Repercussion of Covid-19 on Health and Nutritional Status of Elderly: Current Scenario

Ageing is an inevitable process with numerous changes in a physiological, biological, cognitive, and social environment. The COVID-19 pandemic has posed an unprecedented public health crisis globally. Both the problems adversely affect the nutritional and health status of the elderly. Malnutrition, increase risk of chronic morbidities, low socioeconomic status along with social deprivations influence the health and well-being of old age. Lack of physical activity is common due to loss of skeletal muscle mass and an increase of fat mass eventually causes functional inability. The review aimed to report the impact of Covid-19 on the health and nutritional status of the elderly. A thorough recent literature search was conducted using PubMed, Science Direct, and Google Scholar databases using specific keywords related to the aims. All related articles published on COVID-19 during 2020 and their effect on health and nutrition in the elderly were retrieved. The study found that nutritional status influences mortality and co-morbidities among the elderly during the COVID-19 situation. Furthermore, the study found that though nutritional indicators, that is, overweight or obese, significantly increase the risk of co-morbid conditions among older adults, good nutrition reduces the risk of all-cause mortality. Although ageing is an irreversible process, it is never too late to start practicing a healthy behavioral lifestyle for achieving healthy ageing.

Interpretation of "Decade of Healthy Ageing: Baseline Report" / 中华老年医学杂志

The global population aging problem is increasingly serious.For this reason, WHO proposed the goal of "Healthy Ageing" in 2015, that is to maintain and develop the functional ability of the individuals in order to achieve happiness in old age.At the same time, WHO introduced the relationship between functional ability, intrinsic capacity and the surrounding environment in which older adults live and acquire assistance, providing a new way for solving population aging. "Decade of Healthy Ageing: Baseline Report" was published by WHO in January 2021.It took advantage of existing national studies on ageing in 42 countries to assess the global status of healthy ageing at the start of the decade.And then it outlooks ten years ahead, to 2030, what level we can achieve, and what needs to improve ten years from now.

Neurodinámica del nervio mediano como tratamiento del dolor cervical radicular / Neurodynamics of the median nerve as a treatment for radicular neck pain

Introducción: La radiculopatía cervical es una de las afecciones que con mayor frecuencia se presenta en la población joven. La irradiación del dolor a los miembros superiores causa afectación a la calidad de vida. La neurodinámica ofrece ventajas en el tratamiento de esta afección. Objetivo: Identificar los efectos de la movilización neural mediante neurodinámica en los síntomas irradiados del dolor cervical radicular. Métodos: Investigación aplicada, cuasi experimental, descriptiva y longitudinal aplicada en 28 trabajadores de la Universidad Nacional de Chimborazo diagnosticados de cervicalgia de origen neural. Se aplicaron varios exámenes entre los que destaca el test de tensión neurodinámico del nervio mediano para el diagnóstico del dolor cervical radicular. Se procedió a realizar 6 sesiones de neurodinámica que cambiaron la evolución de la afección diagnosticada. Se aplicó la prueba de McNemar para identificar cambios en la intensidad del dolor. Resultados: Promedio de edad de 46,28 años con predominio de trabajadores entre 40 y 49 años (39,29 por ciento) y del sexo femenino (67,86 por ciento). El 39,28 por ciento de los trabajadores refirió comorbilidades asociadas: el hipotiroidismo (45,45 por ciento) y la hipertensión arterial (36,36 por ciento) fueron las más referidas. Después de aplicada la técnica, solo el 3,57 por ciento de los trabajadores continuó con dolor irradiado y con intensidad moderada, el 60,72 por ciento presentó un dolor leve y el 35,71 por ciento se autoidentificó sin dolor. Conclusiones: La aplicación de la movilización neural mediante neurodinámica provocó cambios estadísticamente significativos en la disminución de la intensidad del dolor cervical y también mejoró la irradiación del dolor a los miembros superiores(AU)

Introduction: Cervical radiculopathy is one of the conditions that occurs most frequently in the young population. The radiation of pain to the upper limbs affects quality of life. Neurodynamics offers advantages in the treatment of this condition. Objective: To identify the effects of neural mobilization by neurodynamics in the radiated symptoms of radicular neck pain. Methods: Applied, quasi-experimental, descriptive and longitudinal research applied to 28 workers from the National University of Chimborazo diagnosed with neck pain of neural origin. Several tests were applied, among which the neurodynamic tension test of the median nerve stands out for the diagnosis of radicular neck pain. 6 neurodynamic sessions were carried out, which changed the evolution of the diagnosed condition. The McNemar test was applied to identify changes in pain intensity. Results: Average age of 46.28 years with a predominance of workers between 40 and 49 years old (39.29 percent) and female (67.86 percent). 39.28 percent of the workers referred associated comorbidities, hypothyroidism (45.45 percent) and arterial hypertension (36.36 percent) were the most referred. After applying the technique, only 3.57 percent of the workers continued with radiating pain and with moderate intensity, 60.72 percent presented mild pain and 35.71 percent self-identified as pain-free. Conclusions: The application of neural mobilization through neurodynamics caused statistically significant changes in the decrease in the intensity of neck pain and also improved the radiation of pain to the upper limbs(AU)

Anthropometric parameters, lower limb functionality and quality of life after high-intensity interval training in healthy young people versus older adults / Parámetros antropométricos, funcionalidad de miembros inferiores y calidad de vida posterior al entrenamiento interválico de alta intensidad en jóvenes versus personas mayores

SUMMARY: The aim of this study was to determine the effects of High-intensity interval training (HIIT) on the quality of life in healthy young people (YNG) and older adults (OLD)and its correlation with physical health status (anthropometric parameters and lower limb functionality) YNG (21 ? 2 years, BMI 26.37 ? 2.69 n = 12) and OLD (67 ? 5 years, BMI 27.16 ? 3.04 n = 12) groups underwent 12weeks of HIIT. Before and after the HIIT, anthropometric assessments, lower limb functionality tests, and SF-36 quality-of-life questionnaire were performed. There were no significant changes in the SF-36 dimensions (P>0.05). After HIIT, there were improvement percentage changes in Mental Component Summary (MCS) (YNG, +8.51 ? 25.80 % vs. OLD, +2.30 ? 9.05 %) and in Physical Component Summary (PCS) (YNG, +2.66 ? 20.54 % vs. OLD, +4.34 ? 22.71 %). Negative correlations were observed between body mass index (BMI) with PCS (R=-0.570, P=0.009) and with MCS (R=-0.649, P=0.002) in OLD as well as between MCS and waist circumference (R=-0.557, P?0.001) in both groups. Also, correlations were observed between PCS and the sit-to-stand test (R=-0.424, P=0.006) in both groups and gait speed (R=0.458, P=0.042) only in YNG. HIIT promotes positive percentage changes in quality of life, with YNG showing better results in PCS and OLD in MCS. Quality of life and physical health status were correlated in both groups.

RESUMEN: Determinar los efectos del entrenamiento interválico de alta intensidad (HIIT) sobre la calidad de vida en jóvenes sanos (YNG) y personas mayores (OLD) y su correlación con el estado de salud física (parámetros antropométricos y funcionalidad de miembros inferiores). Ambos grupos, YNG (21 ? 2 años, IMC 26,37 ? 2,69 n = 12) y OLD (67 ? 5 años, IMC 27,16 ? 3,04 n = 12) realizaron 12 semanas de HIIT. Antes y después del HIIT, se realizaron evaluaciones antropométricas, pruebas de funcionalidad de miembros inferiores y cuestionario de calidad de vida SF-36. No hubo cambios significativos en las dimensiones del SF-36 (P >0,05). Después del HIIT, hubo cambios porcentuales de mejora en el componente sumario mental (MCS) (YNG, +8.51 ? 25.80 % vs. OLD, +2.30 ? 9.05 %) y el componente sumario física (PCS) (YNG, +2,66 ? 20,54 % vs. OLD, +2,30 ? 9,05 %), correspondientes a la calidad de vida. Se observaron correlaciones negativas entre el índice de masa corporal (IMC) con PCS (R=-0,570; P=0,009) y con MCS (R=0,649; P=0,002) en OLD, así como entre MCS y circunferencia de cintura (R = - 0,557, P?0,001) en ambos grupos. Además, se observaron correlaciones entre PCS y la prueba de sentarse y levantarse (R = -0,424; P = 0,006) en ambos grupos y la velocidad de la marcha (R = 0,458; P = 0,042) solo en YNG. HIIT promueve cambios porcentuales positivos en la calidad de vida, con YNG mostrando mejores resultados en PCS y OLD en MCS. La calidad de vida y el estado de salud física se correlacionaron en ambos grupos.

An Exploration of Nutritional Status in Relation to Diet Quality, Functional and Mental Ability among Elderly in Tonk, India

@#Introduction: Ageing is a natural and irreversible process, associated with deterioration of physiological, social and cognitive activities. The nutritional status of the elderly is adversely affected by declining cognitive and functional ability. The association of nutritional status with diet quality, functional and cognitive ability and depression among the elderly is not well understood. This study aimed to compute the association of nutritional status with diet quality, functional and cognitive ability and depression among the elderly. Method: A cross-sectional study was undertaken on 250 elderly (146 men, 104 women) of ≥65 years, residing in Tonk district of Rajasthan (India). Self-developed elderly dietary index (EDI) was used to evaluate diet quality and standardized tools, viz., geriatric depression scale (GDS), activities of daily living (ADL), instrumental activities of daily living (IADL), mini nutritional assessment (MNA), and short portable mental status questionnaire (SPMSQ) were used to assess depression, functional status, nutritional status and cognition respectively. Results: Two-thirds of the elderly in this study were at risk of malnutrition (66.67%, n= 167). MNA scores had significant association with Indian EDI (χ2 = 47.50, p=0.000), ADL (χ2 = 32.37, p= 0.000) and SPMSQ (χ2 =18.61, p= 0.001), whereas MNA scores had non significant association with IADL (χ2 = 14.30, p= 0.006) and GDS scores (χ2 = 5.44, p= 0.066). IADL scores were found to be significantly correlated with GDS (r= -0.255) and SPMSQ (r= -0238) Conclusion: Present study shows that the nutritional status of the elderly is associated with diet quality, functional and cognitive ability, but is not associated with depression in the elderly of Tonk.

Trastorno de la alineación de articulaciones metacarpofalángicas en una adolescente con artritis idiopática juvenil / Metacarpophalangeal joint alignment disorder in a teenager diagnosed with juvenile idiopathic arthritis

La artritis idiopática juvenil es una enfermedad inflamatoria, sistémica y crónica que afecta a personas menores de 18 años de edad. Tiene diversas formas clínicas de presentación, pero todas y cada una de ellas pueden causar un elevado número de complicaciones articulares y extraarticulares que pueden desencadenar discapacidad funcional y disminución de la percepción de la calidad de vida relacionada con la salud. Se presenta la imagen poco frecuente de alteraciones de la alineación en las articulaciones metacarpofalángicas de ambas manos en una paciente de 14 años de edad con antecedentes de 3 años de evolución de artritis idiopática juvenil. Se administró tratamiento con esteroides y medicamentos modificadores de la enfermedad. A los 3 meses se encontraba estable, con una escala visual análoga de dolor ocasional de 2 puntos y con esquema terapéutico adecuado para el control de su enfermedad de base(AU)

Juvenile idiopathic arthritis is an inflammatory, systemic and chronic disease that affects people under 18 years of age. It presents various clinical forms of presentation but each and every one of them can generate a high number of joint and extra-articular complications that can trigger functional disability and decrease in the perception of health-related quality of life. There is a rare image of alterations in the alignment at the level of metacarpophalangeal joints of both hands in a 14-year-old patient with a history of three years of evolution of juvenile idiopathic arthritis(AU)

Feasibility And Outcomes Of Autogenic Relaxation Training In Addition To Usual Physiotherapy For Stroke Survivors – A Pilot Study

@#A significant percentage of stroke survivors are reported to have anxiety and depression. Autogenic Relaxation Training (ART), a psychophysiological self-control therapy which aims to induce relaxation proved to be effective in reducing the anxiety and depression in some health conditions. However, there is lack of studies which evaluated the effects of ART in the rehabilitation of stroke survivors. The aim of this experimental pilot study is to evaluate the feasibility and outcomes of ART in addition to usual physiotherapy for stroke survivors. A total of 14 sub-acute stroke survivors from a teaching hospital were enrolled in this study. All participants received 20 minutes ART followed by 40 minutes usual physiotherapy once a week and they were requested to carry out the intervention at home for twice per week, for six weeks. Intervention outcomes were assessed using Hospital Anxiety and Depression Scale (HADS-A and HADS-D), Barthel Index (BI), Timed Up and Go (TUG) and EuroQol 5-Dimension 5 Levels (EQ5D5L). Changes in all outcome measures were analysed using paired t-test and Wilcoxon signed rank test, with level of significance set at p<0.05. Post-intervention, there is statistically significant reduction of the HADS-A (p=0.04), HADS-D (p=0.02), TUG (p=0.004) and EQ5D5L (p=0.03) scores of the participants. Although not statistically significant, the mean score ± SD of BI increased from 95 ± 12.5 to 100 ± 6.25. The intervention is feasible and acceptable by the stroke survivors with no adverse events reported. In conclusion, ART in addition to usual physiotherapy is feasible and beneficial in reducing anxiety and depression, and improving functional ability, mobility and quality of life among stroke survivors.

Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1 / Fraqueza muscular representa o principal fator limitante da marcha, independência funcional e qualidade de vida de pacientes com mielopatia associada ao HTLV-1

ABSTRACT HTLV-1-associated myelopathy is a progressive disabling disease associated with gait abnormalities. Objective To identify and quantify the main muscles affected by weakness and spasticity, their impact on gait, functional capacity and on quality of life of HTLV-1-associated myelopathy patients. Method We evaluated lower limbs muscular strength according to the Medical Research Council scale, spasticity according to the modified Ashworth scale, daily activities according to the Barthel Index and quality of life according to the Short-Form Health Survey-36 of 26 HTLV-1-associated myelopathy patients. Results The muscles most affected by weakness included the dorsal flexors and knee flexors. Spasticity predominated in the hip adductor muscles and in plantar flexors. Assistance for locomotion, minimal dependence in daily activities, limitations in functional capacity and physical aspects were the most common findings. Conclusion The impairment of gait, functional dependence and quality of life were predominantly a consequence of intense muscle weakness in HTLV-1-associated myelopathy patients.

RESUMO Mielopatia associada ao HTLV-1 é uma doença inflamatória, incapacitante e progressiva que acomete o sistema nervoso central. Objetivo Identificar e quantificar os principais músculos comprometidos pela fraqueza e espasticidade, o impacto na capacidade funcional e na qualidade de vida dos pacientes com mielopatia associada ao HTLV-1. Método Força muscular ( Medical Research Council), espasticidade (escala Ashworth modificada), atividades de vida diária (Índice de Barthel) e qualidade de vida ( Short-Form Health Survey-36) foram avaliados em 26 pacientes . Resultados Os principais músculos comprometidos pela fraqueza incluíram os flexores dorsais e flexores do joelho. A espasticidade predominou nos músculos adutores do quadril e nos flexores plantares. Assistência para locomoção, dependência mínima nas atividades diárias, limitações na capacidade funcional e os aspectos físicos representaram os achados mais frequentes. Conclusão Dificuldade de deambulação, dependência funcional e prejuízo na qualidade de vida foram as principais consequências da intensa fraqueza muscular nos pacientes com mielopatia associada ao HTLV-1.

Comparative study of the effectiveness between balancing exercises and strengthening exercises with common use of TENS to improve functional ability in Osteoarthritis involving knee joint.

Background and purpose: People with knee Osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. Proprioception and balance are important aspects of osteoarthritis treatment because of their strong correlation with function in the knee. The purpose of this study is to evaluate the effects of balancing exercises and strengthening exercises to improve functional ability in knee osteoarthritis patients and also it may be helpful to identify the use of best treatment protocol for OA knee. Material and methods: Thirty OA knee patients randomly allocated into two groups and received either balancing exercises (Group A) or strengthening exercises (Group B). Both the groups received TENS and taken treatment for 4 days a week for 4 weeks. The outcome measures were VAS and WOMAC. VAS was used to measure intensity of knee pain and WOMAC was used for assessment of perceived pain, stiffness and functional ability. Results: After 4 weeks of treatment, significant reduction in the WOMAC score and VAS was found in both the Groups. The result showing statistical improvement is more in Group A than Group B. Conclusion: The results of the study shows that balancing exercise is more effective than strengthening exercise to improve the functional ability of OA involving knee joint. The improvement in Group A is more than Group B and having statistically highly significant.

Accuracy and reliability of the Pfeffer Questionnaire for the Brazilian elderly population / Acurácia e confiabilidade do questionário de Pfeffer para a população idosa brasileira

ABSTRACT. The aging population calls for instruments to assess functional and cognitive impairment in the elderly, aiming to prevent conditions that affect functional abilities. OBJECTIVE: To verify the accuracy and reliability of the Pfeffer (FAQ) scale for the Brazilian elderly population and to evaluate the reliability and reproducibility of the translated version of the Pfeffer Questionnaire. METHODS: The Brazilian version of the FAQ was applied to 110 elderly divided into two groups. Both groups were assessed by two blinded investigators at baseline and again after 15 days. In order to verify the accuracy and reliability of the instrument, sensitivity and specificity measurements for the presence or absence of functional and cognitive decline were calculated for various cut-off points and the ROC curve. Intra and inter-examiner reliability were assessed using the Interclass Correlation Coefficient (ICC) and Bland-Altman plots. RESULTS: For the occurrence of cognitive decline, the ROC curve yielded an area under the curve of 0.909 (95%CI of 0.845 to 0.972), sensitivity of 75.68% (95%CI of 93.52% to 100%) and specificity of 97.26%. For the occurrence of functional decline, the ROC curve yielded an area under the curve of 0.851 (95%CI of 64.52% to 87.33%) and specificity of 80.36% (95%CI of 69.95% to 90.76%). The ICC was excellent, with all values exceeding 0.75. On the Bland-Altman plot, intra-examiner agreement was good, with p>0.05 consistently close to 0. A systematic difference was found for inter-examiner agreement. CONCLUSION: The Pfeffer Questionnaire is applicable in the Brazilian elderly population and showed reliability and reproducibility compared to the original test.

RESUMO. Com o envelhecimento populacional, ocorre a necessidade de instrumentos adequados para avaliar o comprome timento funcional e cognitivo do idoso, visando prevenir qualquer condição que afete sua funcionalidade. OBJETIVO: Verificar a acurácia e confiabilidade da escala de Pfeffer (FAQ) para a população idosa brasileira; avaliar a confiabilidade e reprodutibilidade da versão traduzida do questionário de Pfeffer. MÉTODOS: A versão brasileira do FAQ foi aplicada em 110 idosos divididos em dois grupos. Ambos passaram, em um primeiro momento e após 15 dias, por uma avaliação feita por dois pesquisadores, de forma cega. Para verificar a acurácia e confiabilidade do instrumento, medidas de sensibilidade e especificidade para a ocorrência ou não de declínio funcional e cognitivo foram calculadas para diversos pontos de corte e a curva ROC. Para medir a confiabilidade intra e interexaminadores foram utilizados o Coeficiente de Correlação Interclasse (ICC) e o gráfico Bland-Altman. RESULTADOS: Para a ocorrência de declínio cognitivo a curva ROC forneceu uma área sob a curva igual a 0,90, sensibilidade igual a 75,68% e especificidade de 97,26%. Para a ocorrência de declínio funcional, a curva ROC forneceu uma área sob a curva igual a 0,851, sensibilidade igual a 75,93% e especificidade de 80,36%. O ICC foi excelente, sendo todos os valores superiores a 0,75. No gráfico Bland-Altman, a concordância intraexaminadores foi boa, já na concordância interexaminadores houve uma diferença sistemática. CONCLUSÃO: O questionário de Pfeffer tem aplicabilidade na população idosa brasileira e apresenta confiabilidade e reprodutibilidade quando comparado ao teste original.

Velocidade da marcha, força de preensão e saúde percebida em idosos: dados da rede FIBRA Campinas, São Paulo, Brasil / Gait speed, grip strength and self-rated health among the elderly: data from the FIBRA Campinas network, São Paulo, Brazil

O objetivo do artigo é descrever condições de força de preensão, velocidade da marcha e autoavaliação de saúde e investigar relações entre elas, considerando-se as variáveis gênero, idade e renda familiar, em amostra probabilística de idosos comunitários com 65 anos e mais, integrantes de um estudo populacional sobre fragilidade. Um total de 689 idosos, sem déficit cognitivo sugestivo de demência, foram submetidos a testes de velocidade da marcha e de força de preensão manual. Os idosos foram classificados como de baixa, média e alta força e velocidade. Autoavaliação de saúde foi avaliada por um item escalar com 5 pontos. Os homens e os idosos mais novos pontuaram mais alto em força de preensão e velocidade da marcha; os de 80 anos e mais e as mulheres tiveram menor força de preensão e menor velocidade da marcha; lentidão da marcha e baixa renda foram fatores de risco para pior avaliação de saúde. Baixa força muscular afeta a autoavaliação de saúde porque acarreta diminuição da capacidade funcional, especialmente na presença de pobreza e escassez de recursos compensatórios.

The article seeks to investigate patterns of performance and relationships between grip strength, gait speed and self-rated health, and investigate the relationships between them, considering the variables of gender, age and family income. This was conducted in a probabilistic sample of community-dwelling elderly aged 65 and over, members of a population study on frailty. A total of 689 elderly people without cognitive deficit suggestive of dementia underwent tests of gait speed and grip strength. Comparisons between groups were based on low, medium and high speed and strength. Self-related health was assessed using a 5-point scale. The males and the younger elderly individuals scored significantly higher on grip strength and gait speed than the female and oldest did; the richest scored higher than the poorest on grip strength and gait speed; females and men aged over 80 had weaker grip strength and lower gait speed; slow gait speed and low income arose as risk factors for a worse health evaluation. Lower muscular strength affects the self-rated assessment of health because it results in a reduction in functional capacity, especially in the presence of poverty and a lack of compensatory factors.

Functional disability in community-dwelling elderly: the role of cataracts and contextual factors / Incapacidade funcional em idosos comunitários: o papel da catarata e dos fatores contextuais

Introduction Cataract arises as a risk factor for functional disability in elderly Objective: To determine differences in functional capacity and contextual factors associated with it in elderly affected and not affected by cataract and association between disability and cataracts.Methods A transversal-type observational study was carried out with 100 community elderly, divided into two groups: elderly affected (n = 50) and not affected by cataracts (n = 50). It was evaluated: activities of daily living (ADL) – Katz Index –, instrumental activities of daily living (IADL) – Lawton scale – and mobility – Short Physical Performance Battery. Functional disability was detected when the elderly were dependent or semi-dependent for one or more IADL or ADL and/or when they presented any difficulty in mobility. Data analysis included absolute and relative frequencies, Chi-squared or Fisher’s exact tests (p < 0.05) and Poisson regression.Results No statistically significant associations were observed between IADL, ADL or mobility disability and cataracts. A statistically significant difference was observed between the disabled elderly affected and not affected by cataract according to contextual factors for ADL regarding age (p = 0.037) and comorbidity (p = 0.037), for mobility regarding the practice of physical activity (p = 0.013), and for IADL (p = 0.001), ADL (p = 0.001) and mobility (p = 0.013) regarding the self-reporting of eyesight problems.Conclusions Besides cataracts, physical inactivity, comorbidity and functional aging itself are contributing factors to the process of disability in elderly, so, the physiotherapy is essential both to prevent as to reverse this process.

Introdução Catarata surge como fator de risco para a incapacidade funcional em idosos.Objetivos Determinar diferenças na capacidade funcional e nos fatores contextuais a ela associados em idosos com e sem catarata e associação entre incapacidade funcional e catarata.Métodos Estudo observacional transversal, realizado com uma amostra de 100 idosos comunitários, divididos em dois grupos: idosos com catarata (n = 50) e idosos sem catarata (n = 50). Foram avaliadas: atividades de vida diária (AVD) – Índice de Katz –, atividades instrumentais de vida diária (AIVD) – Escala de Lawton – e mobilidade – Short Physical Pherformance Battery. Incapacidade funcional foi detectada quando os idosos apresentassem dependência ou semi-dependência para uma ou mais AVD ou AIVD e/ou qualquer dificuldade na mobilidade. As análises dos dados incluíram frequência absoluta e relativa, testes Qui quadrado ou Exato de Fisther (p < 0.05) e análise regressiva de Poisson.Resultados Não houve associação estatisticamente significativa entre AIVD, AVD ou mobilidade e ter catarata. Diferença estatisticamente significativa entre os idosos incapacitados de G1 e G2 conforme os fatores contextuais ocorreram para faixa etária (p = 0.037), comorbidade (p = 0.037) e incapacidade para AVD; prática de atividade física (p = 0.013) e incapacidade para mobilidade e autorrelato de dificuldade de enxergar e incapacidade para AIVD (p = 0.001), AVD (p = 0.001) e mobilidade (p = 0.013).Conclusões Além de catarata, inatividade física, comorbidade e o próprio envelhecimento funcional são fatores contribuintes para o processo de incapacidade em idosos, assim, a fisioterapia é essencial tanto para prevenir como para reverter este processo.

Influência do treinamento da potência muscular sobre a capacidade de execução de tarefas motoras em mulheres idosas / Influence of muscle power training on the ability to implement motor tasks for older women

INTRODUÇÃO: A manutenção da capacidade de geração de potência muscular é fator preponderante para a independência física e funcional do idoso. OBJETIVO: Avaliar o efeito de um programa de treinamento contra resistência em velocidade (PTCRV) sobre a potência muscular e o desempenho em tarefas motoras em idosas. MÉTODOS: 58 voluntárias sedentárias e fisicamente independentes foram divididas em dois subgrupos: 31 pertencentes ao grupo intervenção (GI), 68,7±5,2 anos de idade e 27 ao grupo controle (GC) 67,7±3,8 anos de idade. O GI foi submetido a um programa de 24 sessões, três vezes semanais, de treinamento contra resistência em velocidade. Foram avaliadas a carga (CR), a potência (PT) e a velocidade (VL) no exercício extensão de joelhos (EJ) e no teste motor de levantar-se da cadeira (LC), utilizando o sistema computadorizado Tendo Weightlifting Analyzer (TWA). Foi avaliado também o tempo de execução das tarefas motoras: marcha em velocidade de conforto (MVC) e marcha em velocidade máxima (MVM). Para comparação das variáveis estudadas, aplicou-se o teste t, admitindo-se p=0,05. RESULTADOS: Foi observado no GI para o exercício EJ ganho significativo na capacidade de geração da potência (49,56±13,52w / 66,87±16,27w, p=0,0002). No teste LC, houve aumento significativo na capacidade de geração da potência (370,71±106,26w / 434,52±107,15w, p=0,02185) e da velocidade (0,61±0,14m/s / 0,72±0,14m/s, p=0,00274). Nos testes motores, MVC e MVM, houve redução significativa no tempo de execução (4,56±0,63s / 4,20±0,50s, p=0,01560) e (3,45±0,40s / 3,23±0,34s, p=0,02222), respectivamente. No GC não foi observada melhora significativa em nenhum dos testes aplicados. CONCLUSÃO: O PTCRV contribuiu para melhorar os níveis de potência muscular, além de melhorar o desempenho nas tarefas motoras no grupo estudado.

INTRODUCTION: The maintenance of the generating capacity of muscle power is an important factor for physical and functional independence of the elderly. OBJECTIVE: Investigation of the influence of the training of muscular power (PTCRV) in old women during pre-determined motor chores. METHODS: 58 sedentary physically independent volunteers, divided in two groups: 31 belonged to the intervention group (GI) 68.7±5.2 years and 27 to the control group (GC) 67.7±3.8 years. The GI was subjected to a 24-section program, three times a week, of counter-resistance training in speed. Power (PT) and speed (VL) in the exercise were assessed: knee extension (EJ), and in the stand-up-from-a-chair test (LC), using the software Tendo Weighlifting Analyzer (TWA). The time of execution of motor chores was also evaluated: gait in comfortable speed (MVC), and gait in maximum speed (MVM). The variation t test was applied to compare the studied variables and a level of significance p=0.05 was admitted. RESULTS: It was observed in the GI, for the EJ exercise, a significant gain in the ability of power generation (370.71±106.26w / 434.52±107.15w, p=0.02185). In the LC test there was significant gain in the ability of power generation (370.71±106.26w / 434.52±107,15w, p=0.02185) and speed (0.61±0.14m/s / 0.72±0.14m/s, p=0.00274). In the motor tests MVC and MVM, there was significant gain in speed (4.56±0.63s / 4.20±0.50s, p=0.01560) and (3.45±0.40s / 3.23±0.34s, p=0.02222), respectively. No significant improvement in the GC was observed after application of the tests. CONCLUSION: The PTCRV contributed to improve the muscular power, as well as improving the performance in the motor chores in the studied group.

Vulnerabilidade social, individual e programática em idosos da comunidade: dados do estudo FIBRA, Campinas, SP, Brasil / Social, individual and programmatic vulnerability among the elderly in the community: data from the FIBRA Study conducted in Campinas, São Paulo, Brazil

Condições socioculturais e econômicas interagem com os processos biológicos ao longo da vida, determinando vulnerabilidade ou resiliência na velhice. O objetivo foi investigar relações entre vulnerabilidade social (gênero, idade e renda); individual (comorbidades, sinais e sintomas, incapacidade funcional, suporte social percebido e saúde percebida) e programática (índices de SUS-dependência e de vulnerabilidade social e acesso aos serviços de saúde) em amostra de indivíduos com 65 anos e mais. Participaram 688 idosos recrutados em domicílio, em 88 setores censitários urbanos sorteados, em Campinas, SP. Os dados (de autorrelato) foram obtidos em sessão única de coleta. Dos entrevistados, 470 eram mulheres, com mais comorbidades e sinais e sintomas, mas mais envolvidas em atividades avançadas de vida diária (AAVD) e atividades instrumentais de vida diária (AIVD) do que os homens. A média de idade foi 72,28 ± 5,41 anos e a de renda familiar 4,72 ± 5,28 salários mínimos. As variáveis que melhor explicaram a variabilidade dos dados foram acesso e uso de serviços de saúde, índices de SUS-dependência e de vulnerabilidade social e renda familiar. Condições sociais e renda familiar covariam com vulnerabilidade individual na velhice.

Sociocultural and economic conditions interact with biological processes throughout the course of life determining vulnerability or resilience in old age. The scope of this study was to investigate relationships between social vulnerability (gender, age and income); individual vulnerability (comorbidities, signs and symptoms, functional ability, perceived social support and perceived health), and programmatic vulnerability (indices of dependence on the public health system, social vulnerability and access to health services) in a sample of individuals aged 65 and more. 688 elderly people were interviewed in a single data gathering session in their homes in 88 selected urban census sectors in Campinas. 470 of the interviewees were women, with more comorbidities and more signals and symptoms, though more socially engaged in AADL and IADL than men. Mean age was 72.28 ± 5.41; mean family income = 4.72 ± 5.28 minimum wages. The variables with most explanatory power over the joint variation of the data were access and use of health services, levels of social vulnerability and dependence on public healthcare services, and family income. Social conditions as well as family income coexist with individual vulnerability in old age.

Factores que influyen en el bienestar psicológico de pacientes con artritis reumatoide / Factors influencing in psychological wellbeing of patients with rheumatoid arthritis

Introducción: los pacientes con artritis reumatoide pueden tener afectado su bienestar psicológico. Objetivos: evaluar el bienestar psicológico de pacientes con artritis reumatoide y conocer variables asociadas a su deterioro. Métodos: se realizó un estudio observacional descriptivo, de corte transversal, que incluyó 180 pacientes de la consulta de protocolo de artritis reumatoide atendidos desde junio de 2006 hasta mayo de 2008. Se obtuvieron datos demográficos, clínicos y de laboratorio. Se evaluó índice de actividad, capacidad funcional y bienestar psicológico y se determinaron las asociaciones existentes entre ellos. Resultados: el bienestar psicológico estuvo más afectado en pacientes mayores de 60 años, sexo femenino y nivel de escolaridad primario; las variables más afectadas fueron la satisfacción sexual y la laboral. El tiempo de evolución mayor de 10 años mostró diferencias en la satisfacción laboral (p=0,027) y la satisfacción sexual (p=0,043). El grado de actividad de la enfermedad y la positividad del factor reumatoide no se asociaron con el bienestar psicológico. La capacidad funcional se correlacionó de forma negativa con casi todas las variables del bienestar psicológico y se asoció significativamente en varios de los aspectos, tanto por la satisfacción como por el componente afectivo y el índice general del bienestar. Conclusiones: el bienestar psicológico en pacientes con artritis reumatoide se encuentra afectado y se asocia de forma significativa con el grado de discapacidad funcional...

Introduction: the patients presenting with rheumatoid arthritis may to be involved its psychological wellbeing. Objectives: to assess the psychological wellbeing of patients presenting with rheumatoid arthritis and to know the variables associated with its deterioration. Methods: a cross-sectional, descriptive and observational study was conducted including 180 patients from the protocol consultation of rheumatoid arthritis seen from June, 2006 to May, 2008. The demographic, clinical and of laboratory data were obtained. The activity, functional ability and psychological wellbeing were assessed determining the associations among them. Results: the psychological wellbeing was more involved in patients aged over 60, the female sex and the primary schooling level, the more involved variables were the sexual satisfaction and the working one. The greatest course time above 10 years showed differences in working satisfaction (p=0,027) and the sexual one (p=0,043). The disease activity degree and the positive rheumatoid factor were not associated with the psychological wellbeing. The functional ability was negatively correlated with almost all variables of psychological wellbeing and was significantly associated in some features, as much as the satisfaction as the emotional component and the general rate of wellbeing. Conclusions: the psychological wellbeing in patients presenting with rheumatoid arthritis is involved and it is significantly associated with the functional inability degree...

Assessment of cardiovascular endurance in swimmers and nonswimmers by comparing resting blood pressure.

Background and Objective: Swimming is often recommended by various authoritative groups as a mode of exercise for the prevention and treatment of hypertension and cardiovascular disease. Hence the current study compares the cardiovascular functional abilities with respect to Blood pressure in young freestyle swimmers practicing regularly and non-swimmers. Materials and Methods: The present Study was carried out at tertiary health centre of Municipal Corporation of Greater Mumbai on medical students after the informed and written consent. Sixty male medical students of age group 18 – 25 years fulfilling the inclusion criteria were included. The study was carried out by forming 2 groups. One group was the study group, comprising of 30 students who are swimmers, practicing for at least 3 months regularly with one session of 30-60 minutes duration per day and minimum three days in a week were include in the study group. The control group comprised of 30 students who are non-swimmers. Their Blood pressure was measured using sphygmomanometer. The data was recorded and analysed for the statistical significance using student’s‘t’ test. P less than 0.05 were considered the level of significance. Result: The mean resting systolic blood pressure in swimmers is significantly lower than in non-swimmers and is statistically significant (p = 0.000). The mean resting diastolic blood pressure in swimmers is significantly lower than in non-swimmers and is statistically significant. (p = 0.000). Discussion and Conclusion: Finding ways to initiate and maintain a physically active lifestyle, particularly with older adults, is a challenge to the practitioner. Swimming has been recommended as an alternative to land-based activity, particularly for older individuals, those who are obese or those who have limited mobility. Our finding may have important implications for exercise prescription in Younger and Older subjects.

Dor e funcionalidade na atenção básica à saúde / Pain and functionality in primary health care

A dor osteoarticular e a funcionalidade são elementos ligados à saúde dos indivíduos e, portanto, influenciam o modo de interação entre si e entre eles e o meio ambiente que os cerca. Contudo, não são muitos os estudos que levantam essas questões de saúde na população em geral, sobretudo quando aproximamos o olhar da atenção básica sobre elas. Este artigo tem o objetivo de fornecer dados iniciais sobre dor e funcionalidade nos indivíduos com queixa osteoarticular em uma população adscrita a uma unidade básica de saúde (UBS) e suscitar o debate sobre integralidade da atenção nesse serviço. O trabalho descritivo foi realizado na UBS (n1=64) e nos domicílios (n2=48), entre indivíduos a partir dos 20 anos de idade. Foi aplicado um instrumento de avaliação de funcionalidade e a Escala Visual Analógica de dor, e foram exploradas questões sociodemográficas. Com esses instrumentos, buscou-se avaliar o perfil dos indivíduos em relação ao seu grau de dor musculoesquelética, o grau de funcionalidade nas atividades da vida diária, idade e ocupação. Nos resultados, encontramos uma predominância do sexo feminino nos dois grupos, 84,37 por cento e 81,25 por cento, respectivamente. Quase metade das pessoas com dor musculoesquelética eram donas de casa, e a média de idade entre os grupos estava acima dos 55 anos.

Musculoskeletal pain and functionality are linked to the individual health and, thus, influence the mode of interaction between individuals and between them and the environment that surrounds them. However, there are not many studies that question such health issues concerning the population in general, especially when we look at these issues from the basic care point of view. The aim of this article is to present initial data on the subject of pain and functionality in individuals with musculoskeletal complaints enrolled in a primary care unit and prompt a discussion on how complete the services provided by these units are. This study was carried out in a primary care unit and various households, among subjects aging 20 years or older. A functionality assessment tool and a Visual Analogue Scale were applied, and social and demographic issues were also considered. By using these tools, it was made an attempt to evaluate the profile of individuals in association with their degree of musculoskeletal pain and the degree of functionality in the activities of their daily lives, ages and occupations. We found a predominance of women in both groups: 84.37 percent and 81.25 percent, respectively. Nearly half of all people with musculoskeletal pain were housewives, and the average age between groups was over 55.

Atividade física habitual, sintomas depressivos e doenças auto-relatadas em idosos da comunidade / Habitual physical activity,depressed symptons and self-reported illness in elderly from the community

Objetivos. Analisar relações entre os tipos e o nível de atividade física nos últimos doze meses, doenças e sintomas somáticos auto-relatados e sintomas depressivos em idosos de diferentes faixas de idade e renda recrutados na comunidade. Materiais e métodos. Foram 144 idosos (M= 71,2 e DP= 6,65), 94,4% mulheres, frequentadores de um centro de convivência. Os dados foram coletados por meio de uma ficha de identificação sociodemográfica, de um questionário sobre doenças e sintomas autorelatados, da Escala de Depressão do Centro de Estudos Epidemiológicos (CES-D) e do Questionário de Baecke Modificado para Idosos (QBMI). Resultados. A prevalência de sintomas depressivos foi de 33,3%; 49,3% dos idosos relataram ter três ou mais doenças e 43,7% eram ativos, segundo os critérios da American College of Sports Medicine (ACSM). O grupo de 60 a 69 anos apresentou maior freqüência de ativos e escores totais e em atividades esportivas mais altos. Os idosos que pontuaram acima da nota de corte (> 11) para sintomas depresivos apresentaram maior número de doenças, maior freqüência de depressão e maior número sintomas somáticos auto-relatados. Na análise multivariada, ter entre 60 e 69 anos, apresentar escore intermediário ou baixo em atividades esportivas e relatar três ou mais doenças revelaram-se preditivos de sintomas depressivos. Conclusão. As relações identificadas configuram-se como importantes subsídios para a prática no âmbito da promoção em saúde.

Objectives. This study was aimed at investigating relationships between types and levels of physical activities performed during the last 12 months, self-reported illnesses and somatic symptoms, and depressive symptoms among community dwelling elderly. Methods. 144 participants (M = 71,2; DP = 6,65) were recruited in a leisure and educational center attended by older people. Data were collected with aid of socio-demographic questionnaire, another asking about self-reported illnesses and symptoms, the Brazilian versions of the Center for Epidemiological Survey Depression, and the Modified Baecke for Older Adults. Results. The prevalence of depressive symptoms was 33,3%; 49,3% of the participants reported three or more illnesses; 43,7% were physically active, according to criteria of the American College of Sports Medicine. Those aged 60 to 69 were more physically active and scored higher than the sedentary did in global habitual physical activities and sports. Those that scored above the cut-score to depressive symptoms (> 11) reported more illnesses, depression and somatic symptoms; those with higher co-morbidity showed the highest scores in the CES-D. Multivariate analysis of regression showed that the main predictors of depressive symptoms were: being aged 60 to 69, intermediate or low scores in sport activities and three or more self-reported illnesses. Conclusion. Data are suggestive of the important role played by physical activities in health promotion in old age.

Elevada morbimortalidade e reduzida taxa de diagnóstico de osteoporose em idosos com fratura de fêmur proximal na cidade de São Paulo / High morbid-mortability and reduced level of osteoporosis diagnosis among elderly people who had hip fractures in São Paulo City

As fraturas osteoporóticas de fêmur proximal trazem graves conseqüências quanto à morbimortalidade e à qualidade de vida, mas desconhece-se este impacto no Brasil. OBJETIVO: Conhecer a morbimortalidade decorrente deste tipo de fraturas em idosos na cidade de São Paulo. MÉTODOS: Foram incluídos todos os pacientes com mais de 60 anos internados por fraturas de fêmur proximal durante seis meses, em dois hospitais de São Paulo. Os pacientes preencheram o questionário de capacidade funcional (HAQ), tiveram seu prontuário examinado e foram reavaliados após seis meses. Utilizou-se a análise de regressão linear para determinar os fatores relacionados à capacidade funcional. RESULTADOS: Cinqüenta e seis pacientes foram incluídos no estudo (80,7 ± 7,9 anos; 80,4 por cento mulheres). A mortalidade em seis meses foi de 23,2 por cento. Apenas 30 por cento retornaram plenamente às suas atividades prévias e 11,6 por cento tornaram-se completamente dependentes. Os fatores que mais bem conseguiram prever pior capacidade funcional após a fratura foram HAQ pré-fratura, institucionalização pós-fratura e idade (r² 0,482). Somente 13,9 por cento receberam o diagnóstico de osteoporose e 11,6 por cento iniciaram algum tratamento. CONCLUSÕES: Os resultados do presente estudo demonstram o impacto deste tipo de fraturas sobre a mortalidade e a capacidade funcional. Entretanto, a falha médica no diagnóstico e na orientação de tratamento da osteoporose permanece elevada.

OBJECTIVE: To know the morbid-mortality following an osteoporotic hip fracture in elderly patients living in São Paulo. PATIENTS AND METHODS: This study evaluated prospectively all patient over 60 years admitted in 2 school-hospitals in the city of São Paulo in a following 6-month period due to a osteoporotic proximal femur fracture. All of them filled up the Health Assessment Questionnaire (HAQ) and had their chart reviewed. After 6 months they were re-interviewed. Linear regression analysis was utilized to determine the factors related to functional ability. RESULTS: 56 patients were included (mean age 80.7 ± 7.9 years old, 80.4 percent females). After the 6-month follow up the mortality rate was 23.2 percent. Only 30 percent of the patients returned to their previous activities, and 11.6 percent became totally dependent. Factors related to worse functional ability after fracture were HAQ before fracture, institutionalization after fracture and age (r² 0.482). The diagnosis of osteoporosis was informed only by 13.9 percent of them, and just 11.6 percent received any treatment for that. CONCLUSION: Our results showed the great impact of these fractures on mortality and in the functional ability of these patients. Nevertheless, many of our physicians do not inform the patients about the diagnosis of osteoporosis and, consequently, the treatment of this condition is jeopardized.

A capacidade funcional de idosos fisicamente independentes praticantes de atividade física / Fitness of physically independent and active elderly subjects

O objetivo do presente estudo foi traçar o perfi l funcional de idosos acima de 60 anos de níveis funcionais IV e V em relação às capacidades físico-motoras e capacidade funcional. As variáveis analisadas foram: agilidade, fl exibilidade, equilíbrio, força de membros superiores e inferiores, habilidade em realizar tarefas de coordenação motora fi na, habilidade em calçar meias, levantar-se do solo, subir degraus, sentar, levantar e locomover-se com agilidade e equilíbrio. Os testes foram aplicados em 193 idosos de níveis funcionais IV e V com idade, entre 60 e 90 anos. Para comparação dos resultados foi usada a análise de variância de um fator. Os dados mostraram ausência de diferenças, com exceção para a capacidade motora agilidade e para a capacidade funcional levantar-se do solo. Os resultados obtidos permitem concluir que o perfi l funcional de idosos fi sicamente ativos mantém-se em condições ótimas até idades avançadas, acima da média dos idosos sedentários, quando realizam um programa de atividade física.

The object of this paper is to describe functional and motor abilities of physically independent subjects older than 60 years old. We applied tests for agility; fl exibility; upper and lower limbs strength; fi ne motor coordination; ability to wear socks, to rise from the fl oor; to step up stairs, and balance. The subjects were 193 physically independent elderly subjects, classifi ed at motor-physical and functional abilities levels IV and V. We run one-way ANOVA to compare the results. There were no effects of aging on most of variables, but agility and to rise from the fl oor. We conclude the fi tness of physically active elderly people remains stable across aging, higher than sedentary subjects.