance (muscle strength, gait velocity and balance) among elderly people undergoing outpatient follow-up, stratified by sex and age groups. METHODS: We evaluated 125 elderly people, aged 60 years and over, who received care at a geriatric outpatient clinic. The instruments used were: 1) Functional Independence Measure (FIM) to evaluate functional dependence; 2) Short Physical Performance Battery (SPPB) to measure physical performance; and 3) Subjective Well-Being (SWB) with questions about health and satisfaction with life. RESULTS: A convenience sample was used, with predominance of females (who had greater functional impairment). The Spearman correlation coefficients for subjective well-being and the performance tests varied from -0.16 to 0.31 for men and -0.09 to 0.29 for women, therefore there were no differences between the sexes. However, the older participants had a higher level of satisfaction than the younger participants. Perceived health was also more satisfactory among the older participants, however comparative perceived health was better among the elderly participants with moderate to good physical performance. CONCLUSION: The results suggest that older individuals have greater satisfaction with life and better perceived health. Moreover, good physical performance was an important variable for better perceived health when compared to other people.

Comparação entre idosos que sofreram quedas segundo desempenho físico e número de ocorrências / Physical performance and number of falls in older adult fallers

Objetivos: Analisar, entre idosos com ocorrência de quedas, a relação entre as variáveis sociodemográficas, clínicas, físicas e funcionais segundo as variáveis critério desempenho físico e número de quedas. MÉTODOS: Estudo transversal com 72 idosos (76,3±8,3 anos) que sofreram quedas no último ano, sendo 65,3 por cento mulheres, atendidos no ambulatório de geriatria de um hospital universitário de Campinas, SP. Os idosos foram divididos em grupo com pior (PDF) e grupo com melhor desempenho físico (MDF), e em grupo com uma queda (1Q) e grupo com duas quedas ou mais (2Q). As características sociodemográficas, clínicas, físicas e funcionais foram as variáveis independentes do estudo. Foi realizada análise de comparação entre os grupos. RESULTADOS: Os idosos do grupo PDF tiveram maior faixa etária, maior número de doenças e menor independência na maior parte das tarefas da dimensão motora em relação ao grupo MDF. Os idosos do grupo 2Q apresentaram maior número de doenças, menor força de preensão manual e menor independência na tarefa "controle das fezes" na dimensão motora da medida de independência funcional (MIF) em relação ao grupo 1Q. CONCLUSÕES: Entre idosos que já caíram, piores níveis de desempenho físico relacionam-se com maior faixa etária, mais doenças e menos independência funcional. Além disso, ter sofrido quedas recorrentes relaciona-se com mais doenças, menos força muscular e menos independência funcional na tarefa de controle de fezes.

Objectives: The aim of this study was to determine the relationship between sociodemographic, clinical, physical and functional data according to physical performance and number of falls among older fallers. METHODS: Cross-sectional study carried out among 72 older adults (76.3 ±8.3 years) with a history of falls in the past year, 65.3 percent of which were women. The participants received care at the geriatric outpatient clinic of a university hospital in Campinas, SP. They were divided into the following groups: worst physical performance (WPP) and best physical performance (BPP), one-time fallers (1F) and frequent fallers (2F). Sociodemographic, clinical, physical and functional characteristics were considered as independent variables. Comparison analysis between the groups was conducted. RESULTS: The WPP group was older and had a higher number of illnesses and less independence in most motor dimension tasks compared to the BPP group. The 2F group had a higher number of illnesses, less handgrip strength and less independence in the bowel management task in the motor dimension of the Functional Independence Measure (FIM) compared to the 1F group. CONCLUSIONS: Among older adults fallers, poor physical performance is associated with more advanced age, more illnesses and less functional independence. Moreover, recurrent falls are associated with more illnesses, less muscle strength and less functional independence in the bowel management task.