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Abstract The aim of this study was to evaluate the association between diabetes and cognitive performance in a nationally representative study in Brazil. We also aimed to investigate the interaction between frailty and diabetes on cognitive performance. A cross-sectional analysis of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline data that included adults aged 50 years and older was conducted. Linear regression models were used to study the association between diabetes and cognitive performance. A total of 8,149 participants were included, and a subgroup analysis was performed in 1,768 with hemoglobin A1c data. Diabetes and hemoglobin A1c levels were not associated with cognitive performance. Interaction of hemoglobin A1c levels with frailty status was found on global cognitive z-score (P-value for interaction=0.038). These results suggested an association between higher hemoglobin A1c levels and lower cognitive performance only in non-frail participants. Additionally, undiagnosed diabetes with higher hemoglobin A1c levels was associated with both poor global cognitive (β=-0.36; 95%CI: -0.62; -0.10, P=0.008) and semantic verbal fluency performance (β=-0.47; 95%CI: -0.73; -0.21, P=0.001). In conclusion, higher hemoglobin A1c levels were associated with lower cognitive performance among non-frail participants. Higher hemoglobin A1c levels without a previous diagnosis of diabetes were also related to poor cognitive performance. Future longitudinal analyses of the ELSI-Brazil study will provide further information on the role of frailty in the association of diabetes and glycemic control with cognitive decline.
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Introducción. En las últimas décadas se han desarrollado diferentes scores y modelos para predecir el pronóstico en pacientes con enfermedad hepática crónica avanzada. Los más reconocidos y utilizados son el sistema de estadificación de Child-Pugh (CP) y el score de MELD, pero estos carecen de herramientas para evaluar objetivamente otros factores pronósticos. Por este motivo, se ha incorporado el concepto de fragilidad a la hepatología clínica. El objetivo de este artículo es examinar la aplicabilidad del índice de fragilidad hepática (IFH) en pacientes con cirrosis evaluados para trasplante hepático en Uruguay. Metodología. Estudio observacional, descriptivo y retrospectivo en el Servicio de Enfermedades Hepáticas del Hospital Central de las Fuerzas Armadas (HCFFAA) de enero de 2018 a diciembre de 2021. Resultados. Se evaluaron un total de 78 pacientes, excluyéndose 19 de estos, culminando con una muestra final de 59 pacientes. La edad media fue de 52 años, siendo el 66 % hombres. La principal etiología de la cirrosis fue la alcohólica, y la comorbilidad más frecuente fue el sobrepeso/obesidad (66 %). La media de IFH fue de 4,03 ± 0,45. El 90 % de los pacientes eran prefrágiles, el 10 % frágiles y ningún paciente fue clasificado como no frágil. El 76 % presentaba un estadio avanzado de la enfermedad al momento de la evaluación 42 % CP estadio B, 34 % CP C, 24 % CP A, con una media de MELD-Na de 17,8 ± 7,6. El 17 % tuvo complicaciones infecciosas. La mortalidad global (n=78) fue del 12 %, y la de los pacientes con IFH calculado fue del 22 %. Conclusiones. El cálculo del IFH es realizable en cirróticos como herramienta objetiva que brinda una mirada integral del paciente. A mayor severidad de la cirrosis, mayor es el IFH. Sin embargo, este índice no parece ser un predictor de la eventual realización del trasplante hepático, ni de muerte en lista de espera en nuestros pacientes.
Introduction. In recent decades, several scores and models have been proposed to predict prognosis in patients with advanced chronic liver disease. The most recognized and used are the Child-Pugh (CP) and the Model for End-stage Liver Disease (MELD) scores, but they lack tools to objectively evaluate other prognostic factors. For this reason, the concept of fragility has been incorporated into clinical hepatology. The objective of this study was to evaluate the applicability of the liver frailty index (LFI) in patients with cirrhosis evaluated for liver transplantation in Uruguay. Methodology. Observational, descriptive and retrospective study at the Hospital Central de las Fuerzas Armadas (HCFFAA) Liver Disease Service from January 2018 to December 2021. Results. A total of 78 patients were evaluated, 19 were excluded, culminating in a final sample of 59 patients. The mean age was 52 years, with 66% being men. The main etiology of cirrhosis was alcoholic and the most frequent comorbidity was overweight/obesity (66%). The mean LFI was 4.03 ± 0.45. 90% of patients were pre-fragile, 10% were fragile, and no patient was classified as non-fragile. 76% had an advanced stage of the disease at the time of evaluation: 42% CP stage B, 34% CP C, 24% CP A, with a mean MELD-Na of 17.8 ± 7.6. 17% had infectious complications. Overall mortality (n=78) was 12%, and that of patients with calculated LFI was 22%. Conclusions. The LFI can be calculated in cirrhotic patients, and it is an objective tool that provides a comprehensive view of the patient. LFI depends on the severity of the cirrhosis. However, this index is not a predictor of liver transplantation or death on the waiting list in our patients.
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ABSTRACT. Frailty is defined as a recognizable state of increased vulnerability resulting from age-associated decline of function in various physiological systems, such that the ability to deal with acute or everyday stressors is compromised. Objective: The aim of the study was to characterize the sample of older adults with cognitive impairment, according to the frailty status indirectly assessed by family members, other clinical and sociodemographic variables; and to assess the overlap of clinical conditions evaluated in this sample with cognitive impairment. Methods: Data were extracted from the follow-up database of the Frailty in Brazilian Older Adults (FIBRA) study (2016-2017). The sample consisted of 130 elderly people with cognitive impairment assessed by the Mini Mental State Examination (MMSE). The scores for the Clinical Dementia Scale (CDR), Cornell Scale for Depression in Dementia and Functional Activities Questionnaire were described. Frailty was indirectly measured through questions answered by family members about the five criteria that compose the frailty phenotype. Results: The sample consisted mostly of older women (n=91) with a mean age of 82.4 (SD=5.3) years, mean schooling of 3.3 years (SD=3.07), widowed (47.7%) and who lived with children and/or grandchildren (68%). More than half had multimorbidity (74.90%), 39.5% had depression symptoms suggestive of major depression, 57% had impaired functionality, 49.3% were frail, 37.6% pre-frail, and 13.10% robust. Conclusion: Among older adults with cognitive impairment, frailty and functional limitations are common.
RESUMO. A fragilidade é definida como um estado reconhecível de vulnerabilidade aumentada resultante do declínio da função associado à idade em vários sistemas fisiológicos, de modo que a capacidade de lidar com estressores agudos ou cotidianos fica comprometida. Objetivo: Caracterizar uma amostra de pessoas idosas com comprometimento cognitivo, segundo o estado de fragilidade, avaliado de forma indireta por familiares, assim como outras variáveis clínicas e sociodemográficas; e avaliar a sobreposição das condições clínicas avaliadas nesta amostra com o comprometimento cognitivo. Métodos: Os dados foram extraídos do banco de dados de acompanhamento do estudo Fragilidade em Idosos Brasileiros (FIBRA - 2016-2017). A amostra foi composta por 130 idosos com comprometimento cognitivo avaliado pelo Mini-Exame do Estado Mental (MEEM). Foram descritos os escores da Escala Clínica de Demência (CDR), da Escala Cornell de Depressão em Demência e do Questionário de Atividades Funcionais. A fragilidade foi mensurada indiretamente por meio de questões respondidas junto aos familiares sobre os cinco critérios que compõem o fenótipo de fragilidade. Resultados: A amostra foi composta em sua maioria por mulheres idosas (n=91) com idade média de 82,4 (DP=5,3) anos, escolaridade média de 3,3 anos (DP=3,07), viúvas (47,7%) e que viviam com filhos e/ou netos (68%). Mais da metade apresentava multimorbidade (74,90%), 39,5% apresentavam sintomas depressivos sugestivos de depressão maior, 57% tinham funcionalidade prejudicada, 49,3% eram frágeis, 37,6% pré-frágeis e 13,10% robustos. Conclusão: Entre idosos com alterações cognitivas, é comum a co-ocorrência de fragilidade e de limitações funcionais.
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ABSTRACT Introduction: Antiretroviral therapy increased the survival and life expectancy of People living With HIV (PWH). Frailty-related syndromes among older PWH (aged 50+ years) may affect their Health-related Quality of Life (HQoL). Additionally, the COVID-19 pandemic has impacted health-related outcomes. This study aimed to estimate the prevalence of frailty and pre-frailty among older PWH, and to explore associations of HQoL with the study assessment period and frailty status. Methods: Cross-sectional study conducted pre- (23-Mar-2019 to 5-Mar-2020) and post-COVID-19 pandemic onset (23-Jun-2021 to 5-May-2022), among older PWH at INI-Fiocruz, the largest cohort of PWH in Rio de Janeiro, Brazil. We measured frailty using Fried assessment, consisting of five domains: unintentional weight loss; self-reported exhaustion, weakness, slow walking speed, low physical activity. HQoL was assessed using the ACTG SF-21, which contains 21 questions divided into 8 domains. We used Chi-Square test, Fisher's exact test, Kruskal-Wallis and ranksum test for comparisons. Results: We included 250 older PWH: 109 (43.6 %) pre- and 141 (56.4 %) post-COVID-19 pandemic onset. Median age was 60-years (IQR: 55‒64). Most self-identified as cisgender men 152 (60.8 %), Pardo/Black 146 (58.4 %), with completed secondary education or less 181 (72.7 %) and low income 132 (52.8 %). Overall, prevalence of frailty and pre-frailty were 9.2 % (95 % CI: 8.1‒10.3) and 61.6 % (95 % CI: 54.0‒69.2). Prevalence of frailty in the pre- and pos-COVID-19 pandemic periods were 7.3 % and 10.6 % (p = 0.66). HQoL scores were lower among participants with frailty compared to those with non-frailty and pre-frailty in all eight domains, and among those included in the post-COVID-19 compared to pre-COVID-19 period for four domains. Conclusions: We observed low prevalence of frailty, but high prevalence of pre-frailty among older PWH. Frailty status did not differ according to the COVID-19 assessment period. Assessment of frailty and HQoL should be incorporated in clinical practice for older PWH. Programs to reverse or prevent frailty should be implemented within the public health system.
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OBJECTIVE To investigate the effects of renally inappropriate medication （RIM） on the frailty of elderly patients with diabetes. METHODS The data of elderly patients with diabetes mellitus admitted to a third-grade class A hospital in Yunnan province from January to December 2022 were collected， and Beers criteria （2019 edition） and Chinese version of FRAIL scale were used to evaluate RIM and the frailty of the patients； the patients were divided into the trial group （with RIM） and the control group （without RIM） according to whether there was RIM. The propensity score matching was used to balance confounding factors between two groups， and the influence of RIM on the frailty of elderly diabetic patients was analyzed by the Logistic regression model. RESULTS Among the 367 patients， 80 patients （21.80%） had RIM， the drugs involved RIM were spironolactone （82.56%）， rivaroxaban （13.95%） and gabapentin （3.49%）. After reaching the balance between groups using the propensity score matching method， the incidence of frailty was 77.94% in trial group and 27.94% in control group （P＜0.001）； the difference was not statistically significant in other confounding factors between the two groups （P＞0.05）. Results of Logistic regression analysis showed that the risk of frailty in the experimental group was 3.118 times that of the control group （odds ratio was 3.118，95% confidence interval was 1.758-5.530， P＜0.001）. CONCLUSIONS RIM is a risk factor for the frailty of elderly patients with diabetes， which can be considered as an indicator for early identification and screening of the frailty of elderly diabetes patients.
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ABSTRACT Introduction: Frailty and its association with chronic kidney disease (CKD) has been established previously. The present study examined this association further by studying the distribution of frailty among groups defined by different stages of the disease. It also identified associated health deficits and explored their association with estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). Methods: A cross-sectional survey was conducted on 90 non-dialysis dependent CKD Stage 1-4 patients, recruited in three stratified groups of 30 participants each based on the stage of disease. Frailty was assessed using Fried's frailty criteria and associated health deficits were recorded using a pre-determined list. Depression was screened using a 4-point depression scale. Results: 21.1% of the participants were frail and 43.3% were pre-frail. The proportion of frailty in CKD groups A (Stages 1 and 2), B (Stage 3a), and C (Stages 3b and 4) was 10%, 13.3%, and 40%, respectively. The association of health deficits including co-morbidities, physical parameters, mental status, daily activities, etc. with UACR, eGFR, and CKD stages was not statistically significant. Nearly one in two frail participants was depressed compared with 14% among non-frail participants. Conclusion: The skewed distribution of 21% frail subjects identified in our study indicates an association between frailty and advancing kidney disease. Frail individuals had a lower eGFR, higher UACR, were more likely to be depressed, and had higher count of health deficits and poorer performance on Barthel Index of Activities of Daily Living and WHOQOL. Early identification of depression would improve care in these patients.
RESUMO Introdução: Fragilidade e sua associação com DRC foram estabelecidas anteriormente. O presente estudo aprofundou esta associação, estudando distribuição da fragilidade entre grupos definidos por diferentes estágios da doença. Também identificou déficits de saúde associados e explorou sua associação com taxa de filtração glomerular estimada (TFGe) e relação albumina/creatinina urinária (RAC). Métodos: Realizou-se uma pesquisa transversal em 90 pacientes com DRC Estágios 1-4 não dependentes de diálise, recrutados em três grupos estratificados de 30 participantes cada, conforme estágio da doença. Avaliou-se fragilidade usando os critérios de fragilidade de Fried e registraram-se os déficits de saúde associados usando uma lista pré-determinada. A depressão foi verificada utilizando a escala de depressão de 4 pontos. Resultados: 21,1% dos participantes eram frágeis e 43,3% eram pré-frágeis. A proporção de fragilidade nos grupos de DRC A (Estágios 1 e 2), B (Estágio 3a), e C (Estágios 3b e 4) foi de 10%, 13,3%, 40% respectivamente. A associação de déficits de saúde, incluindo comorbidades, parâmetros físicos, estado mental, atividades diárias etc. com RAC, TFGe e estágios da DRC não foi estatisticamente significativa. Cerca de um em cada dois participantes frágeis estava depressivo comparados com 14% entre não frágeis. Conclusão: A distribuição enviesada de 21% dos indivíduos frágeis identificados em nosso estudo indica associação entre fragilidade e doença renal progressiva. Indivíduos frágeis apresentaram menor TFGe, maior RAC, eram mais propensos a depressão, tinham maior índice de déficits de saúde e desempenho inferior no Índice de Atividades da Vida Diária de Barthel e WHOQOL. A identificação precoce da depressão melhoraria o atendimento desses pacientes.
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Objetivo: relacionar el Síndrome de la Fragilidad y la sarcopenia en ancianos con y sin diabetes mellitus tipo 2; e identificar los potenciales factores de riesgo para la fragilidad y sarcopenia. Método: estudio epidemiológico descriptivo realizado en 140 ancianos del municipio de Sinop, Mato Grosso, Brasil. Para evaluar el Síndrome de la Fragilidad se utilizó el fenotipo de fragilidad y para la evaluación de la sarcopenia el cuestionario de evaluación física con medida de la circunferencia de la pantorrilla. Resultados: en lo que se refiere al Síndrome de la Fragilidad se obtuvo un mayor porcentaje para ancianos con diabetes mellitus tipo 2, cuando comparados con aquellos sin la enfermedad (p = 0,00). En relación a la presencia de sarcopenia, los ancianos con y sin diabetes mellitus tipo 2 presentaron valores semejantes, sin significación estadística (p = 0,74). El Síndrome de la Fragilidad presentó asociación con: inactividad física (IC95%: 3,29-56,55); intervalo etario superior a 75 años (IC95%: 3,30-27,82); baja renta familiar (IC95%: 1,80-50,98); y, comorbilidades (IC95%: 4,9-5,4). Entre tanto, la sarcopenia fue asociada a la presencia de la inactividad física (IC95%: 1,26-10,44), al bajo peso/eutrófico (IC95%: 3,32- 26,76) y a la desnutrición/riesgo nutricional (IC95%: 1,30-7,70), en los ancianos con y sin diabetes mellitus tipo 2. Conclusión: los ancianos diabéticos tienen mayor vulnerabilidad para desarrollar el Síndrome de Fragilidad, lo que requiere la adopción de medidas preventivas en la atención primaria a la salud.
Objective: to relate Frailty Syndrome and sarcopenia in older adults with and without type 2 diabetes mellitus and identify potential risk factors for frailty and sarcopenia. Method: this descriptive epidemiological study was conducted with 140 older adults in the municipality of Sinop, Mato Grosso, Brazil. The frailty phenotype was used for the assessment of Frailty Syndrome, and a physical assessment questionnaire with calf circumference measurement was used for the assessment of sarcopenia. Results: regarding Frailty Syndrome, a higher percentage was observed in older adults with type 2 diabetes mellitus compared to those without the disease (p = 0.00). Concerning the presence of sarcopenia, older adults with and without type 2 diabetes mellitus showed similar values, with no statistical significance (p = .74). Frailty Syndrome was associated with physical inactivity (95%CI: 3.29-56.55), age over 75 years (95%CI: 3.30- 27.82), low family income (95%CI: 1.80-50.98), and comorbidities (95%CI: 4.90-5.40). However, sarcopenia was associated with the presence of physical inactivity (95%CI: 1.26-10.44), low weight/ eutrophic (95%CI: 3.32-26.76), and malnutrition/nutritional risk (95%CI: 1.30-7.70) for older adults with and without type 2 diabetes mellitus. Conclusion: older adults with diabetes have a higher vulnerability to develop Frailty Syndrome, necessitating the adoption of preventive measures in primary healthcare.
Objetivo: relacionar a Síndrome da Fragilidade e a sarcopenia em idosos com e sem diabetes mellitus tipo 2; e identificar os potenciais fatores de risco para fragilidade e sarcopenia. Método: estudo epidemiológico descritivo realizado com 140 idosos do município de Sinop, Mato Grosso, Brasil. Para a avaliação da Síndrome da Fragilidade, utilizou-se o fenótipo de fragilidade, e, para a avaliação da sarcopenia, o questionário de avaliação física com medida de circunferência da panturrilha. Resultados: quanto à Síndrome da Fragilidade, obteve-se maior percentual para idosos com diabetes mellitus tipo 2 quando comparado àqueles sem a doença (p = 0,00). Em relação à presença de sarcopenia, os idosos com e sem diabetes mellitus tipo 2 apresentaram valores semelhantes, sem significância estatística (p = 0,74). Síndrome da Fragilidade apresentou associação com inatividade física (IC95%: 3,29-56,55), faixa etária superior a 75 anos (IC95%: 3,30-27,82), baixa renda familiar (IC95%: 1,80-50,98) e comorbidades (IC95%: 4,9-5,4). Entretanto, a sarcopenia foi associada à presença da inatividade física (IC95%: 1,26-10,44), baixo peso/eutrófico (IC95%: 3,32-26,76) e desnutrição/risco nutricional (IC95%: 1,30-7,70) para os idosos com e sem diabetes mellitus tipo 2. Conclusão: os idosos diabéticos têm maior vulnerabilidade para desenvolver a Síndrome de Fragilidade, requerendo a adoção de medidas preventivas na atenção primária à saúde.
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Humans , Middle Aged , Sarcopenia/epidemiologyABSTRACT
Objetivo: Conocer la relación entre mortalidad y nivel de fragilidad mediante los índices de fragilidad-valoración geriátrica integral (IF-VGI) a los 12 meses de seguimiento en adultos mayores. Materiales y métodos: Estudio descriptivo, observacional y prospectivo, con muestreo no probabilístico. Se incluyeron pacientes mayores de 60 años del Servicio de Geriatría. Se utilizaron los IF-VGI, y se diagnosticó la fragilidad si la puntuación era mayor o igual a 0,2 en los diferentes niveles de atención: unidad de agudos, hospital de día, consulta externa y consulta domiciliaria; se realizó un seguimiento de 12 meses después de su evaluación por vía telefónica. En caso de fallecimiento, se corroboró el suceso y la causa en el Sistema Informático Nacional de Defunciones (SINADEF) del Ministerio de Salud del Perú. Se excluyeron los pacientes que fallecieron por complicaciones de coronavirus. Para determinar la asociación entre IF-VGI y mortalidad se utilizaron las pruebas ji al cuadrado y t de Student, tanto para las variables cualitativas y cuantitativas, respectivamente. Resultados: Se incluyeron 241 sujetos, con una edad media de 85,08 años. De esta población, 222 (92,12 %) tenían fragilidad con un IF mayor-igual a 0,2. De ellos, 82 presentaron fragilidad leve (IF entre 0,2-0,36); 59, fragilidad moderada (IF entre 0,4-0,52), y 54, fragilidad severa (IF mayor 0,56). En el seguimiento de la población reevaluada a los 12 meses, 28 (11,61 %) fallecieron en este periodo. De los fallecidos, 23 (82,14 %) registraron un IF mayor igual a 0,56. Al analizar la asociación entre la mortalidad y el IF-VGI, se encontró que, a mayor índice de fragilidad, mayor mortalidad, con diferencias muy significativas (p = 0,001). No hubo asociación entre edad y mortalidad (p = 0,95). Conclusiones: El IF-VGI es una herramienta útil para predecir la mortalidad en los pacientes frágiles, según su severidad, a los 12 meses de seguimiento.
Objective: To determine the relationship between mortality and level of frailty using the Frailty Index-Comprehensive Geriatric Assessment (FI-CGA) among older adults at a 12-month follow-up. Materials and methods: A descriptive, observational and prospective study with non-probabilistic sampling conducted with patients over 60 years of age from the Geriatrics Service. Using the FI-CGA, frailty was diagnosed if the score was greater than or equal to 0.2 at the different levels of care: acute care unit, day hospital, outpatient clinic and house call. Moreover, a follow-up was conducted 12 months following their telephone consultation. In case of death, the event and cause were confirmed in the Sistema Informático Nacional de Defunciones (SINADEF, National Death Computer System) of the Ministry of Health of Peru. Patients who died from coronavirus complications were excluded. To determine the association between FI-CGA and mortality, chi-square and Student's t tests were used for the qualitative and quantitative variables, respectively. Results: A total of 241 subjects with an average age of 85.08 years were included in the research. Out of this population, 222 (92.12 %) were classed as frail (FI-CGA score ≥ 0.2), among which 82 were considered mildly frail (0.2-0.36), 59 moderately frail (0.4-0.52) and 54 severely frail (> 0.56). At the 12-month follow-up, 28 (11.61 %) older adults had died during that period. Out of the deceased, 23 (82.14 %) had a FI-CGA score greater than or equal to 0.56. When analyzing the association between mortality and the FI-CGA, it was found that the higher the FI, the higher the mortality, with very significant differences (p = 0.001). There was no association between age and mortality (p = 0.95). Conclusions: The FI-CGA is a useful tool to predict mortality in frail patients, according to their severity, at a 12-month follow-up.
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Objetivo: Verificar a associação entre indicadores espirométricos e a incidência da síndrome de fragilidade em pessoas idosas. Métodos: Trata-se de um estudo com delineamento longitudinal realizado em 2014-2019, com uma amostra de estudo de 104 pessoas idosas. A variável dependente foi a síndrome de fragilidade, avaliada por meio do fenótipo de Fried et al. e as variáveis independentes foram os indicadores espirométricos, sendo eles a Capacidade Vital Forçada (CVF), Pico de Fluxo Expiratório (PFE), Volume Expiratório Forçado no primeiro segundo (VEF1), relação VEF1/CVF e o Fluxo Expiratório Forçado 25%-75% (FEF25-75%). Resultados: A incidência de pessoas idosas frágeis foi de 16,3% em ambos os sexos, sendo que o sexo masculino apresentou melhores indicadores de função pulmonar que as mulheres. Apesar disso, observamos que não houve associação entre a síndrome de fragilidade e os indicadores espirométricos (p>0,05). Conclusão: Os indicadores espirométricos não são preditores de fragilidade em pessoas idosas residentes na comunidade, após cinco anos de seguimento.
Objective: To verify the association between spirometric indicators and the incidence of frailty syndrome in elderly people. Methods: This is a study with a longitudinal design carried out in 2014-2019, with a study sample of 104 elderly people. The dependent variable was the frailty syndrome, assessed using the phenotype of Fried et al. and the independent variables were the spirometric indicators, namely Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF), Forced Expiratory Volume in one second (FEV1), FEV1/FVC ratio and Forced Expiratory Flow 25%-75 % (FEF25-75%). Results: The incidence of frail elderly people was 16.3% in both genders, with males presenting better lung function indicators than females. Despite this, we observed that there was no association between the frailty syndrome and the spirometric indicators (p>0.05). Conclusion: Spirometric indicators are not predictors of frailty in community-dwelling elderly people after five years of follow-up.
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El envejecimiento ocasiona un aumento en la vulnerabilidad del adulto mayor. El ejercicio multicomponente se ha propuesto como una práctica para mejorar la funcionalidad física y cognitiva del adulto mayor, reducir la frecuencia de caídas y fracturas y prevenir la sarcopenia. Por tanto, en esta revisión bibliográfica se propone determinar los efectos del ejercicio multicomponente en el adulto mayor para evitar la progresión del síndrome de fragilidad. Se realizó una búsqueda bibliográfica en las bases de datos Hinari, PubMed, Scopus y Embase utilizando los operadores booleanos «AND¼ y «OR¼ y como palabras clave «fragilidad¼, «adulto mayor¼, «caídas¼, «fracturas¼, «sarcopenia¼ para delimitar literatura de utilidad a esta investigación. Se tomaron en cuenta artículos de revisión bibliográfica, casos y controles, metaanálisis, artículos originales, revisiones sistemáticas con vigencia menor a cinco años, en los idiomas inglés y español. El ejercicio multicomponente ocasiona una mejoría en la funcionalidad física, dependencia, prevención de caídas y reducción de la sarcopenia, siendo una herramienta útil para la regresión del síndrome de fragilidad en el adulto mayor
Aging causes an increase in the vulnerability of older adults. The practice of multicomponent exercise has been proposed to improve the physical and cognitive functionality of the older adult, reduce the frequency of falls and fractures, and prevent sarcopenia. Therefore, this literature review aims to determine the effects of multicomponent exercise in the older adult to prevent the progression of frailty syndrome. A literature search was performed in the Hinari, PubMed, Scopus and Embase databases, using the Boolean operators "AND" and "OR" and as keywords "frailty", "older adult", "falls", "fractures", "sarcopenia" to delimit useful literature for this research. Literature review articles, case-controls, meta-analysis, original articles, systematic reviews less than five years old, published in both English and Spanish were taken into account. Multicomponent exercise causes an improvement in physical functionality, independence, fall prevention, and reduction of sarcopenia, being a useful tool for the regression of frailty syndrome in the elderly.
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Humans , Aged , Aged , Exercise , Frailty , El SalvadorABSTRACT
Abstract This cross-sectional study aimed to evaluate the association between food consumption (meat, fish, and fruits and vegetables), anthropometric indicators (body mass index, waist circumference, and waist-to-height ratio), and frailty; and to verify whether these associations vary with edentulism. We used data from 8,629 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) (2015-16). Frailty was defined by unintentional weight loss, weakness, slow walking speed, exhaustion, and low physical activity. Statistical analyses included multinomial logistic regression. Of the participants, 9% were frail and 54% pre-frail. Non-regular meat consumption was positively associated with pre-frailty and frailty. Non-regular fish consumption, and underweight were associated only with frailty. Models with interactions reveled a marginal interaction between meat consumption and edentulism (p-value = 0.051). After stratification, non-regular meat consumption remained associated with frailty only in edentulous individuals (OR = 1.97; 95%CI 1.27-3.04). Our results highlight the importance of nutritional assessment, oral health, and public health-promoting policies to avoid, delay and/or reverse frailty in older adults.
Resumo Este estudo transversal teve como objetivo avaliar a associação entre consumo alimentar (carnes, peixe e frutas e hortaliças), indicadores antropométricos (índice de massa corporal, circunferência da cintura e relação cintura/estatura) e fragilidade; e verificar se essas associações variam com o edentulismo. Usamos dados de 8.629 participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil) (2015-16). A fragilidade foi definida por perda de peso não intencional, fraqueza, baixa velocidade da marcha, exaustão e baixa atividade física. As análises estatísticas incluíram regressão logística multinomial. Dos participantes, 9% eram frágeis e 54% pré-frágeis. O consumo não regular de carnes foi positivamente associado à pré-fragilidade e fragilidade. O consumo não regular de peixe e o baixo peso foram associados apenas à fragilidade. Modelos com interações revelaram uma interação marginal entre consumo de carnes e edentulismo (p-valor = 0,051). Após estratificação, o consumo não regular de carnes permaneceu associado à fragilidade apenas em indivíduos edêntulos (OR = 1,97; IC95% 1,27-3,04). Nossos resultados destacam a importância da avaliação nutricional, saúde bucal e políticas públicas de promoção da saúde para evitar, retardar e/ou reverter a fragilidade em adultos mais velhos.
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ABSTRACT Objective: To identify the obesity diagnosis with the highest association with physical frailty associated with sarcopenia EWGSOP II (sarcopenic obesity). Subjects and methods: We performed a cross-sectional analysis of 371 community-dwelling older adults. Appendicular skeletal lean mass and total body fat (TBF) were assessed using dual-energy x-ray absorptiometry, and physical frailty was defined using Fried's criteria. The phenotypes were identified according to the presence of sarcopenia by EWGSOP II and obesity, which was diagnosed using two concepts: BMI obesity (BMI ≥ 30 kg/m2) and TBF obesity (percentage of TBF ≥ 35% for women and ≥ 25% for men). Finally, the association of each group with physical frailty was evaluated. Results: The mean age was 78.15 ± 7.22 years. Sarcopenia EWGSOP II was diagnosed in 19.8% (n = 73), body mass index obesity was identified in 21.8% (n = 81), TBF obesity was identified in 67.7% (n = 251), and physical frailty was identified in 38.5% (n = 142). In a regression analysis for frailty, sarcopenic TBF obesity presented an odds ratio of 6.88 (95% confidence interval 2.60-18.24; p < 0.001). Conclusion: In older Brazilian adults, sarcopenic obesity diagnosed by TBF obesity has a robust association with frailty and is independent of body mass index.
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RESUMO Objetivo: analisar o conhecimento produzido na literatura científica sobre os instrumentos utilizados na avaliação da capacidade funcional, fragilidade e sarcopenia do idoso. Método: revisão integrativa da literatura, nas bases de dados Cinahl, MEDLINE/PubMed, Embase, Web of Science e Scopus, de 2012-2021. Foram extraídos os dados: autores, ano, país de publicação, tipo de estudo, características da amostra, objetivo, resultados e os instrumentos. Ademais, foi realizada a avaliação da qualidade metodológica e nível de evidência. Resultados: a amostra final incluiu 13 artigos. Os instrumentos mais utilizados foram: Índice de Lawton e Brody para avaliação da capacidade funcional; modelo conceitual do fenótipo para fragilidade; e a conceituação e diagnóstico do Grupo de Trabalho Europeu da Sarcopenia. Conclusão: as evidências científicas demonstraram a importância da utilização de instrumentos para o rastreio destas condições que podem interferir na saúde da população idosa, reforçando a necessidade do fortalecimento de práticas de cuidados interprofissionais.
ABSTRACT Objective: to analyze the knowledge produced in the scientific literature on the instruments used to assess functional capacity, frailty, and sarcopenia in older adults. Method: integrative literature review, in the Cinahl, MEDLINE/PubMed, Embase, Web of Science and Scopus databases, from 2012-2021. Data were extracted: authors, year, country of publication, type of study, sample characteristics, objective, results, and instruments. In addition, the methodological quality and level of evidence were assessed. Results: The final sample included 13 articles. The most used instruments were Lawton and Brody Index for functional capacity assessment; conceptual model of the frailty phenotype; and the conceptualization and diagnosis of the European Working Group on Sarcopenia. Conclusion: The scientific evidence demonstrated the importance of using instruments to screen for these conditions that can interfere with the health of the elderly population, reinforcing the need to strengthen interprofessional care practices.
RESUMEN Objetivo: analizar el conocimiento producido en la literatura científica sobre los instrumentos utilizados en la evaluación de la capacidad funcional, fragilidad y sarcopenia de las personas mayores. Método: revisión bibliográfica integradora, en las bases de datos Cinahl, MEDLINE/PubMed, Embase, Web of Science y Scopus, entre 2012 y 2021. Se extrajeron datos: autores, año, país de publicación, tipo de estudio, características de la muestra, objetivo, resultados e instrumentos. Además, se evaluó la calidad metodológica y el nivel de evidencia. Resultados: La muestra final incluyó 13 artículos. Los instrumentos más utilizados fueron: el índice de Lawton y Brody para evaluar la capacidad funcional; el modelo conceptual del fenotipo de fragilidad; y la conceptualización y diagnóstico del Grupo de Trabajo Europeo sobre Sarcopenia. Conclusión: La evidencia científica demostró la importancia del uso de herramientas para la detección de estas condiciones que pueden interferir con la salud de la población anciana, reforzando la necesidad de fortalecer las prácticas de atención interprofesional.
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Introducción Gracias al tratamiento antirretroviral en Occidente, la infección por el virus de la inmunodeficiencia humana (VIH) se ha convertido en una enfermedad crónica. Hoy, el 50% de las personas que viven con VIH son mayores de 50 años y en torno al 20% de los nuevos casos de esta infección se dan en ese mismo grupo etario. Este trabajo tiene por objeto el analizar los factores clínicos y sociodemográficos asociados a eventos adversos en salud (caídas, visitas a urgencias, ingresos hospitalarios y muerte) en una cohorte de personas mayores de 55 años con infección por VIH. Métodos Estudio exploratorio prospectivo con cuatro años de seguimiento. Se incluyeron personas con infección por VIH seguidas en las consultas de enfermedades infecciosas de dos hospitales de Madrid. Se recogieron datos sociodemográficos y variables clínicas. Se evaluó la situación funcional, mental y social de los participantes. Se revisaron en las historias clínicas de los pacientes número de caídas, visitas a los servicios de urgencias, ingresos hospitalarios y muertes producidas durante el periodo estudiado. Resultados Se incluyeron 117 pacientes con una edad media de 61,4 (desviación estándar 6,6) años y una mediana de seguimiento de 47 meses (35 a 50). De estos sujetos, el 25% tenía síntomas depresivos y el 10% tenía algún grado de deterioro cognitivo en la visita inicial. Las frecuencias de eventos adversos en salud registradas fueron: caídas del 7,7%, visitas a urgencias del 53%, ingresos hospitalarios del 33,3% y muertes del 2,6%. Los síntomas de depresión se asociaron con caídas y visitas a urgencias en el análisis bivariado. Los factores asociados a ingreso hospitalario fueron haber adquirido la infección por consumo de drogas por vía parenteral, ser frágil y ser menor de 65 años. Se realizó análisis multivariado para el resultado de ingresos hospitalarios con las variables que mostraron p < 0,05 en el análisis bivariado y ninguna de ellas alcanzó significación estadística. Conclusiones Los síntomas de depresión y el deterioro cognitivo se presentan con una alta frecuencia en estos pacientes, por lo que debería realizarse tamizaje de ambos de forma sistemática en este grupo poblacional. Son necesarios estudios con más pacientes y mayor tiempo de seguimiento que permitan identificar los factores de riesgo asociados a eventos adversos en las personas mayores que viven con VIH.
Introducción Gracias al tratamiento antirretroviral en Occidente, la infección por el virus de la inmunodeficiencia humana (VIH) se ha convertido en una enfermedad crónica. Hoy, el 50% de las personas que viven con VIH son mayores de 50 años y en torno al 20% de los nuevos casos de esta infección se dan en ese mismo grupo etario. Este trabajo tiene por objeto el analizar los factores clínicos y sociodemográficos asociados a eventos adversos en salud (caídas, visitas a urgencias, ingresos hospitalarios y muerte) en una cohorte de personas mayores de 55 años con infección por VIH. Métodos Estudio exploratorio prospectivo con cuatro años de seguimiento. Se incluyeron personas con infección por VIH seguidas en las consultas de enfermedades infecciosas de dos hospitales de Madrid. Se recogieron datos sociodemográficos y variables clínicas. Se evaluó la situación funcional, mental y social de los participantes. Se revisaron en las historias clínicas de los pacientes número de caídas, visitas a los servicios de urgencias, ingresos hospitalarios y muertes producidas durante el periodo estudiado. Resultados Se incluyeron 117 pacientes con una edad media de 61,4 (desviación estándar 6,6) años y una mediana de seguimiento de 47 meses (35 a 50). De estos sujetos, el 25% tenía síntomas depresivos y el 10% tenía algún grado de deterioro cognitivo en la visita inicial. Las frecuencias de eventos adversos en salud registradas fueron: caídas del 7,7%, visitas a urgencias del 53%, ingresos hospitalarios del 33,3% y muertes del 2,6%. Los síntomas de depresión se asociaron con caídas y visitas a urgencias en el análisis bivariado. Los factores asociados a ingreso hospitalario fueron haber adquirido la infección por consumo de drogas por vía parenteral, ser frágil y ser menor de 65 años. Se realizó análisis multivariado para el resultado de ingresos hospitalarios con las variables que mostraron p < 0,05 en el análisis bivariado y ninguna de ellas alcanzó significación estadística. Conclusiones Los síntomas de depresión y el deterioro cognitivo se presentan con una alta frecuencia en estos pacientes, por lo que debería realizarse tamizaje de ambos de forma sistemática en este grupo poblacional. Son necesarios estudios con más pacientes y mayor tiempo de seguimiento que permitan identificar los factores de riesgo asociados a eventos adversos en las personas mayores que viven con VIH.
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Introducción: La fuerza de prensión débil suele ser un marcador de dependencia funcional y pobre rendimiento físico, sin embargo, esta asociación es controversial en adultos mayores de 80 años. Objetivo: Determinar la asociación entre la fuerza de prensión y la dependencia funcional y rendimiento físico entre adultos mayores de 80 años. Métodos: El presente estudio es de tipo analítico transversal, fue realizado en 147 sujetos pertenecientes a la Marina de Guerra del Perú. Evaluamos la fuerza muscular, el rendimiento físico, la funcionalidad, las medidas antropométricas y la valoración nutricional. Resultados: Encontramos una asociación significativa entre la fuerza de prensión débil y la dependencia para actividades básicas de la vida diaria (ORa: 2,81, IC95%: 1,32 a 10,11), así como el rendimiento físico alterado (ORa: 4,32, IC95%: 1,97 a 9,59), dichas asociaciones fueron independientes de la edad, número de comorbilidades, síndromes geriátricos, hemoglobina, ferritina, glucosa, colesterol total, linfocitos, vitamina b12, triglicéridos, albúmina sérica, puntaje de MMSE, circunferencia de pantorrilla, circunferencia braquial, IMC, grado de instrucción, estado civil, sexo y índice cintura/cadera. Conclusiones: En los participantes mayores de 80 años, tener una fuerza de prensión débil estuvo asociada con tener fuerza muscular débil y pobre rendimiento físico. Nuestros resultados podrían ser útiles para la inclusión de estas medidas dentro de protocolos de atención hacia poblaciones de edad avanzada y alta comorbilidad. Con ello, se busca mejorar la integridad y atención de los pacientes geriátricos.
Introduction: Weak grip strength is a well-known associated factor with disability and physical performance, but this association is controversial in older adults aged 80 years or more. Objective: To determine the association between prehensile strength and functional dependence and physical performance among adults older than 80 years. Methods: This research was an analytical, cross-sectional study, conducted in 147 older adults aged 80 years or more, from Naval Peruvian Service. We included assessments about muscle strength, physical performance, disability, anthropometric variables, and nutritional assessment. Results: We found a significant association between weak grip strength and dependence for basic activities of daily living (aOR: 2.81, 95% CI: 1.32 to 10.11), as well as altered physical performance (aOR: 4.32, 95% CI: 1.97 to 9.59), these associations were independent of age, number of comorbidities, geriatric syndromes, hemoglobin, ferritin, glucose, total cholesterol, lymphocytes, vitamin B12, triglycerides, serum albumin, MMSE score, calf circumference, brachial circumference, BMI, level of education, marital status, sex, and waist/hip ratio. Conclusions: In persons older than 80 years, having weak grip strength was associated with weak muscle strength and poor physical performance. Our results could be useful for the inclusion of these measures within care protocols for elderly and high comorbidity populations. With this, it seeks to improve the integrity and care of geriatric patients.
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Resumen: Introducción: con los cambios demográficos el término «fragilidad¼ trasciende cada vez más en el ámbito quirúrgico. La relación entre fragilidad medida por dinamometría y la morbimortalidad en cirugía cardíaca no ha sido del todo estudiada. Objetivo: establecer la utilidad de la fragilidad determinada mediante dinamometría como predictor de morbimortalidad en pacientes geriátricos con bajo riesgo quirúrgico sometidos a cirugía cardíaca. Material y métodos: se realizó un estudio de cohortes prospectivo que incluyó 65 pacientes geriátricos de moderado riesgo quirúrgico sometidos a cirugía cardíaca electiva con derivación cardiopulmonar. A los pacientes se les realizó dinamometría preoperatoria para determinar fragilidad y se estimó su relación con la morbimortalidad postoperatoria. Se calculó sensibilidad, especificidad, valores predictivos y coeficientes de probabilidad positivos y negativos, coeficiente alfa de Cronbach y área bajo la curva ROC. Los datos se procesaron con SPSS v-24.0. Resultados: la evaluación del componente de calibración mostró que se ajusta a nuestra muestra (coeficiente alfa de Cronbach 0.79). La evaluación del componente de discriminación mostró que puede distinguir la población con riesgo de morbilidad (0.625) y mortalidad (0.597). Conclusión: la fragilidad determinada mediante dinamometría es útil como predictor de morbimortalidad en pacientes ancianos con bajo riesgo quirúrgico sometidos a cirugía cardíaca.
Abstract: Introduction: recent demographic changes have meant that more and more frail patients undergo surgery. The relationship between frailty, measured by dynamometry, and morbidity and mortality in cardiac surgery has not been fully studied. Objective: determine the usefulness of frailty, as measured by dynamometry, as a predictor of morbidity and mortality in geriatric patients with low surgical risk undergoing cardiac surgery. Material and methods: a prospective cohort study including 65 geriatric patients with moderate surgical risk undergoing elective cardiac surgery with cardiopulmonary bypass. The patients underwent preoperative dynamometry to determine their frailty, whose relationship with postoperative morbidity and mortality was evaluated. Sensitivity, specificity, predictive values, positive and negative probability coefficients, Cronbach's alpha coefficient and area under the ROC curve were calculated. The data were processed with SPSS v-24.0. Results: the evaluation of the calibration component showed that it fitted our sample (Cronbach's alpha coefficient 0.79). The evaluation of the discrimination component showed that it was able to distinguish between risk of morbidity (0.625) and risk of mortality (0.597). Conclusion: frailty, measured by dynamometry, is a useful predictor of morbidity and mortality in elderly patients with low surgical risk undergoing cardiac surgery.
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ABSTRACT BACKGROUND: Frailty comprises three dimensions: physical, psychological, and social. It is established that social frailty is correlated with several variables, such as quality of life, depression, and loneliness. These findings reinforce the need to investigate and define predictors of social frailty. OBJECTIVE: To translate, culturally adapt, and assess the reliability of the HALFT scale for Brazil. DESIGN AND SETTING: Methodological study conducted at Universidade Federal de São Carlos. METHODS: This study aimed to translate and culturally adapt the HALFT scale from English to Brazilian Portuguese, for which the steps of translation, synthesis of translations, back translation, evaluation by an expert committee, pre-test, and test-retest were followed. RESULTS: Two independent translators translated the HALFT. The consensual version was established by merging the translations, which were back translated into English by a third translator. The expert committee comprised seven health professionals working in frailty and/or social fields of study. Only one item on the scale had a content validity index of less than one (0.85). The instrument was pre-tested with 35 older adults who considered it clear and understandable, with no suggestion of changes. The reliability analysis (reproducibility) of the adapted version of the HALFT with test-retest of the scale with 23 participants showed a Kappa index of 0.62, showing good agreement. CONCLUSION: The HALFT scale is translated and adapted for Brazil, and shows good reliability. However, it is necessary to conduct psychometric analysis of the instrument to provide normative data for this population.
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Resumo Objetivo analisar a relação entre a síndrome de fragilidade e qualidade de vida em pessoas idosas hospitalizadas. Métodos estudo de abordagem quantitativa e corte transversal, desenvolvido com uma amostra de 323 pessoas idosas assistidas em hospitais universitários da Paraíba, durante agosto de 2019 a julho de 2020. Os dados foram tabulados no SPSS, versão 26.0, mediante teste qui-quadrado de Pearson, teste de correlação de Spearman e regressão logística múltipla entre variáveis sociodemográficas, de fragilidade e qualidade de vida. Resultados dos participantes, 60,7% eram mulheres, 49,2% tinham idade entre 60 e 69 anos, 51% tinham cônjuge, 67,8%, sabiam ler e escrever, 89,2% moravam com pelo menos uma pessoa, 78,3% não exercia atividade laboral e 57,9% recebiam até um salário mínimo. A síndrome de fragilidade foi significativa com gênero, idade, letramento, atividade laboral, renda e qualidade de vida. Já a qualidade de vida foi estatisticamente significativa com gênero e atividade laboral, somente. Foi visto que não saber ler, não exercer atividade laboral e ter baixa qualidade de vida aumentava em 3,04 (IC95%; 1,70-5,44), 4,51 (IC95%; 2,39-8,49) e 3,81 (IC95%; 2,22-6,53), a probabilidade de ter síndrome da fragilidade, respectivamente; enquanto que não exercer atividade remunerada acrescia em 2,61 (IC95%; 1,45-4,73) a probabilidade de ter baixa qualidade de vida. Conclusões a síndrome da fragilidade está associada a uma redução na qualidade de vida de pessoas hospitalizadas, o que sinaliza propostas de melhorias para gestores hospitalares no que tange a assistência além das condições clínicas já estudadas no cotidiano laboral.
Abstract Objective to analyze the relationship between frailty syndrome and quality of life in hospitalized older adults. Methods a quantitative cross-sectional study of 323 older individuals was carried out at university hospitals of Paraíba from August 2019 to July 2020. Data were analyzed by SPSS, version 26.0, using Pearson´s chi-square, Spearman´s correlation and multiple logistic regression for sociodemographic, frailty and quality of life variables. Results regarding participant profile, 60.7% were women, 49.2% aged 60-69 years, 51% had a partner, 67.8% were literate, 89.2% lived with at least 1 other person, 78.3% were not working, and 57.9% received ≤ 1 minimum wage. Frailty syndrome was significantly associated with gender, age, literacy, work status, income, and quality of life. Quality of life was statistically significantly associated with only gender and work status. Results showed that illiteracy, not working and low quality of life increased the probability of frailty syndrome by 3.04 (95%CI; 1.70-5.4), 4.51 (95%CI; 2.39-8.49), and 3.81 (95%CI; 2.22-6.53), respectively; while not working increased the probability of low quality of life.by 2.61 (95%CI;1,45-4,73). Conclusions frailty syndrome was associated with low quality of life in the hospitalized older adults, indicating the need for measures by hospital managers to improve care beyond the clinical conditions addressed in routine practice.
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Resumo Objetivo Comparar os escores do Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) e da Edmonton Frail Scale (EFS) entre pessoas idosas com 80 anos ou mais de idade que vivem na comunidade, considerando a prevalência e o grau de concordância. Método Trata-se de estudo transversal, aninhado a uma coorte de base populacional. A amostragem na linha de base foi probabilística, por conglomerados, em dois estágios. No primeiro, utilizou-se como unidade amostral o setor censitário. No segundo, definiu-se o número de domicílios segundo a densidade populacional de pessoas idosas. Foram determinados a sensibilidade, a especificidade e os valores preditivos. A estatística Kappa analisou o grau de concordância entre os instrumentos. Resultados Foram avaliadas 92 pessoas idosas longevas. A prevalência do alto risco de vulnerabilidade clínico-funcional, considerado pessoa idosa frágil, foi de 45,7% pelo IVCF-20 e a prevalência de fragilidade pela EFS foi de 44,6%. Os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo foram, respectivamente, 88,23%, 87,80%, 90,0% e 85,71%. A acurácia foi de 88,04%. A estatística Kappa foi 0,759 (p<0,001). Conclusão Os instrumentos IVCF-20 e EFS possuem boa acurácia e concordância forte, quando aplicado em pessoas idosas longevos que vivem na comunidade. A identificação da fragilidade foi superior, quando utilizado o IVCF-20. O resultado indica que os instrumentos avaliados possuem similaridade na prevalência da fragilidade em pessoas idosas longevas comunitárias.
Abstract Objective To compare Clinical-Functional Vulnerability Index-20 (IVCF-20) and Edmonton Frail Scale (EFS) scores among community-dwelling older people aged ≥80 years for prevalence and degree of agreement. Method A cross-sectional study nested within a population-based cohort, was conducted. Baseline sampling was probabilistic by two-stage clustering. In the first stage, the census tract was used as the sampling unit. In the second stage, the number of households was defined according to the population density of individuals aged ≥60 years. Sensitivity, specificity and predictive values were determined and Kappa statistics expressed degree of agreement between the instruments. Results 92 oldest-old people were evaluated. The prevalence of high risk of clinical and functional vulnerability on the IVCF, indicating frailty, was 45,7%, whereas the prevalence of frailty using the EFS was 44,6%. Sensitivity, specificity, positive predictive value and negative predictive values were 88,23%, 87,80%, 90,0% and 85,71%, respectively. Accuracy was 88,04% and the Kappa statistic 0.759 (p<0.001). Conclusion The IVCF-20 and EFS instruments showed good accuracy and strong agreement when applied to community-dwelling oldest-old people. The identification of frailty was superior using the IVCF-20. These results show that the instruments detected similar frailty prevalence in community-dwelling oldest-old people.
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Resumo Objetivo Investigar a associação entre fragilidade e edentulismo em pessoas idosas domiciliadas e determinar os fatores individuais, sociodemográficos e clínicos associados. Método Participaram deste estudo 333 pessoas idosas com 65 anos ou mais; eles responderam ao instrumento Edmonton Frail Scale Instrument (EFS). Também foram coletados dados sobre fatores socioeconômicos, saúde bucal e uso e necessidade de próteses dentárias. Aqueles com dificuldades cognitivas foram excluídos. Foram realizadas regressões logísticas multivariadas por meio dos métodos stepwise e backward que testaram a relação da perda dentária e covariáveis com os resultados da EFS. Variáveis com p<0,20 nas análises não ajustadas foram incluídas na regressão logística ajustada. Resultados A prevalência de fragilidade moderada a grave foi de 12,3%. O edentulismo foi relacionado à fragilidade (OR 3,45; IC 95%: 1,45 - 8,25; p=0,01), idade (OR 2,19; IC 95%: 1,07 - 4,46; p=0,03), sexo feminino (OR 2,75; IC 95%: 1,23 - 6,15; p=0,01), necessidade de prótese dentária inferior (OR 3,19; IC 95%: 1,27 - 8,05; p=0,01) e percepção de dor de dente (OR 2,74; IC 95%: 1,15 - 6,15; p=0,02). Conclusões A fragilidade foi associada ao edentulismo, idade, sexo feminino, necessidade de prótese dentária inferior e percepção de dor de dente. Essas condições bucais são altamente prevalentes entre os idosos e podem ser prevenidas por políticas públicas e ações multiprofissionais. Os exames bucais devem ser considerados nas avaliações de pacientes pré-frágeis e frágeis, pois os indicadores de saúde bucal foram associados a fragilidade da pessoa idosa.
Abstract Objective To investigate the association between frailty and edentulism in community-dwelling older adults and determine the individual, sociodemographic, and clinical factors associated. Method A total of 333 older adults aged 65 years or more participated in this study; they responded to the Edmonton Frail Scale instrument (EFS). Data on socioeconomic factors, oral health, and use of and need for dentures were also collected. Those with cognitive difficulties were excluded. Hierarchical multivariable logistic regression models were performed using the stepwise and backward procedure, which tested the relationship of edentulism and covariates with EFS results. Variables with p<0,20 in the unadjusted analyzes were included in the adjusted logistic regression. Results The prevalence of moderate to severe frailty was 12.3%. Edentulism was related to frailty (OR 3,45; IC 95%: 1,45 - 8,25; p=0,01), age (OR 2,19; IC 95%: 1,07 - 4.46; p=0,03), female sex (OR 2,75; IC 95%: 1,23 - 6,15; p=0,01), the need of lower dental prosthesis (OR 3,19; IC 95%: 1,27 - 8,05; p=0,01) and toothache perception (OR 2,74; IC 95%: 1,15 - 6,15; p=0,02). Conclusions Frailty was associated with edentulism, age, female sex, the need for lower dental prosthesis and toothache perception. These oral conditions are highly prevalent among older adults and can be prevented by multiprofessional actions supported by public policies. Oral examinations should be considered in pre-frail and frail patients' assessments as oral health indicators were associated of older adults' frailty.