Association between frailty and depression among hemodialysis patients: a cross-sectional study

ABSTRACT BACKGROUND: Frailty is consensually understood to be a clinical syndrome in which minimal stressors can lead to negative outcomes such as hospitalization, early institutionalization, falls, functional loss and death. Frailty is more prevalent among patients with chronic kidney disease (CKD), and those on dialysis are the frailest. Depression contributes towards putting patients with CKD into the frailty cycle. OBJECTIVE: To assess frailty and its relationship with depression among patients with CKD undergoing hemodialysis. DESIGN AND SETTING: Observational and quantitative cross-sectional study conducted in a renal therapy unit, located in the interior of the state of São Paulo, Brazil. METHODS: This investigation took place in 2019, among 80 patients. The following instruments were applied: a sociodemographic, economic and health condition characterization and the Subjective Frailty Assessment (SFA) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: Among the patients, there was higher prevalence of females, individuals with a steady partner and retirees, and their mean age was 59.63 (± 15.14) years. There was high prevalence of physical frailty (73.8%) and depression (93.7%). Depression was associated with frailty, such that patients with depression were 9.8 times more likely to be frail than were patients without depression (odds ratio, OR = 9.80; 95% confidence interval, CI, 1.93-49.79). CONCLUSION: Based on the proposed objective and the results achieved, it can be concluded that depression was associated with the presence of frailty among patients with CKD on hemodialysis.

Una experiencia ecuatoriana en la determinación del comportamiento clínico del síndrome de fragilidad en el adulto mayor con ancylostomiasis / An Ecuadorian experience in determining the clinical behavior of frailty syndrome in the elderly with ancylostomiasis

En adultos mayores, la ancylostomiasis tiene manifestaciones básicas como pérdida del apetito y masa muscular, evacuación excesiva, debilidad y otras que hacen propenso al adulto mayor a un estado de fragilidad, un tipo de síndrome de fallo multiorgánico crónico, donde interviene la disfunción de diversos sistemas. Este agravante fundamenta el objetivo de la presente investigación, centrado en identificar el comportamiento de los criterios clínicos, funcionales, mentales y sociodemográficos en la evaluación geriátrica del síndrome de fragilidad en adultos mayores parasitados por Ancylostoma spp. en el cantón Santiago de Píllaro. La muestra resultó integrada por un total de 102 adultos mayores a 65 años. Mediante la revisión de las historias clínicas y la aplicación de una encuesta a los participantes, se evaluó el comportamiento de los criterios sociodemográficos, médicos, funcionales, mentales y de comorbilidad asociada. Los datos obtenidos fueron procesados estadísticamente mediante análisis bivariado y regresión logística múltiple. Los factores estadísticamente asociados a la fragilidad fueron el sexo femenino (p= 0,003, IC 95% ,LI= 1,564 y LS= 8,950), los bajos ingresos económicos (p= 0,011, IC 95%: LI= 1,786 y LS= 7,433), la polifarmacia (p= 0,006, IC 95%: LI= 2,452 y LS= 14,415) ), las evacuaciones frecuentes (p=0,009, con IC95%: LI=2,704 y LS=7,536) y las afecciones bucodentales (p= 0,004, IC 95%: LI= 1,895 y LS= 6,572), por lo que se justifica la elaboración de estrategias y acciones de salud que minimicen los efectos del estado de fragilidad en la población estudiada(AU)

In older adults, ancylostomiasis has basic manifestations such as loss of appetite and muscle mass, excessive evacuation, weakness and others that make the older adult prone to a state of fragility, a type of chronic multi-organ failure syndrome, where dysfunction of various systems. This aggravating factor supports the objective of the present investigation, focused on identifying the behavior of the clinical, functional, mental and sociodemographic criteria in the geriatric evaluation of frailty syndrome in elderly adults parasitized by Ancylostoma spp. in the canton Santiago de Pillaro. The sample was made up of a total of 102 adults over 65 years of age. By reviewing the medical records and applying a survey to the participants, the behavior of the sociodemographic, medical, functional, mental and associated comorbidity criteria was evaluated. The data obtained were statistically processed using bivariate analysis and multiple logistic regression. The factors statistically associated with frailty were female sex (p = 0.003, 95% CI, LI = 1.564 and LS = 8.950), low income (p = 0.011, 95% CI: LI = 1.786 and LS = 7.433) , polypharmacy (p = 0.006, 95% CI: IL = 2.452 and LS = 14.415)), frequent bowel movements (p = 0.009, with 95% CI: IL = 2.704 and LS = 7.536) and oral disorders (p = 0.004 , 95% CI: LI = 1.895 and LS = 6.572), which is why the development of health strategies and actions that minimize the effects of the state of frailty in the population studied is justified(AU)

Validity of the short physical performance battery for screening for frailty syndrome among older people in the Brazilian Amazon region. A cross-sectional study

ABSTRACT BACKGROUND: Environmental and population characteristics seem to influence the variation in cutoff points of the Short Physical Performance Battery (SPPB) for diagnosing frailty syndrome among older adults. OBJECTIVE: To verify the validity of the SPPB for screening for frailty syndrome among older adults in the Amazonian context. DESIGN AND SETTING: Cross-sectional population-based study on older adults in the urban area of Coari (AM), Brazil. METHODS: In total, 264 older adults (60 years of age or over) were included. Frailty syndrome was defined using the Fried phenotype criteria. The SPPB cutoff points were compared in relation to frailty and validity measurements were calculated for the test. RESULTS: A strong association between poor physical performance and frailty was identified (P < 0.001). The cutoff point of 6 demonstrated the best validity measurements for frailty in the sample studied (sensitivity: 0.28; specificity: 0.94; accuracy: 0.88; area under the receiver operating characteristic curve, AUC-ROC: 0.61; likelihood ratio, LR+: 4.44; LR-: 0.77; prevalence: 8.3%; post-test probability, PTP+: 0.32; PTP-: 0.07), with emphasis on high specificity and the positive likelihood ratio value. CONCLUSION: The SPPB was shown to be useful for screening frail older adults in the Amazon region. The score of 6 demonstrated the best cutoff point for this population. This could be used in healthcare services for diagnostic screening for frailty among older people within the Amazonian context.

Prevalência e fatores associados à síndrome da fragilidade no idoso do Distrito Federal / Prevalence and factors associated with the frailty syndrome in older adults in the Brazilian Federal District

INTRODUÇÃO: A síndrome da fragilidade no idoso (SFI) tem sido reconhecida como uma condição de vulnerabilidade fisiológica associada ao envelhecimento, resultante de uma reserva homeostática reduzida e da dificuldade do organismo em responder adequadamente ao estresse, característica altamente preditiva de uma variedade de desfechos clínicos adversos associados, que incluem declínio funcional, institucionalização e mortalidade. OBJETIVO: Identificar a prevalência e os fatores associados à SFI em população assistida por uma unidade ambulatorial de atenção secundária em centro especializado de atendimento em geriatria e gerontologia do Distrito Federal. MÉTODOS: Trata-se de um estudo observacional, descritivo, transversal e analítico realizado com idosos atendidos no centro especializado em geriatria e gerontologia da Secretaria de Saúde do Distrito Federal (SES/DF). Na avaliação dos idosos, foram coletados dados para identificação do perfil, capacidade funcional, informações referentes às multimorbidades e desfechos clínicos, como quedas. Os idosos também foram classificados na SFI pelos critérios de Fried. Para a análise estatística, utilizaram-se o teste de χ2 e a regressão de Poisson. RESULTADOS: No presente estudo, 24% da amostra total foi considerada frágil, 32,9% pré-frágil e 42,1% não frágil. Com relação aos aspectos sociodemográficos, houve associação de fragilidade com maior faixa etária e menor nível educacional. Diabetes, hipertensão arterial sistêmica, incontinência urinária, polifarmácia, depressão, quedas e alteração cognitiva tiveram associação com maior risco de fragilidade. CONCLUSÃO: Mediante os resultados obtidos, será possível definir medidas e estratégias para prevenção de morbimortalidade e proporcionar melhor qualidade de vida para os idosos.

INTRODUCTION: Frailty syndrome (FS) in older adults has been recognized as a physiological vulnerability condition associated with aging, resulting from reduced homeostatic reserve and a difficulty of the body to respond adequately to stress, a highly predictive feature of a variety of adverse clinical outcomes including functional decline, institutionalization, and mortality. OBJECTIVE: To identify the prevalence and factors associated with FS in a population assisted by an outpatient geriatric unit at a specialized geriatric and gerontological care center in the Brazilian Federal District. METHODS: This is an observational, descriptive, cross-sectional and analytical study conducted with older people who were assisted at the specialized center for geriatrics and gerontology of the Brazilian Federal District Health Department. In the baseline evaluation of the participants, data were collected to identify the profile, functional capacity, multimorbidities and clinical outcomes such as falls, as well as the level of frailty, which was classified according to Fried's criteria. Statistical analysis was performed using the chi-square test and Poisson's regression. RESULTS: In the present study, 24% of the total sample was considered frail, 32.9% pre-frail and 42.1%, non-frail. Regarding sociodemographic aspects, there was an association of frailty with the higher age group and with lower educational level. Diabetes, systemic arterial hypertension, incontinence, polypharmacy, depression, falls, and cognitive impairment were directly related to higher risk of frailty. CONCLUSION: The results obtained were useful to help define measures and strategies to prevent morbidity and mortality as well as to provide better quality of life for older adults.

HIV/AIDS related frailty syndrome in the elderly and related research progress / 中华流行病学杂志

Frailty syndrome, caused by degenerative changes in the body and the body vulnerability due to a variety of chronic diseases, is associated with adverse outcomes, such as fall, disability and mortality. With the development of antiretroviral therapy, the average life span of HIV/AIDS patients is extended, the number of elderly living with HIV/AIDS has increased, resulting the increase of the incidence of frailty syndrome in this population. The incidence of frailty syndrome in the elderly is associated with HIV infection and adverse reaction of antiretroviral therapy. Early assessment and intervention of frailty syndrome in elderly HIV/AIDS patients can reduce adverse clinical events and improve the quality of life.

HIV/AIDS related frailty syndrome in the elderly and related research progress / 中华流行病学杂志

Frailty syndrome, caused by degenerative changes in the body and the body vulnerability due to a variety of chronic diseases, is associated with adverse outcomes, such as fall, disability and mortality. With the development of antiretroviral therapy, the average life span of HIV/AIDS patients is extended, the number of elderly living with HIV/AIDS has increased, resulting the increase of the incidence of frailty syndrome in this population. The incidence of frailty syndrome in the elderly is associated with HIV infection and adverse reaction of antiretroviral therapy. Early assessment and intervention of frailty syndrome in elderly HIV/AIDS patients can reduce adverse clinical events and improve the quality of life.

Frailty-associated factors among Brazilian community-dwelling elderly people: longitudinal study

ABSTRACT BACKGROUND: Frailty among elderly people is associated with negative health outcomes. Through gaining better understanding of this syndrome over different time periods, healthcare actions that take predictive factors into consideration may be facilitated. OBJECTIVE: To identify factors associated with frailty syndrome among community-dwelling elderly people over a two-year follow-up. DESIGN AND SETTING: Longitudinal study on elderly people living in Uberaba (MG), Brazil. Methods: Elderly individuals were selected through multiple-stage conglomerate sampling from a national database. Participants were interviewed and evaluated in 2014 and again in 2016. Predictors were considered at the baseline, and frailty categories (frail, pre-frail or non-frail) at the follow-up. Frailty was identified based on the Fried criteria. Associations with socioeconomic factors, health status and physical performance were investigated using multinomial logistic regression. RESULTS: 353 individuals participated in both assessments. The final model showed that age over 80 years was predictive of both pre-frailty and frailty (odds ratio, OR 4.92; 95% confidence interval, CI: 1.57-15.38; OR 8.64; 95% CI: 2.05-36.35, respectively), while dependency regarding basic activities of daily living (OR 3.66; 95% CI: 1.22-11.02) and poor lower-limb physical performance (OR 7.87; 95% CI: 1.97-31.39) predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15% (OR 0.85; 95% CI: 0.74-0.99). CONCLUSION: Age over 80 years was predictive of pre-frailty and frailty, while dependency in basic activities of daily living and poor physical performance predicted frailty. A one-unit increased score for advanced activities of daily living decreased the frailty rate by 15%.

Asociación de disfunción tiroidea subclínica con el síndrome de fragilidad en pacientes adultos mayores / Relation of subclinical thyroid dysfunction to frailty syndrome in older patients

Resumen OBJETIVO: Evaluar la asociación entre disfunción tiroidea subclínica y síndrome de fragilidad en pacientes adultos mayores. MATERIAL Y MÉTODO: Estudio de casos y controles efectuado de enero de 2016 a junio de 2017 en adultos mayores con síndrome de fragilidad (casos) y sin síndrome de fragilidad (controles). El diagnóstico de síndrome de fragilidad se estableció con los criterios de Fried. Se compararon las concentraciones séricas de TSH y T4 libre en pacientes robustos, prefrágiles y frágiles. También se determinó la razón de momios (OR) para fragilidad en pacientes con hipotiroidismo subclínico e hipertiroidismo subclínico. RESULTADOS: La edad promedio de los casos (n = 100) y controles (n = 104) fue de 83.2 y 78.1 años, respectivamente (p ≤ 0.01). Las concentraciones de TSH en sujetos frágiles en comparación con pacientes robustos fueron 3.1 vs 2.7 ng/mL (p = 0.5) y las concentraciones séricas de T4 libre fueron 1.26 y 1.32 ng/dL, respectivamente (p = 0.315). El OR para fragilidad en pacientes con hipotiroidismo subclínico fue de 1.21 (IC95% 0.39-3.80, p = 0.740) y en pacientes con hipertiroidismo subclínico fue OR = 0.74 (IC95% 0.14-3.75, p = 0.714). CONCLUSIONES: No existen diferencias significativas en las concentraciones séricas de TSH ni T4 libre entre pacientes frágiles y robustos. El hipotiroidismo y el hipertiroidismo subclínico no se asociaron con mayor riesgo de síndrome de fragilidad.

Abstract OBJECTIVE: To evaluate the association between subclinical thyroid dysfunction and frailty syndrome in elderly patients. MATERIAL AND METHOD: A case-control study was carried out from January 2016 to June 2017 in older adults with frailty syndrome (cases) and without frailty syndrome (controls). The diagnosis of frailty syndrome was made according to the Fried criteria. The serum levels of TSH and free-T4 were compared in robust, pre-frailty and frailty patients. Also, the odds ratio (OR) for frailty was determined in patients with subclinical hypothyroidism and subclinical hyperthyroidism. RESULTS: The mean age of the cases (n = 100) and controls (n = 104) was 83.2 and 78.1 years, respectively (p ≤ 0.01). The TSH levels in fragile and robust were 3.1 and 2.7 ng/ mL (p = 0.594) and the serum levels of free T4 were 1.26 and 1.32 ng/dL, respectively (p = 0.315). The OR for fragility in patients with subclinical hypothyroidism was 1.21 (CI95% 0.39-3.80, p = 0.740) and in patients with subclinical hyperthyroidism it was of 0.74 (CI95% 0.14-3.75, p = 0.714). CONCLUSIONS: There are no significant differences in serum levels of TSH or free T4 between fragile and robust patients. Subclinical hyperthyroidism and hypothyroidism were not associated with an increased risk of frailty syndrome.

Study on the effects of oral hypotensive compliance in elderly patients with frailty syndrome / 中国实用护理杂志

Objective To investigate the relationship between elderly hypertension patients with frailty syndrome and oral medication compliance. Methods Two hundred elderly patients with hypertensionwho visited the department of cardiology of the First Hospital Affiliated to Dalian Medical University from March 2015 to March 2017were randomly selected. General information was recorded for each patient. The Tilburg Frailty Indicator (TFI), Healthy behavior inventory (HBI) and medication adherence inventory (mmas-8) were assessed for each patient. The population variable and TFI were taken as independent variables, and the mmas-8 score and HBI score were taken as dependent variables to evaluate the linear correlation between each independent variable and each dependent variable. The above independent variables were used as covariates and the results were corrected by disordered multiple Logistic regression analysis. Results The average age of 200 patients was (73.5 ± 7.5) years old, including 103 women (51.5％, 103/200), 97 males (48.5％, 97/200), and the average medical history of hypertension was (12.5 ± 6.1) years. There were 74 patients (37％, 74/200) and 126 patients (63％, 126/200). The mean TFI was 4.3 ± 3.0. The average scores of physical, psychological and social factors were 7.6±3.1, 3.9±2.0, 1.4±0.9, and the average HBI was 3.3±0.3. Among them, the average scores of healthy eating habits, preventive health care, positive mentality and healthy behavior were 3.3±0.8, 3.3±0.4, 3.4± 0.5, and 3.4 ± 0.5, respectively. The mean MMAS-8 was 5.2 ± 2.0, with 144 patients (72％, 144/200) with low compliance and 38 (19％, 38/200) with moderate compliance. Age (Rho:- 0.443), history of hypertension (r:-0.421), TFI score (Rho:-0.483) were negatively correlated with drug adherence (P<0.05). Married/cohabiting patients (tau_b: 0.293), education level (tau_b:0.391), monthly income (tau_b: 0.398) were positively correlated with drug compliance, and the latter two were significantly positively correlated with drug compliance (P<0.01). Monthly income (tau_b:0.371) was significantly positively correlated with HBI, and TFI score (Rho:-0.364) were significantly negatively correlated with HBI, P<0.01. Logistic regression analysis suggested that education degree was a positive determinant of drug compliance (mmas-8) (B=0.81,P=0.01), and monthly income was a positive determinant of health behavior (HBI). Frailty syndrome (TFI) is a negative determinant of poor drug adherence (B=-0.11, P<0.01) and poor health behavior (B=-0.71, P=0.03). Conclusions Frailty syndrome is an important independent factor in predicting drug adherence and adherence to healthy behaviors. High education level improves patient compliance, and good financial status can make patients more active in adherence to healthy behaviors.

Síndrome da fragilidade e o comprometimento cognitivo em idosos: revisão sistemática da literatura / Frailty syndrome and cognitive impairment in older adults: a systematic literature review

O processo de envelhecimento é universal, contínuo, heterogêneo, de caráter lento e complexo. Dentre os possíveis danos do processo de envelhecimento destaca-se o comprometimento cognitivo e a síndrome da fragilidade. O objetivo deste estudo foi sintetizar o conhecimento sobre a associação entre a síndrome da fragilidade e o comprometimento cognitivo do idoso. Para este estudo, foi adotado o referencial do The Joanna Briggs Institute (2017) e dentre os modelos propostos por este Instituto e considerando os objetivos deste estudo, optou-se pela revisão sistemática de etiologia e fatores de risco, que se desenvolveu em nove passos. O primeiro é a elaboração do protocolo. O segundo foi a formulação da questão de estudo e teve como referência a estratégia PEO. No terceiro foram definidos os critérios de inclusão e exclusão. Posteriormente, no quarto passo, foi realizada a busca dos artigos com a utilização das seguintes bases de dados: National Center for Biotechnology Information (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Latin-American and Caribbean Center on Health Sciences Information (LILACS) e a Excerpta Medica Database (EMBASE), além da busca manual, tendo como resultado uma amostra inicial de 3024 estudos. A seguir, no quinto passo, foi realizada a seleção dos artigos, após serem excluídos os duplicados, houve a seleção por título e resumo e leitura na íntegra dos artigos selecionados. Tais ações foram realizadas por três revisores, sendo incluído um total de 10 artigos no estudo e posteriormente a avaliação crítica. O sétimo passo se refere à extração dos dados, seguida de síntese e análise e, por último a apresentação dos resultados. Os estudos incluídos apresentaram diferentes definições operacionais sobre a síndrome da fragilidade. A definição mais utilizada foi o Fenótipo da Fragilidade, utilizada em nove estudos. Já a avaliação do comprometimento cognitivo foi realizada por instrumentos validados para cada população de estudo, dos quais destaca-se o Mini Exame do Estado Mental (MMSE), uma vez que esteve presente em cinco estudos. Sobre as associações entre a síndrome da fragilidade e o comprometimento cognitivo, três estudos identificaram a associação por meio da medida de Odds Ratio (OR) e de quatro estudos foi possível estabelecer a relação pela análise do Relative Risk (RR). Assim, foram realizadas duas meta-análises entre a síndrome da fragilidade e o comprometimento cognitivo. Na primeira, pela comparação do OR, demonstrou-se que os idosos frágeis apresentam 1,24 mais chance de apresentarem comprometimento cognitivo em relação aos não frágeis. Já, na segunda metaanálise, realizada através do RR, os resultados encontrados não foram estatisticamente significantes. Assim, os resultados sugerem que a ausência da uniformidade entre os estudos para avaliar a síndrome da fragilidade e o comprometimento cognitivo, compromete a comparação entre os resultados. Tornase evidente a necessidade de desenvolver outras pesquisas na área que unifiquem a avaliação dessas duas condições de saúde, tendo em vista sua relevância para a prevenção de desfechos adversos de saúde

The aging process is universal, continuous, heterogeneous, with a slow and complex character. Possible and noteworthy damages of the aging process include cognitive impairment and the frailty syndrome. The objective of this study was to synthesize knowledge about the association between the frailty syndrome and cognitive impairment in older adults. In this study, the authors adopted the framework of the Joanna Briggs Institute (2017) and among the models proposed by this institute, and considering the objectives of this study, a systematic review of etiology and risk factors was chosen and developed in nine steps. The first step was the protocol creation. The second step was the formulation of the study question, which was based on the PEO strategy. At a third moment, inclusion and exclusion criteria were defined. Next, at the fourth step, articles were searched in the following databases: National Center for Biotechnology Information (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Latin-American and Caribbean Center on Health Sciences Information (LILACS) and the Excerpta Medica Database (EMBASE), in addition to a manual search as well, which resulted in an initial sample of 3,024 studies. At the fifth step, the articles were selected, once duplicates were removed, and later there was a second selection by title, abstract, and reading of the full texts selected. These actions were conducted by three reviewers, who reached a total of 10 articles to be included in the study. The seventh stage consisted of the data extraction, followed by its synthesis and analysis, and, at last, the presentation of the results. The included studies presented different operational definitions regarding the frailty syndrome. The most commonly used definition was the Frailty Phenotype, which was used in nine studies. The cognitive impairment evaluation was conducted by means of tools previously validated to each study population, among which the Mini-Mental State Examination (MMSE) stood out, for being present in five studies. Regarding the associations between the frailty syndrome and cognitive impairment, three studies identified an association by means of the Odds Ratio (OR) measurement, and in four studies it was possible to establish a relationship by the Relative Risk (RR) analysis. Thus, two meta-analyses were conducted between the frailty syndrome and cognitive impairment. The first, by comparison of the OR, showed that frail older people had 1.24 higher chances of presenting cognitive impairment in relation to non-frail individuals. In the second meta-analysis, performed through the RR analysis, the results found were not statistically significant. Therefore, the results suggest that the absence of uniformity among the studies to assess the frailty syndrome and cognitive impairment compromises their comparison. Hence, there is a clear need for developing further research in the area to consolidate the assessment of these two health conditions, considering their relevance to preventing adverse health outcomes

Rastreio da condição de fragilidade em idosos internados em um Hospital Universitário / Screening of the Fragility Condition in Older Patients in a University Hospital

Introdução: a síndrome de fragilidade é um tema de pesquisa recente e requer investigação adicional em todos os aspectos, incluindo sobre as variáveis demográficas. Várias orientações recentes recomendam o rastreio de rotina em relação à fragilidade em idosos, sobretudo em ambientes clínicos mais adversos, como no âmbito de uma hospitalização. Objetivos: identificar a prevalência de síndrome de fragilidade em idosos internados nas enfermarias de um hospital universitário, suas características e associação com variáveis sociodemográficas e clínicas. Métodos: estudo de modelo observacional e Recebido em: 04/12/2017 transversal, de abordagem quantitativa, em que foram entrevistados 100 pacientes com idade maior ou igual a 60 anos, utilizando-se um instrumento contendo questionário sociodemográfico, a Escala de Fragilidade de Edmonton (EFE) e o Tilburg Frailty Indicator (TFI). Resultados: a média de idade da amostra foi de 70,9 (±8,25) anos, 61% do sexo masculino. Através da aplicação da EFE, a prevalência de fragilidade foi de 73%, 21% na categoria grave, enquanto pelo TFI, a prevalência foi de 62%. A síndrome de fragilidade relacionou- -se com idade, histórico de internações, número de medicamentos e apoio social. Conclusões: a prevalência da condição de fragilidade observada, superior àquela registrada entre idosos hospitalizados, indica que esses pacientes deveriam ser submetidos a uma avaliação geriátrica abrangente, e não apenas serem atendidos como pacientes adultos de outras faixas de idade. Nesse sentido, a utilização de instrumentos de avaliação e fragilidade poderia ser uma forma de valorizar esta síndrome geriátrica de alta prevalência nessa população.

Introduction: Fragility syndrome is a recent research topic and requires additional research in all aspects, including demographic variables. Several recent guidelines recommend routine screening for frailty in the elderly, especially in more adverse clinical settings, such as in a hospital setting. Objectives: To identify the prevalence of fragility syndrome in the elderly hospitalized in university hospital wards, its characteristics and association with sociodemographic and clinical variables. Methods: an observational and crosssectional study of 100 patients aged 60 years and older using an instrument containing a sociodemographic questionnaire, the Edmonton Fragility Scale (EFE) and the Tilburg Frailty Indicator (TFI). Results: the mean age of the sample was 70,9 (± 8,25) years, 61% of the male years. Through the application of EFE, the prevalence of fragility was 73%, 21% in the severe category, whereas by the TFI, the prevalence was 62%. The fragility syndrome was correlated to age, hospitalization history, number of medications and social support. Conclusions: the prevalence of the observed fragility condition, wich was higher than that observed among hospitalized elderly, indicates that these patients should undergo a comprehensive geriatric evaluation, and not only be treated as adult patients of other age groups. This, the use of evaluation and fragility instruments could be a way of valuing this geriatric syndrome of high prevalence in this population.

Effect of frailty syndrome on falls in Chinese elderly diabetics in the communities: a prospective cohort study / 中华流行病学杂志

Objective To explore the relationship between frailty syndrome and falls in the elderly diabetics,in the communities.Methods A three-year cohort study involving 653 community-dwelling adults who were over 65 years of age and participated in the Survey of Disease,Psychological and Social Needs in Dujiangyan Pingyi Community.Diabetic patients would include those who self-reported as having histories of diabetes or on anti-hyperglycemic therapies.Frailty,functional and other geriatric status were assessed respectively.Falls was defined as having had multiple falls or at least one event but with injury.Results The highest prevalence of falls was found in the group of frail diabetic group (62.5％).Data showed that baseline frailty was associated with falls in both diabetic and non-diabetic groups but the odds ratio in the diabetic group was higher than that of the non-diabetic group (OR=3.87,95％ CI:1.45-10.28 vs.OR=6.68,95％ CI:1.14-38.99).Conclusion Frailty could be used as a strong clinical predictor to prevent falls,for the elderly diabetic Chinese living in the communities.

Effect of frailty syndrome on falls in Chinese elderly diabetics in the communities: a prospective cohort study / 中华流行病学杂志

Objective To explore the relationship between frailty syndrome and falls in the elderly diabetics,in the communities.Methods A three-year cohort study involving 653 community-dwelling adults who were over 65 years of age and participated in the Survey of Disease,Psychological and Social Needs in Dujiangyan Pingyi Community.Diabetic patients would include those who self-reported as having histories of diabetes or on anti-hyperglycemic therapies.Frailty,functional and other geriatric status were assessed respectively.Falls was defined as having had multiple falls or at least one event but with injury.Results The highest prevalence of falls was found in the group of frail diabetic group (62.5％).Data showed that baseline frailty was associated with falls in both diabetic and non-diabetic groups but the odds ratio in the diabetic group was higher than that of the non-diabetic group (OR=3.87,95％ CI:1.45-10.28 vs.OR=6.68,95％ CI:1.14-38.99).Conclusion Frailty could be used as a strong clinical predictor to prevent falls,for the elderly diabetic Chinese living in the communities.

Research progress of frailty syndrome in critically ill elderly patients / 中华危重病急救医学

Frailty syndrome is the core of the comprehensive geriatric assessment of the elderly, which affects the prognosis of elderly critical illness patients and becomes the hotspot of the current geriatric medical research of elderly patients. In critically ill elderly patients, the incidence rate of frailty syndrome is 21％-59％. Frailty syndrome is an independent risk factor in elderly patients with complications, short-term and long-term mortality. Moreover frailty is always accompanied by poor state and affects the health quality of these patients. In the field of critical care medicine in our country, the study of the frailty syndrome is still in its infancy. This article focuses on the research progress of frailty syndrome, and the assessment of the frailty critical illness elderly patients is helpful for the clinical doctors to determine the prognosis and treatment decision.

Research progress of frailty syndrome in critically ill elderly patients / 中华危重病急救医学

Frailty syndrome is the core of the comprehensive geriatric assessment of the elderly, which affects the prognosis of elderly critical illness patients and becomes the hotspot of the current geriatric medical research of elderly patients. In critically ill elderly patients, the incidence rate of frailty syndrome is 21％-59％. Frailty syndrome is an independent risk factor in elderly patients with complications, short-term and long-term mortality. Moreover frailty is always accompanied by poor state and affects the health quality of these patients. In the field of critical care medicine in our country, the study of the frailty syndrome is still in its infancy. This article focuses on the research progress of frailty syndrome, and the assessment of the frailty critical illness elderly patients is helpful for the clinical doctors to determine the prognosis and treatment decision.

Costo de la atención médica de pacientes con síndrome de fragilidad vs. pacientes con pre-fragilidad / Cost of patients care with fragility syndrome vs. pre-frailty patients

Introducción: el síndrome clínico de fragilidad se ha relacionado con eventos adversos como caídas, discapacidad, el estado cognitivo, hospitalizaciones e incluso la muerte, implicando con ello un mayor uso de los servicios de salud y de recursos. Objetivo: determinar el costo de la atención médica de pacientes con síndrome de fragilidad vs. pre-fragilidad. Métodos: estudio de costos en pacientes adultos mayores adscritos a tres unidades de medicina familiar que recibieron atención de enero 2011 a mayo de 2013. Se incluyeron expedientes de pacientes adultos mayores. Se integraron dos grupos: frágiles y pre-frágiles. El tamaño de la muestra (n=64) se calculó con la fórmula de promedios para dos poblaciones. La técnica muestral fue aleatoria estratificada, empleando como marco de muestra el listado de pacientes adultos mayores. Se estudiaron características sociodemográficas, de salud, perfil de uso de los servicios de medicina familiar, rayos x y laboratorio, y costos (costo unitario, costo promedio y costo promedio total). El análisis estadístico incluyó promedios y porcentajes. Resultados: la prevalencia de la hipertensión arterial en el grupo de pre-frágiles es 80,7 % y en el grupo frágil 95,5 %. La enfermedad con mayor tiempo de evolución en el grupo de pacientes con pre-fragilidad es la hipertensión arterial con 12,13 años y en el grupo de fragilidad la diabetes con promedio de 15,50. En pacientes frágiles el promedio de glucosa es de 156,67 mg/dl. El costo promedio total en el paciente con fragilidad es de $1 911,02 y en el paciente pre-frágil de $1 802,48. Conclusiones: el costo promedio total en ambos grupos presenta mínima diferencia, y su costo se relaciona con la inclusión del tratamiento de las enfermedades crónicas.

Introduction: the clinical syndrome of frailty has been linked to adverse events such as falls, disability, cognitive status, hospitalization and even death, implying greater use of health services and resources. Objective: determine the care cost of fragility syndrome patients vs. pre-frailty patients. Methods: acost study was conducted on elderly patients assigned to three family medicine units that received attention from January 2011 to May of 2013. Elderly patients' records were included. Two groups were formed: Pre-frail and fragile. The sample size (n = 64) was calculated with the average formula for two populations. The stratified random sampling technique was used as a framework for the list of elderly patients. Socio-demographic characteristics and other variables were studied: health, usage profile of family medicine services, x-rays and lab, and costs (unit cost, average cost and average total cost). Statistical analysis included averages and percentages. Results: the prevalence of hypertension is 80.7% in pre-frail group and 95.5% in the fragile group. Hypertension has the longest history in the pre- fragility group of patients with 12-13 years and diabetes has the longest history in the fragility group with average of 15, 50. In frail patients average glucose is 156.67 mg / dl. The total average cost in patients with fragility is $ 1 911.02 and $ 1 802.48 in pre-frail patients. Conclusions: the total average cost in both groups has minimal difference and its cost is related to the inclusion of treatment of chronic diseases.

Evaluación y cuidado del adulto mayor frágil / Assessment and health care for frail elderly people

La mantención de la funcionalidad y autonomía de los adultos mayores desafía a la geriatría en la búsqueda de herramientas de evaluación sensibles en la pesquisa e identificación de pacientes vulnerables y frágiles. Revisamos el síndrome de fragilidad caracterizado por la disminución de la reserva fisiológica, como aviso de mayor morbilidad y mortalidad para el adulto mayor. Se describen las características clínicas, sicológicas y biológicas. Hacemos énfasis que la identificación temprana de los pacientes frágiles permitiría intervenciones preventivas que los mantendrían saludables después de los 80 años. Estas intervenciones incluyen modelos de cuidado de salud, apoyo de una red social, ayuda sicológica para resolver la crisis de identidad, e intervención con actividad física que puede atenuar la pérdida de la funcionalidad y disminuir la mortalidad asociada al síndrome de fragilidad.

Maintaining functionality and autonomy in elderly people is an important challenge for geriatric clinicians. The challenge consists in designing assessment tools that allow the identification of frail and vulnerable patients. The frailty syndrome is characterized by the diminishing of the physiological reserve, which constitutes an alert of greater morbility and mortality in elderly persons. We emphasize that the early detection of fragile persons allows preventive interventions that help maintain them healthy after 80.These interventions include health care models, social network support, psychological support for identity crisis, and physical activity, that may lessen loss of functionality and diminish mortality associated to fragility syndrome.