Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study.

INTRODUCTION: Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. We aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥55 years in Lima, Peru. METHODS: This cross-sectional study was conducted between 2018 and 2020. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS2) guidelines. We measured muscle strength by maximum handgrip strength and muscle mass using bioelectrical impedance analyzer. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia. RESULTS: The study participants had a mean age of 66.2 years (SD 7.1), age range between 60 to 92 years old, of which 621 (53.9%) were men. Among the sample, 41.7% were classified as obese (BMI ≥30.0 kg/m²). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3-25.1) using the EWGSOP2 criteria and 27.8% (95%CI: 25.2-30.4) using the AWGS2 criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4-7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7-9.9) using AWGS2 criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8-20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3-1.3) to 5.0% (95%CI: 3.8-6.3). CONCLUSION: Our findings reveal substantial variation in the prevalence of sarcopenia and SO, underscoring the necessity for context-specific cut-off values. Although the prevalence of SO was relatively low, this result may be underestimated. Furthermore, the consistently high proportion of probable sarcopenia and sarcopenia point to a substantial public health burden.

Correlation between Instrumental Activities of Daily Living and muscle mass in older adults: impact of comorbidities.

Background: There is evidence that sarcopenia and functionality are closely related. However, the association between geriatric syndromes, such as dependence, on instrumental activities and sarcopenia could be affected by the presence of certain comorbidities, such as overweight, obesity, diabetes, and chronic obstructive pulmonary disease (COPD). Therefore, the present study aimed to determine the association between instrumental activities of daily living and muscle mass in the elderly and evaluate the impact of certain comorbidities on this association. Methods: This was a retrospective analytical observational study, including 1897 patients. Muscle mass was measured with calf circumference, and instrumental activities were measured with the Lawton index. Results: Among different parameters studies, a statistical correlation was found in a stratified regression analysis between the Lawton index score and muscle mass in patients who were overweight (p value:0.001 ;beta coefficient: 0.08), obese (p value: 0.001 ; beta coefficient: 0.05), had diabetes (p value: 0.012 ;beta coefficient: 0.03), and had COPD (p value:0.001 ;beta coefficient:0.03). Conclusion: The correlation between muscle mass and instrumental activities of daily living should be evaluated individually according to the needs of each participant and according to their comorbidities, promoting patient-centered geriatric medicine.

Evaluation of factors influencing handgrip strength asymmetry in elderly Peruvians.

Background: Sarcopenia is a musculoskeletal disease involving the reduction of muscle mass, strength, and performance. Handgrip strength (HGS) measurements included in frailty assessments are great biomarkers of aging and are related to functional deficits. We assessed the association between potential influencing factors and HGS asymmetry in older Peruvian adults. Methods: We used a database of the Peruvian Naval Medical Center "Cirujano Santiago Távara" located in Callao, Peru. All the patients included were ≥60 years old and had an HGS measurement in the dominant and non-dominant hand. Results: From a total of 1468 patients, 74.66% had HGS asymmetry. After adjustment, calf circumference weakness (aPR = 1.08, 95% CI = 1.01 - 1.15), falls risk (aPR = 1.08, 95% CI = 1.02 - 1.16), and an altered Lawton index (aPR = 0.92, 95% CI = 0.84 - 0.99) were associated with HGS asymmetry. Conclusion: Our findings suggest that HGS asymmetry should be measured along with other geriatric assessments used to evaluate health outcomes in the elderly to enhance health promotion and prevention aimed at preserving muscle strength to curb functional limitations in the elderly.

Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study.

Background: Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. However, there remains a lack of consensus on the criteria and cut-off thresholds for assessing sarcopenia and SO. Moreover, limited data are available on the prevalence of these conditions in Latin American countries. To address this evidence gap, we aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥ 55 years in Lima, Peru. Methods: Data collection for this cross-sectional study was conducted between 2018 and 2020 in two urban low-resource settings in Lima, Peru. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS) guidelines. We measured muscle strength by maximum handgrip strength; muscle mass using a whole-body single-frequency bioelectrical impedance analyzer, and physical performance using the Short Physical Performance Battery and 4-meter gait speed. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia. Results: The study participants had a mean age of 66.2 years (SD 7.1), of which 621 (53.9%) were men, and 41.7% were classified as obese (BMI ≥ 30.0 kg/m2). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3-25.1) using the EWGSOP2 criteria and 27.8% (95%CI:25.2-30.4) using the AWGS criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4-7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7-9.9) using AWGS criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8-20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3-1.3) to 5.0% (95%CI: 3.8-6.3). Conclusions: Our findings reveal substantial variation in the prevalence of sarcopenia and SO when using different guidelines, underscoring the necessity for context-specific cut-off values. Nevertheless, regardless of the chosen guideline, the prevalence of probable sarcopenia and sarcopenia among community-dwelling older adults in Peru remains noteworthy.

A task force for diagnosis and treatment of people with Alzheimer's disease in Latin America.

Alzheimer's disease (AD) represents a substantial burden to patients, their caregivers, health systems, and society in Latin America and the Caribbean (LAC). This impact is exacerbated by limited access to diagnosis, specialized care, and therapies for AD within and among nations. The region has varied geographic, ethnic, cultural, and economic conditions, which create unique challenges to AD diagnosis and management. To address these issues, the Americas Health Foundation convened a panel of eight neurologists, geriatricians, and psychiatrists from Argentina, Brazil, Colombia, Ecuador, Guatemala, Mexico, and Peru who are experts in AD for a three-day virtual meeting to discuss best practices for AD diagnosis and treatment in LAC and create a manuscript offering recommendations to address identified barriers. In LAC, several barriers hamper diagnosing and treating people with dementia. These barriers include access to healthcare, fragmented healthcare systems, limited research funding, unstandardized diagnosis and treatment, genetic heterogeneity, and varying social determinants of health. Additional training for physicians and other healthcare workers at the primary care level, region-specific or adequately adapted cognitive tests, increased public healthcare insurance coverage of testing and treatment, and dedicated search strategies to detect populations with gene variants associated with AD are among the recommendations to improve the landscape of AD.

Asociación entre el bajo nivel de vitamina B12 y deterioro cognitivo en adultos mayores del centro médico naval del Perú

Introducción: Los adultos mayores son suscepctibles a la malnutrición y el déficit de vitaminas. Objetivo: Determinar la asociación entre el bajo nivel de vitamina B12 y el deterioro cognitivo en adultos mayores del centro médico naval, ubicado en Lima-Perú, en el periodo 2010-2015. Métodos : Se realizó un estudio transversal analítico, a partir de un análisis secundario de la base de datos Texas-Cemena UTMB 2010-2015 del centro de investigación del envejecimiento (CIEN) de la Universidad De San Martín De Porres. Para la cuantificación de la variable de deterioro cognitivo se utilizó el MiniMental test. Para analizar la asociación, se realizó la prueba de chi cuadrado y la regresión de Poisson. Resultados : El 57,6% de los pacientes fueron de sexo masculino y la edad promedio fue de 78 ± 8,4. El 41,2% presentó deterioro cognitivo y el 9,5% de los pacientes presentó déficit de vitamina b12. Los factores independientemente asociados al deterioro cognitivo fueron el antecedente de enfermedad cerebro vascular (RP= 1,38 IC 95% [1,24-1,53]), depresión (RP = 1,88 IC 95% [1,80-1,97]),) y déficit de vitamina B12 (RP = 1,10 ic 95% [1,01-1,20]),). Conclusiones : En el presente estudio se encontró asociación entre un bajo nivel de vitamina B12 y el deterioro cognitivo en adultos mayores.

Introduction: Older adults are susceptible to malnutrition and vitamin deficiency. Objective: To determine the association between the low level of vitamin B12 and cognitive deterioration in older adults from the Naval Medical Center, located in Lima-Peru, in the period 2010-2015. Methods: An analytical cross-sectional study was carried out, based on a secondary analysis of the Texas-Cemena UTMB 2010-2015 database of the center for research on aging (cien) of The University Of San Martín De Porres. To quantify the cognitive impairment variable, the mini mental test was used. To analyze the association, the chi-square test and poisson regression were performed. Results: 57.6% of the patients were male and the mean age was 78 ± 8.4. 41.2% presented cognitive deterioration and 9.5% of the patients presented vitamin B12 deficiency. The factors independently associated with cognitive impairment were a history of cerebrovascular disease (pr= 1.38 95% ci [1.24-1.53]), depression (pr= 1.88 95% ci [1.80-1 .97]) and vitamin B12 deficiency (pr = 1.10 95% ci [1.01-1.20]). Conclusions: In the present study, an association was found between a low level of vitamin B12 and cognitive deterioration in older adults.

Agency and Mental Health Among Peruvian Older Adults During the COVID-19 Lockdown.

OBJECTIVES: To explore the experiences of older Peruvian adults living in urban areas of Lima under lockdown due to the National COVID-19 Emergency, this study analyzes how older adults (aged 60 and older) exercise agency while also living with the negative impacts of coronavirus disease 2019 (COVID-19) and related control measures. METHODS: Between August and December 2020, our research team conducted a telephone-based, qualitative study, in which we undertook semistructured interviews with a purposive sample of low-income older adults living with chronic multimorbidities and limited resources. Forty older adults, 24 women and 16 men, with a mean age of 72 years, participated in the study. For data analysis, we employed thematic analysis with a predominantly inductive approach. RESULTS: Older adults demonstrated several forms of agency to regulate emotions, maintain crucial bonds, foster social relationships, and seek economic and food security. Older adults experienced entertainment and support by caring for pets, undertaking farm work, and practicing their religious beliefs. For several participants and their families, quarantine was an opportunity to strengthen family relationships and learn new technologies. Older adults and their families reorganized themselves to assume new roles and perform activities that improved self-worth and confidence, thereby improving their well-being and mental health. DISCUSSION: Peruvian older adults exerted agency in different ways to respond to and sustain their mental health during the COVID-19 lockdown. Policymakers should value and recognize the agency of older adults when planning future health responses.

Type 2 diabetes mellitus and hypertension as predictors of community-acquired pneumonia in Peruvian older adults with cancer

Objective: To evaluate DM2 and hypertension as predictors of CAP in older adults with cancer. Material and Methods: We conducted a secondary data analysis of a prospective cohort study in older adults with cancer from the Geriatrics Service of the Centro Médico Naval (CEMENA) of Peru during 2013-2015. T2DM and hypertension diagnosis were obtained from medical records. CAP was defined according to clinical and radiological diagnostic criteria and it was collected from the medical records of the patients up to one year after their inclusion in the study. We used the statistical software STATA v14.0 to develop the analysis. We performed multivariate analysis using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI). Results: A total of 231 older adults with cancer were analyzed. The mean age of the participants was 78.6 ± 4.2 (range: 74-92 years) and all of them were men. 33 (14.29%) patients developed CAP during the follow-up, 53 (21.65%) had hypertension, and 56 (22.65%) T2DM. CAP was more frequent in patients with lung cancer and lymphomas. In the adjusted Cox regression models, we found T2DM (aHR=1.49; 95%CI: 1.21-1.79) and hypertension (aHR=1.32; 95%CI: 1.24-1.50) were predictors of CAP incidence. Conclusion: T2DM and hypertension were associated with CAP incidence in oncogeriatric patients. Future intervention studies are needed to improve the functionality and prevent CAP in this vulnerable population.

Objetivo: Evaluar la DM2 y la hipertensión como predictores de NAC en adultos mayores con cáncer. Materiales y métodos: Se realizó un análisis de base secundaria de una cohorte prospectiva en adultos mayores con diagnóstico de cáncer del Servicio de Geriatría del Centro Médico Naval (CEMENA) del Perú durante 2013-2015. Los diagnósticos de DM2 e hipertensión se obtuvieron de las historias clínicas. La NAC se definió según criterios diagnósticos clínicos y radiológicos y se recogió de las historias clínicas de los pacientes hasta un año después de su inclusión en el estudio. Utilizamos el software estadístico STATA v14.0 para desarrollar el análisis. Realizamos un análisis multivariante utilizando modelos de regresión de Cox crudos y ajustados. La medida reportada fue la razón de hazards (HR) con sus respectivos intervalos de confianza del 95% (IC95%). Resultados: Se analizaron un total de 231 adultos mayores con cáncer. La edad media de los participantes fue de 78,6 ± 4,2 (rango: 74-92 años) y todos ellos eran hombres. 33 (14,29%) pacientes desarrollaron NAC durante el seguimiento, 53 (21,65%) tenían hipertensión y 56 (22,65%) DM2. La NAC fue más frecuente en pacientes con cáncer de pulmón y linfomas. En los modelos de regresión de Cox ajustados se encontró que tener DM2 (HRa=1,49; IC95%: 1,21-1,79) o hipertensión arterial (HRa=1,32; IC95%: 1,24-1,50) fueron predictores para la incidencia de NAC. Conclusiones: La DM2 y la hipertensión se asociaron con la incidencia de NAC en pacientes oncogeriátricos. Son necesarios futuros estudios de intervención para mejorar la funcionalidad y prevenir la NAC en esta población vulnerable.

Never Thought I was Going to be Placed in a Situation Like This: In the Shoes of the Doctor Responsible for Municipal Health, Back in My Country, Perú.

The COVID-19 pandemic changed the way of living on the planet and, in my case, revealed the fragility of primary care services to respond to a health emergency that mainly affected older adults. Upon obtaining my medical degree, I felt guaranteed to have the skills to be a primary care physician; however, the coronavirus gave me "a reality bath with the aroma of impotence, bewilderment, and abandonment." Contradictory provisions and regulations, absence of a continuous policy, poor leadership, insufficient resources, and mismanagement by the Ministry of Health. Scandals of possible corruption and vices in the processes of research studies on vaccines. Anti-vaccine strategies, screening tests without evidence. The reference hospitals without oxygen, intensive care beds, and the outpatient consultations of specialist doctors closed. A community that is organized and wants to help but does not have a clear technical guide. These are some of the things I have had to deal with as head of a municipal health program. Meanwhile, I watched helplessly as members of my community continued to die and become disabled. Learning from mistakes and horrors is our duty. I narrate this experience to contribute to being prepared for the next time.

Cognitive Frailty as a Predictor of Mortality in Older Adults: A Longitudinal Study in Peru.

Objective: To evaluate the role of cognitive frailty and its components as risk factors of mortality in older adults of the Centro Médico Naval (CEMENA) in Callao, Peru during 2010-2015. Methods: We performed a secondary analysis of data from a prospective cohort that included older adults (60 years and older) treated at the CEMENA Geriatrics service between 2010-2015. Frailty was defined as the presence of three or more criteria of the modified Fried Phenotype. Cognitive impairment was assessed using the Peruvian version of the Mini Mental State Examination (MMSE), considering a score <21 as cognitive impairment. Cognitive frailty was defined as the coexistence of both. In addition, we included sociodemographic characteristics, medical and personal history, as well as the functional evaluation of each participant. Results: We included 1,390 older adults (mean follow-up: 2.2 years), with a mean age of 78.5 ± 8.6 years and 59.6% (n = 828) were male. Cognitive frailty was identified in 11.3% (n = 157) and 9.9% (n = 138) died during follow-up. We found that cognitive frailty in older adults (aHR = 3.57; 95%CI: 2.33-5.49), as well as its components, such as sedentary behavior and cognitive impairment (aHR = 7.05; 95%CI: 4.46-11.13), weakness and cognitive impairment (aHR = 6.99; 95%CI: 4.41-11.06), and exhaustion and cognitive impairment (aHR = 4.51; 95%CI: 3.11-6.54) were associated with a higher risk of mortality. Conclusion: Cognitive frailty and its components were associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies with a longer follow-up and that allow evaluating the effect of interventions in this vulnerable group of patients to limit adverse health outcomes, including increased mortality.

Asociación entre dependencia funcional y calidad de vida en pacientes adultos mayores oncológicos / Association between functional dependence and quality of life in older adult oncology patients

RESUMEN Introducción: La presencia de comorbilidades modula el proceso de envejecimiento, el diagnóstico de cáncer puede comprometer de manera importante la salud del adulto mayor, lo cual repercute en su calidad de vida. Objetivo: Determinar la asociación entre la dependencia funcional y la calidad de vida en pacientes oncológicos adultos mayores tratados con radioterapia. Métodos: Estudio analítico retrospectivo, realizado en 181 pacientes ambulatorios del Centro Médico Naval del Callao, Perú, varones, mayores de 60 años. Se valoró la dependencia funcional mediante los índices de Barthel y el de Lawton; y la calidad de vida mediante la escala de calidad de vida en adultos mayores de la Organización Mundial de la Salud (WHOQoL-Old). Resultados: Se encontró asociación estadísticamente significativa entre dependencia funcional y calidad de vida, tanto para las actividades básicas de la vida diaria (PR= 1,04 [IC 95 %; 1,01-1,07]) como para las actividades instrumentales de la vida diaria (PR= 1,08 (IC 95 %: 1,01 - 1,13). Conclusiones: En los pacientes adultos mayores oncológicos tratados con radioterapia, se encuentra asociación significativa entre dependencia funcional y una pobre calidad de vida.

ABSTRACT Introduction: The presence of comorbidities modulates the aging process, the diagnosis of cancer can significantly compromise the health of the elderly, which affects their quality of life. Objective: Determine the association between the functional dependence and the quality of life in elderly oncology patients treated with radiotherapy. Methods: Retrospective analytical study, carried out in 181 outpatients of Centro Médico Naval del Callao, Perú, male, older than 60 years. The functional dependence was assessed with Barthel index and Lawton scale; and the quality of life was assessed with World Health Organization Quality of Life-Older Adults Module (WHOQoL-Old). Results: A statistically significant association was found between functional dependence and quality of life, for both the basic activities of daily living (PR= 1.04 [IC 95 %: 1.01-1.07]), and the instrumental activities of daily living (PR= 1.08 [IC 95 %: 1.01 - 1.13]). Conclusion: There was significant association between the functional dependence and the poor quality of life in the elderly oncology patients treated with radiotherapy.

Validation of Picture Free and Cued Selective Reminding Test for Illiteracy in Lima, Peru.

Dementia in Latin America is a crucial public health problem. Identifying brief cognitive screening (BCS) tools for the primary care setting is crucial, particularly for illiterate individuals. We evaluated tool performance characteristics and validated the free and total recall sections of the Free and Cued Selective Reminding Test-Picture version (FCSRT-Picture) to discriminate between 63 patients with early Alzheimer's disease dementia (ADD), 60 amnestic mild cognitive impairment (aMCI) and 64 cognitively healthy Peruvian individuals with illiteracy from an urban area. Clinical, functional, and cognitive assessments were performed. FCSRT-Picture performance was assessed using receiver operating characteristic curve analyses. The mean ± standard deviation scores were 7.7 ± 1.0 in ADD, 11.8 ± 1.6 in aMCI, and 29.5 ± 1.8 in controls. The FCSRT-Picture had better performance characteristics for distinguishing controls from aMCI compared with several other BCS tools, but similar characteristics between controls and early ADD. The FCSRT-Picture is a reliable BCS tool for illiteracy in Peru.

Covid 19, mortalidad en adulto mayor y factores asociados / Covid 19, mortality in the elderly and associated factors

Objetivo: Determinar las variables asociadas a la mortalidad por COVID 19 en población adulta mayor. El estudio: estudio observacional, 521 pacientes de 60 a más años con diagnóstico clínico/laboratorial de COVID -19; incluyó variables edad, sexo, prioridad de atención, procedencia, comorbilidades, estancia, frecuencia respiratoria y cardiaca, SO2, temperatura y signos/síntomas. Hallazgos: fallecidos, mayor frecuencia en julio (50.7%), 91,9% prioridad I/II, edad 70.1 ± 7.5 años, masculinos (71,0%), FC 103,7 ± 18,1 lat./min, FR 29,4 ± 6,4 resp./min (p<0,001), SO2 75,1% ± 14,35 y estancia 6,9 días ± 5,7; tos (68,3%), fiebre (38,0%) y cefalea (23,3%) signos/síntomas más frecuentes. El asma se asoció a la mortalidad (p=0,049). Conclusiones: El adulto mayor es una prioridad para los sistemas de salud pública; a mayor edad, masculino, que presente fiebre, tos y asma tendría mal pronóstico frente a la COVID-19.

Objetive:to determine the variables associated with mortality from COVID 19 in the older adult population. : observational study, 521 patients The studyaged 60 years and over with a clinical/laboratory diagnosis of COVID -19; variables included age, sex, priority of care, origin, comorbidities, stay, respiratory and heart rate, SO2, temperature and signs/symptoms. Findings: deaths, higher frequency in July (50.7%), 91.9% priority I/II, age 70.1 ± 7.5 years, male (71.0%), HR 103.7 ± 18.1 beats/min, RF 29.4 ± 6.4 breaths/min (p<0.001), SO2 75.1% ± 14.35 and stay 6.9 days ± 5.7; cough (68.3%), fever (38.0%) and headache (23.3%) most frequent signs/symptoms. Asthma was associated with mortality (p=0.049). The elderly is a priority for Conclusions:public health systems; older, male, with fever, cough and asthma have a poor prognosis against COVID-19.

Gait speed as a predictor of mortality in older men with cancer: A longitudinal study in Peru.

BACKGROUND: Given the increase in incidence and mortality from cancer in recent years in Latin America and Peru, it is necessary to identify frailty older adults at higher risk of disability, hospitalizations and mortality. However, its measure is complex and requires time. For this reason, it has been proposed that frailty can be evaluated by a single measure, as gait speed. We aimed to evaluate the role of gait speed as a predictor of mortality in older men with cancer in Peru. METHODS: A prospective cohort study was carried out that included military veterans (aged 60 years and older) with an oncological diagnosis evaluated at the Centro Médico Naval in Peru during the period 2013-2015. Slow gait speed was defined as <0.8 m/s. All-cause mortality was recorded during a 2-year follow-up. Sociodemographic characteristics, medical and personal history, and functional assessment measures were collected. We performed Cox regression analysis to calculate hazard ratios with their respective 95% confidence intervals. RESULTS: 922 older men were analyzed from 2013 to 2015, 56.9% (n = 525) of whom were >70 years of age. 41.3% (n = 381) had slow gait speed with a mortality incidence of 22.9% (n = 211) at the end of follow-up. The most frequent types of cancer in the participants who died were of the lung and airways (26.1%), liver and bile ducts (23.2%), and lymphomas and leukemias (16.6%). In the adjusted Cox regression analysis, we found that slow gait speed was a risk factor for mortality in older men with cancer (adjusted hazard ratio = 1.55; 95% confidence interval: 1.21-2.23). CONCLUSIONS: Slow gait speed was associated with an increased risk of mortality in older men with cancer. Gait speed could represent a simple, useful, inexpensive, rapidly applicable marker of frailty for the identification of older men at higher risk of mortality. Gait speed could be useful in low- and middle-income countries, and in rural areas with limited access to health services.

The depressed frail phenotype as a risk factor for mortality in older adults: A prospective cohort in Peru.

INTRODUCTION: Frailty and depression can coexist as depressed frail phenotype, useful for the comprehensive evaluation of older adults and prevention of adverse outcomes. The objective of this study was to evaluate the role of the depressed frail phenotype and its components as risk factors for mortality in older adults of the Centro Médico Naval (CEMENA) of Peru during 2010-2015. MATERIAL AND METHODS: We carried out a secondary data analysis of a prospective cohort that included older adults (60 years and older) treated in the Geriatrics service of CEMENA between the years 2010-2015. Frailty was defined as the presence of three or more Fried phenotype criteria and depression was determined using a Yesavage ultrashort scale score of three or more. The presence of both conditions was defined as depressed frail phenotype. In addition, sociodemographic characteristics, medical and personal history, and performance-based measures were included. We employed crude and adjusted Cox regression models to evaluate the association of interest and estimate Hazard Ratios (HR) with their respective 95% confidence intervals (95% CI). RESULTS: 946 older adults were included in the analysis, with a mean age of 78.0 ± 8.5 years. 559 (59.1%) were male, 148 (15.6%) were found to be frail, 231 (24.4%) had depressive symptoms, 105 (11.1%) had depressed frail phenotype, and 79 (8.3%) participants died during follow-up. The adjusted Cox regression analysis revealed that depressed frail phenotype (HR = 3.53; 95%CI: 2.07-6.00; p < 0.001) was a risk factor for mortality in older adults. CONCLUSIONS: The depressed frail phenotype was associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies that allow estimating this phenotype's impact on mortality and evaluate interventions to improve quality of life and reduce the risk of adverse outcomes.

Programa de ejercicio multimodal para mejorar la función muscular en adultos mayores del Hospital de la Fuerza Aérea del Perú, 2018 / Multimodal exercise program for muscle function improvement in older adults from the Hospital de la Fuerza Aérea del Perú 2018

RESUMEN Objetivo: Conocer los beneficios de un programa de ejercicio multimodal para mejorar la función muscular en adultos mayores del Hospital de la Fuerza Aérea del Perú en el 2018. Materiales y métodos: Estudio de intervención, analítico, prospectivo y longitudinal. Un total de 66 pacientes fueron evaluados, pero solo 24 de ellos cumplieron con el tiempo de intervención de 6 meses. Resultados: La edad promedio fue de 75 ± 7,01 años. La Short Physical Performance Battery (SPPB), que incluye dentro de sus parámetros tanto balance, velocidad de marcha y la prueba de la silla, tuvo un impacto positivo en el grupo de intervención y mostró resultados estadísticamente significativos. No se encontró significancia estadística en la fuerza de presión en kilogramos ni en la medición del diámetro de la pantorrilla. Conclusiones: El programa de ejercicios multimodal en adultos mayores que pertenecen a la Fuerza Aérea del Perú tiene un impacto positivo en la función muscular.

ABSTRACT Objective: To find out the benefits of a multimodal exercise program for muscle function improvement in older adults from the Hospital de la Fuerza Aérea del Perú in 2018. Materials and methods: An interventional, analytical, prospective and longitudinal study. A total of 66 patients were assessed, out of whom only 24 completed the six-month intervention period. Results: The patients' median age was 75 ± 7.01. The Short Physical Performance Battery (SPPB), which combines the results of the balance, gait speed and chair stand tests, had a positive impact on the intervention group and showed statistically significant results. No statistical significance was found in grip strength in kilograms or calf circumference measurement. Conclusions: The multimodal exercise program for older adults from the Peruvian Air Force has a positive impact on muscle function.

Tamizaje en las personas mayores con dependencia de cuidados: clave en la estrategia para mitigar la pandemia por COVID-19 / Screening for care-dependent older people: a key element in the strategy to mitigate COVID-19 pandemic

RESUMEN En la pandemia por la COVID-19, las personas mayores son el grupo que concentra la mayor mortalidad, sobre todo quienes precisan de cuidados de largo plazo por haber perdido su habilidad funcional. Esta población vive en sus domicilios, con la familia o en un centro residencial. Se ha descrito que las personas mayores pueden desarrollar una forma de enfermedad oligosintomática o con una sintomatología clínica particular; por esta razón, las estrategias de tamizaje basadas en síntomas no son las más recomendables. Es necesario detectar de manera precoz a los enfermos en este grupo; por ello, analizamos y proponemos las mejores alternativas disponibles para conseguir este objetivo.

ABSTRACT During the COVID-19 pandemic, older people have been the group with the highest mortality rate, especially those who require long-term care for having lost their functional ability. These people are living at home with their family or in a nursing home. It has been described that older people may develop an oligosymptomatic SARS-CoV-2 infection or particular symptoms of the disease. Therefore, symptom-based screening is not the most recommended strategy in this scenario. Since it is necessary to detect early cases in the elderly population, this research work analyzes and proposes the best available alternatives for attaining such goal.

Association between depressive symptoms and disability in older adults of 12 high Andean communities from Peru.

OBJECTIVE: Our objective was to evaluate the association between depressive symptoms and disability in older adults residing in 12 high Andean communities in Peru. MATERIAL AND METHODS: We carried out a secondary data analysis of a cross-sectional study that included older adults (60 years or older) from 12 high Andean communities in Peru from 2013 to 2019. Depressive symptoms were defined as a score of two or more in the abbreviated Geriatric Depression Scale, while disability was defined as a score of less than 95 in the Barthel index. We also included sociodemographic characteristics, medical and personal history, and functional and performance-based tests. We used crude and adjusted Poisson regression models to evaluate the association of interest and estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI). RESULTS: We included 442 older adults with a mean age of 73 ± 6.9 in the analysis; 63.1% (n = 279) were women, and 79.9% (n = 353) had no education or incomplete primary school. 50.9% (n = 225) of the participants had depressive symptoms, and 49.8% (n = 220) had disability. The adjusted Poisson regression model showed that depressive symptoms increased the probability of disability (adjusted PR = 1.67; 95% CI: 1.34-2.08; p < 0.001) in older adults living at high altitude. CONCLUSIONS: Depressive symptoms was associated with a greater probability of disability in older adults living at high altitude. Longitudinal studies are needed for better understanding of this association in high altitude populations along with timely interventions to reduce the impact of both geriatric syndromes.

[Impact of social support on limited mobility in older people in high Andean communities in PeruImpacto do apoio social na mobilidade reduzida em idosos de comunidades do altiplano andino no Peru]. / Impacto del soporte social sobre la movilidad limitada en personas mayores de comunidades altoandinas peruanas.

OBJECTIVE: To determine whether there is a relationship between physical mobility and lack of social support in elderly people living in high Andean communities in Peru. METHODOLOGY: Observational, analytical, retrospective study using the database of a previous cross-sectional study containing information on 449 people aged 60 years and over, who participated in the ANDES-FRAIL project. The dependent variable was mobility, evaluated using the Short Physical Performance Battery; the independent variable was social support, evaluated using an item from the Edmonton Frail Scale. Sociodemographic parameters, comorbidities, number of drugs commonly used, and scores received from several instruments were used as covariates. These included the Barthel Index to determine functionality in older people and the Yesavage questionnaire to evaluate depression in the elderly. Frequencies and percentages were calculated for the categorical variables. An adjusted model was developed using the variables that were statistically significant in the two-factor logistic regression analysis. RESULTS: The frequency of limited mobility in the studied population was 58.6% (n = 263) and the frequency of inadequate social support was 58.1% (n = 261); 70.7% of participants (n = 186) with inadequate social support had limited mobility. According to the adjusted regression model, inadequate social support would make it 2.5 times more likely (95% CI: 1.3-4.5) to have limited mobility, regardless of the confounding covariates. CONCLUSIONS: Lack of social support is associated with limited mobility in older people living in high Andean communities in Peru.

OBJETIVO: Determinar se existe relação entre mobilidade física e falta de apoio social em idosos que vivem em comunidades do altiplano andino no Peru. MÉTODOS: Estudo observacional analítico de coorte retrospectiva baseado em dados obtidos em uma pesquisa transversal anterior com 449 participantes, com idade de 60 anos ou mais, como parte do Projeto ANDES-FRAIL. A variável dependente foi a mobilidade, avaliada com o Short Physical Performance Battery, um instrumento que avalia o desempenho físico funcional com uma série curta de testes. A variável independente foi o apoio social, avaliado por um item da Escala de Fragilidade de Edmonton (The Edmonton Frail Scale, EFS). As covariáveis foram parâmetros sociodemográficos, presença de comorbidades, número de medicamentos de uso habitual e pontuação em vários instrumentos de avaliação, como o índice de Barthel de avaliação da independência funcional de idosos e a Escala de Depressão Geriátrica de Yesavage. Foram calculadas as frequências e as porcentagens das variáveis categóricas e elaborado um modelo ajustado com as variáveis com significância estatística na análise de regressão logística bifatorial. RESULTADOS: Na amostra estudada, 58,6% (n = 263) apresentavam mobilidade reduzida e 58,1% (n = 261) recebiam apoio social inadequado. Entre as pessoas com apoio social inadequado, 70,7% (n = 186) apresentavam mobilidade reduzida. De acordo com o modelo de regressão logística ajustado, a chance de ter mobilidade reduzida foi 2,5 vezes maior (IC 95% 1,3­4,5) quando o apoio social era inadequado, independentemente das covariáveis de confusão. CONCLUSÃO: A falta de apoio social está associada à mobilidade reduzida em idosos que vivem em comunidades do altiplano andino no Peru.