Instrumentos para medir la capacidad funcional intrínseca y la fragilidad de personas mayores en la Atención Primaria en Chile / Instruments to assess functional capacity and the presence of frailty in older people

BACKGROUND: The evaluation of functional capacity and the presence of frailty is an essential prognostic indicator in older people. Aim: To explore the instruments used to characterize the intrinsic functional capacity (CFI) and frailty in elderly people cared at Primary Health Care Centers (PHC) in Chile. MATERIAL AND METHODS: A narrative review of national and international scientific literature was carried out, including observational studies published in Pubmed (since 2015) and Scielo (since 2010) about tools to assess CFI or frailty. Studies in English or Spanish carried out in Chilean beneficiaries of PHC aged 60 years and over, were included. Results: After the first search, 110 articles were selected in Pubmed and 86 in Scielo. According to the relevance of the title and abstract, 36 articles were preliminarily screened, of which 25 were selected for full reading, 12 of which were finally included in this review. In Chile, the main instrument used to assess CFI is the Functional Examination of the Elderly (EFAM). There are few national studies to assess frailty and the instruments used are mainly based on the Fried criteria and the FTI (Frailty Tilburg Indicator). The reviewed studies suggest improving the coverage and reconsidering the predictive capacity of the measurements used for the assessment of CFI and frailty in older people, suggesting the incorporation of handgrip strength as a predictor of frailty. CONCLUSIONS: The main instruments to assess CFI and frailty in older people cared in PHC in Chile are the EFAM, and the Fried and FTI criteria, respectively.

¿Qué se debería evaluar frente al paciente adulto mayor con cáncer? / What should we evaluate in an older adult with cancer?

En la medida en que el crecimiento poblacional continúe en aumento, la cantidad de adultos mayores que sufran patología oncológica será cada vez mayor. Esta población, por su heterogeneidad y su comorbilidad diferente de la del adulto joven, requiere un manejo más específico e individualizado. La realización de una valoración geriátrica integral y el trabajo multidisciplinario, colaborarán en la toma de decisiones con el fin de priorizar la calidad de vida de cada paciente en particular y optimizar el manejo de los pacientes vulnerables. (AU)

As the population grows, there will be more cancer diagnoses in the elderly population. This group, due to its heterogeneity and comorbidities different from those of young adults, requires a specific and individualized assessment. The geriatric assessment and multidisciplinary work, together, would help in decision-making in order to prioritize the quality of life of each patient and optimize management of the vulnerable patients.Key words: elderly, geriatric assessment, frailty, cancer, sarcopenia, abilities of daily living. (AU)

Prevalence of Frailty in Patients Undergoing Cardiac Valve Surgery: Comparison of Frailty Tools

Abstract Background There is no consensus among tools for assessing frailty. Objective To evaluate the prevalence of frailty according to different tools in patients referred for elective valve cardiac surgery. Methods This is a cross-sectional study. All patients were ≥ 18 years of age, clinically stable. The following patients were excluded: those unable to perform the tests because of physical, cognitive, or neurological limitations; those requiring non elective/emergency procedures or hemodynamic instability. During the preoperative cardiology visit, frailty was assessed by the Short Physical Performance Battery (SPPB), the Frailty Deficit Index (FDI), handgrip strength, and gait speed 3m. For the entire analysis, the statistical significance was set at 5%. Results Our cohort consisted of 258 subjects. From the total cohort, 201 were ≤ 70 years of age (77.9%), the predominant etiology according to rheumatic disease (50.7% vs 8.8%; p=0.000) with double mitral lesion (24.9% vs 0%; p=0.000). Frailty was present in 32.9% according SPPB, 29.1% with reduced muscular strength. and 8.9% with FDI. Handgrip strength was weaker in elderly patients (26.7 vs 23.6; p=0.051) and gait speed was lower in the younger group, in which 36% were considered frail (36% vs 14%; p=0.002). Variables associated with frailty were age ≥ 70 years, female gender, aortic stenosis, and regurgitation. Conclusion Frailty in adult patients who will have elective heart valve surgery is present even in the younger groups, although the older group with comorbidities are more frail. Frailty was more clearly shown by the SPPB than by the FDI and handgrip tests.

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

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

Polypharmacy is associated with multiple health-related outcomes in Mexican community-dwelling older adults / La polifarmacia se asocia con múltiples resultados en salud

Abstract: Objective: To determine the association between polypharmacy and multiple health-related outcomes in older adults. Materials and methods: We carried out a cross-sectional analysis with 274 community-dwelling older adults aged ≥60 years in Mexico City. We used the following health-related outcomes: frailty, dementia, functional capacity, falls, disability, and quality of life. The main exposure was polypharmacy (chronic use of six or more drugs). Ordinal logistic regression, binary logistic regression, Poisson regression, and linear regression models were used to estimate the association between polypharmacy and the outcomes analyzed. Results: Polypharmacy was present in 45% of the sample. Polypharmacy was significantly associated with frailty status, and marginally, with dementia. We also observed significant associations for instrumental activities of daily living, falls, disability, and quality of life. Conclusions: Given that polypharmacy has reached levels of a global epidemic, it is necessary to take radical actions to reduce the concomitant problems of the use of multiple drugs.

Resumen: Objetivo: Determinar la asociación entre la polifarmacia y múltiples resultados relacionados con la salud de los adultos mayores. Material y métodos: Se llevó a cabo un análisis transversal con 274 adultos mayores que residen en comunidad, edad ≥60 años, en la Ciudad de México. Se utilizaron los siguientes resultados relacionados con la salud: fragilidad, demencia, capacidad funcional, caídas, discapacidad y calidad de vida. La exposición principal fue la polifarmacia (uso crónico de seis o más fármacos). Se utilizaron modelos de regresión logística ordinal, regresión logística binaria, regresión de Poisson y regresión lineal para estimar la asociación entre la polifarmacia y los resultados analizados. Resultados: La polifarmacia estuvo presente en 45% de la muestra. La polifarmacia se asoció significativamente con el estado de fragilidad y marginalmente con la demencia. También se observaron asociaciones significativas para actividades instrumentales de la vida diaria, caídas, discapacidad y calidad de vida. Conclusiones: Dado que la polifarmacia ha alcanzado niveles de epidemia global, es necesario tomar medidas radicales para reducir los problemas concomitantes del uso de múltiples medicamentos.

Frailty in community-dwelling older people: comparing screening instruments / Fragilidade em idosos comunitários: comparando instrumentos de triagem

ABSTRACT OBJECTIVE: To compare the Edmonton Frail Scale (EFS) and Clinical-Functional Vulnerability Index-20 (CFVI-20) instruments regarding degree of agreement and correlation and compare descriptive models with frailty-associated variables in community-dwelling older people in Brazil. METHODS: Cross-sectional study, nested in a population-based and household cohort. Baseline sampling was calculated based on a probabilistic approach by conglomerate in two stages. In the first stage, census tract was used as sampling unit. In the second, the number of households was defined according to the population density of individuals aged ≥ 60 years. The Kappa statistic evaluated the agreement between instruments and Pearson's coefficient their correlation. Factors associated with frailty and high risk of clinical-functional vulnerability were identified by multiple analysis of Poisson regression with robust variance. RESULTS: Kappa statistics was 0.599 and Pearson's correlation coefficient 0.755 (p < 0.001). The EFS found a 28.2% prevalence of frailty, and the CFVI-20 found a 19.5% prevalence of high risk of clinical-functional vulnerability. Age equal to or greater than 80 years, history of stroke, polypharmacy, negative self-perceived health, fall in the past 12 months, and hospitalization in the past 12 months were variables associated with frailty in both instruments after multiple analysis. Less than four years of education, osteoarticular disease, and weight loss were associated with frailty only by EFS, and having a caregiver was associated with a high risk of clinical-functional vulnerability only by CFVI-20. CONCLUSIONS: Although the analyses show moderate agreement and strong positive correlation between the instruments, the indicated prevalence of frailty is discrepant. Our results attest the need to standardize the instrument for assessing frailty in community-dwelling older people.

RESUMO OBJETIVO: Comparar os instrumentos Edmonton Frail Scale (EFS) e Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) quanto ao grau de concordância e de correlação, bem como comparar modelos descritivos com variáveis associadas à fragilidade em idosos brasileiros comunitários. MÉTODOS: Estudo transversal, aninhado a uma coorte de base populacional e domiciliar. 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 indivíduos com idade ≥ a 60 anos. A estatística Kappa analisou a concordância, e o coeficiente de Pearson avaliou a correlação entre os instrumentos. Os fatores associados à fragilidade e ao alto risco de vulnerabilidade clínico-funcional foram identificados por análise múltipla de regressão de Poisson com variância robusta. RESULTADOS: A estatística Kappa foi 0,599, e o coeficiente de correlação de Pearson foi de 0,755 (p < 0,001). A prevalência da fragilidade foi de 28,2% pela EFS, e a prevalência do alto risco de vulnerabilidade clínico-funcional foi de 19,5% pelo IVCF-20. As variáveis associadas à fragilidade, após análise múltipla, em ambos os instrumentos, foram: idade igual ou superior a 80 anos, histórico de acidente vascular encefálico, polifarmácia, autopercepção negativa de saúde, queda nos últimos 12 meses e internação nos últimos 12 meses. Escolaridade inferior a quatro anos, doença osteoarticular e perda de peso foram associadas a fragilidade apenas pela EFS, enquanto possuir cuidador esteve associado a alto risco de vulnerabilidade clínico-funcional somente pelo IVCF-20. CONCLUSÕES: Embora as análises revelem concordância moderada e forte correlação positiva entre os instrumentos, a prevalência de fragilidade apontada é discrepante. O resultado destaca a necessidade de padronizar o instrumento para aferir a fragilidade em idosos comunitários.

Estudo do fenótipo de fragilidade em idosos residentes na comunidade / Study of the fragility phenotype among elderly residents in the community

Resumo O objetivo foi estabelecer pontos de corte por sexo para a avaliação dos componentes de fragilidade de idosos residentes na comunidade. Estudo transversal de base populacional, com 555 idosos adscritos às Estratégias Saúde da Família; selecionados por amostragem estratificada proporcional. Foram avaliados dados socioeconômicos e os componentes do fenótipo de fragilidade. Quanto à classificação de fragilidade, 17,7% dos idosos eram frágeis, 45,4% pré-frágeis e 36,9% não frágeis. Os pontos de corte estabelecidos para essa população foram: para força de preensão palmar, em homens e mulheres respectivamente com 0 < IMC < 23 foi 20,30 e 13,36; 23 < IMC < 28 foi 23,52 e 16,12; 28 < IMC < 30 foi 22,04 e 15,17; e 30 < IMC < 50 foi 25,42 e 17,51; para velocidade da marcha, para homens com 0 < altura < 1,67 foi ≥ 7,08s e altura > 1,68 foi 6,46s; e mulheres com 0 < altura < 1,55 foi 7,60s e com altura > 1,56 foi 7,45s; e gasto metabólico semanal para homens foi de 1603,96 e para mulheres foi de 2182,25. Os resultados poderão apoiar as equipes de saúde para avaliar e estratificar o risco de fragilidade dos idosos na comunidade e subsidiar o planejamento de ações de promoção, prevenção e recuperação da capacidade funcional.

Abstract The objective was to establish cutoff points per gender for the evaluation of the fragility components of elderly residents in the community. It involved a cross-sectional population-based study with 555 elderly people enrolled in the Family Health Strategies selected by proportional stratified sampling. Socioeconomic data and the components of the fragility phenotype were evaluated. Regarding the classification of fragility, 17.7% of the elderly were fragile, 45.4% pre-fragile and 36,9% non-fragile. The cutoff points established for this population were: for hand grip strength, in men and women respectively with 0 < BMI < 23 was 20.30 and 13.36; 23 < BMI < 28 was 23.52 and 16.12; 28 < BMI < 30 was 22.04 and 15.17; And 30 < BMI < 50 was 25.42 and 17.51; For gait speed, for men with < height < 1.67 was ≥ 7.08s and height > 1.68 was 6.46s; And women with < height < 1.55 were 7.60s and with height > 1.56 were 7.45s; And weekly metabolic expenditure for men was 1,603.96 and for women it was 2,182.25. The results may support health teams to assess and stratify the risk of frailty of the elderly in the community and to subsidize the planning of actions to promote, prevent and recover functional capacity.

Rendimiento físico en adultos mayores del Policlínico Héroes del Moncada / Physical performance in elder people of the policlinic Heroes del Moncada

RESUMEN Introducción: la evaluación del rendimiento físico en los adultos mayores es una importante herramienta de trabajo para determinación de la sarcopenia, la fragilidad y evaluar así la capacidad funcional en esta etapa. Objetivo: evaluar el rendimiento físico en adultos mayores del Policlínico "Héroes del Moncada", del municipio Plaza de la Revolución, La Habana. Materiales y método: se realizó una investigación descriptiva, de corte transversal en 422 adultos mayores del Policlínico "Héroes del Moncada" en el período comprendido de mayo 2011 a mayo 2014. Se determinó el rendimiento físico a través de la aplicación del test levantarse cinco veces de una silla y la velocidad de la marcha a 4,5 metros de distancia. Resultados: el 90,3% de los adultos mayores completaron el test Levantarse de una silla 5 veces, con tiempo de 13.8 seg, el valor medio de la velocidad de la marcha fue de 0.74m/seg. Conclusiones: la mayoría de las personas mayores fueron del sexo femenino, de 70 a 79 años, independientes para las actividades básica e instrumentadas de la vida diaria y con buen rendimiento físico (AU).

SUMMARY Introduction: to evaluate physical performance of elder people is an important working tool for determining sarcopenia, frailty and that way assessing the functional capacity at this age. Objective: to evaluate physical performance in elder people from policlinic "Heroes del Moncada". Materials and methods: a cross-sectional, descriptive research was carried out in 422 elder people from the Teaching Policlinic "Heroes del Moncada" in the period from May 2011 to May 2014. Physical performance was determined applying the test staying 5 times up from a chair and measuring the speed of a 4.5- meters-long walk. Results: 90.3 % of the people completed the test staying 5 times up from a chair in 13.8 sec. The average speed of the walk was 0.74 m/sec. Conclusions: most of elder people were female, aged 70-79 years, independent according to the Basic and Instrumented Activities of the Daily Life and showing good physical performance (AU).

Prevalência e transição para a fragilidade em idosos com alteração cognitiva em uma coorte de um ano / Prevalence and transition to frailty in older adults with cognitive impairment: a 1-year cohort study

Alteração cognitiva e fragilidade são frequentemente encontradas em idosos e parece haver uma relação entre elas. Entretanto, pouco se sabe sobre a prevalência e a transição para a fragilidade nos idosos com alteração cognitiva, principalmente para a população brasileira. O objetivo do estudo foi avaliar a prevalência e a transição entre os estados de fragilidade em um grupo de idosos com alteração cognitiva em uma coorte prospectiva de um ano. Neste estudo de coorte foram avaliados 59 idosos comunitários com alteração cognitiva (≥ 65 anos). O indivíduo frágil foi identificado por apresentar pelo menos três dos seguintes critérios: perda de peso não intencional, fraqueza da força de preensão palmar, exaustão, lentidão na marcha e baixo nível de atividade física. Quando o indivíduo apresentou um ou dois critérios, foi considerado pré-frágil; quando não apresentou nenhum critério, foi considerado não frágil. A função cognitiva foi avaliada pelo Mini Exame do Estado Mental e a gravidade, pela Clinical Dementia Rating Scale. Do total de 59 idosos avaliados na linha de base, 28 (47,5%) eram frágeis, a mesma quantidade era de pré-frágeis e apenas 3 idosos eram não frágeis. Em 12 meses, verificou-se uma transição para fragilidade de 33,3%. Este estudo mostrou que a prevalência de fragilidade é alta entre os idosos com alteração cognitiva e, em um período de 12 meses, novos casos de fragilidade ocorreram entre os idosos com alteração cognitiva. Entretanto, mais estudos são necessários para investigar com melhor precisão uma relação existente entre o declínio cognitivo e a fragilidade

Cognitive impairment and frailty are often found in older people, and they appear to be related to each other. However, little is known about the prevalence and transition to frailty in older adults with cognitive impairment, especially in the Brazilian population. The present study aimed to determine the prevalence and transitions between frailty states in a cohort of older adults with cognitive impairment followed prospectively for 1 year. A cohort of 59 community-dwelling older adults (aged ≥ 65 years) with cognitive impairment was evaluated. Individuals were classified as frail by the presence of 3 or more of the following criteria: unintentional weight loss; reduced grip strength; exhaustion; slowness; and low physical activity level. Individuals meeting 1 or 2 criteria were classified as prefrail, and those meeting 0 criteria as nonfrail. Cognitive function was assessed by the Mini-Mental State Examination, and severity, by the Clinical Dementia Rating scale. Of 59 older adults evaluated at baseline, 28 (47.5%) were classified as frail, 28 (47.5%) as prefrail, and only 3 (5%) as nonfrail. Over 12 months, 33.3% of participants transitioned from prefrail to frail. The present study showed a high prevalence of frailty in older adults with cognitive impairment and, within 12 months, new cases of frailty were identified in this population. Therefore, more research is needed to further investigate the relationship between cognitive decline and frailty.

Indicadores antropométricos como preditores na determinação da fragilidade em idosos / Anthropometric indicators as predictors in determining frailty in elderly people

Resumo O objetivo deste artigo é analisar Os indicadores antropométricos como preditores na determinação da fragilidade em idosos. Trata-se de um estudo transversal de base domiciliar e analítico. A pesquisa foi constituída por 316 idosos. A associação entre os marcadores antropométricos e a fragilidade foi testada por meio da técnica de Regressão Logística. Já o poder de diagnóstico de fragilidade, utilizando os marcadores antropométricos e a identificação dos melhores pontos de corte, foi avaliado por meio dos parâmetros fornecidos pela curva Receiver Operating Characteristic. Os indicadores antropométricos de estado nutricional, Perímetro da Panturrilha, Índice de Massa Corpórea e Área Muscular do Braço Corrigida, são inversamente associados à fragilidade, assim o incremento nos valores desses indicadores é fator de proteção para esta síndrome. Recomenda-se que o Perímetro da Panturrilha e o Índice de Massa Corpórea sejam analisados de forma combinada para realizar de forma ainda mais simples a triagem de idosos frágeis, já que possuem boa sensibilidade e têm maior facilidade de mensuração de seus valores.

Abstract The scope of this article is to analyze anthropometric indicators as predictors in determining frailty in elderly people. This is a cross-sectional, family-based and analytical study. The survey was composed of 316 elderly subjects. The association between the anthropometric markers and frailty was tested using the Logistic Regression technique. However, the power of frailty diagnosis using anthropometric markers and the identification of the best cutoff points were evaluated using the parameters provided by the Receiver Operating Characteristic (ROC) curve. The anthropometric indicators of nutritional status: calf circumference, body mass index and corrected arm-muscle area are inversely associated with frailty. Thus, an increase in the values of these indicators is a protective factor against this syndrome. Analyzing body mass index and calf circumference simultaneously in order to perform a simpler screening for frail elderly people is recommended, as these indicators show good sensitivity and are easier to measure.

Changes in frailty conditions and phenotype components in elderly after hospitalization / Mudanças nas condições de fragilidade e componentes do fenótipo em idosos após hospitalização / Cambios en las condiciones de fragilidad y componentes del fenotipo en ancianos después de hospitalización

ABSTRACT Objective: describing the changes in frailty conditions over the period of a year after hospital discharge, verifying predictive variables for changes in frailty conditions and frailty phenotype components according to worsening, improving and stable groups. Method: a longitudinal survey carried out with 129 elderly. A structured form for socioeconomic and health data, scales (Geriatric Depression Scale - short form, Katz scale, Lawton and Brody scale) and frailty phenotype according to Fried were used. Descriptive analysis and multinomial logistic regression model (p<0.05) were performed. Results: we found that 56.7% of older adults changed their condition from non-frail to pre-frail, with no changes from non-frail to frail. Deaths were found between frail and pre-frail elderly. In the worsening group, the increase in the number of morbidities was a predictor for exhaustion and/or fatigue, while in the improving group, increased dependence on instrumental activities of daily living was a predictor for weight loss, and reduced scores indicative of depression due to low level of physical activity. Conclusion: a greater percentage of changes from non-frail condition to pre-frail older adults were observed, and health variables were only predictive for frailty phenotype components.

RESUMO Objetivo: descrever as mudanças nas condições de fragilidade ao longo de um ano após a alta hospitalar, e verificar as variáveis preditoras da mudança das condições de fragilidade e dos componentes do fenótipo de fragilidade, segundo grupos de piora, melhora e estabilidade. Método: inquérito longitudinal, realizado com 129 idosos. Utilizou-se formulário estruturado para dados socioeconômicos e saúde, escalas (Depressão Geriátrica Abreviada, Katz, Lawton e Brody) e fenótipo de fragilidade, segundo Fried. Procederam-se às análises descritiva e modelo de regressão logística multinomial (p<0,05). Resultados: constatou-se que 56,7% dos idosos mudaram sua condição de não frágeis para pré-frágeis, não ocorrendo mudança dos não frágeis para frágeis. Observou-se o óbito entre idosos frágeis e pré-frágeis. No grupo de piora, o aumento do número de morbidades foi preditor para exaustão e/ou fadiga, enquanto que, no grupo de melhora, o aumento na dependência das atividades instrumentais de vida diária foi preditor para a perda de peso, e a diminuição dos escores do indicativo de depressão para o baixo nível de atividade física. Conclusão: houve maior percentual de mudança na condição de idosos não frágeis para pré-frágeis e as variáveis de saúde foram preditoras apenas para os componentes do fenótipo de fragilidade.

RESUMEN Objetivo: describir los cambios en las condiciones de fragilidad a lo largo de un año después del alta hospitalaria, y verificar las variables predictoras del cambio de las condiciones de fragilidad y de los componentes del fenotipo de fragilidad, según grupos de empeoramiento, mejoría y estabilidad. Método: encuesta longitudinal, realizada con 129 ancianos. Se utilizó formulario estructurado para recoger datos socioeconómicos y salud; se utilizaron las escalas Depresión Geriátrica Abreviada (GDS-15), Actividades Básicas de Vida Diaria de Katz, Actividades Instrumentales de Vida Diaria de Lawton y Brody, y Fenotipo de Fragilidad, según Fried. Se procedió al análisis descriptivo y modelo de regresión logística multinomial (p<0,05). Resultados: se constató que 56,7% de los ancianos cambiaron su condición de no-frágiles para prefrágiles, no habiendo ocurriendo cambio de los no-frágiles para frágiles. Se observó muerte entre ancianos frágiles y prefrágiles. En el grupo de empeoramiento, el aumento del número de morbilidades fue predictor para agotamiento y/o fatiga, en cuanto en el grupo de mejoría, el aumento en la dependencia de las actividades instrumentales de vida diaria fue predictor para la pérdida de peso y la disminución de los puntajes del indicativo de depresión para el bajo nivel de actividad física. Conclusión: hubo mayor porcentaje de cambio en la condición de ancianos no-frágiles para prefrágiles y las variables de salud fueron predictoras apenas para los componentes del fenotipo de fragilidad.

Prevalencia de la fragilidad en adultos mayores del municipio La Lisa / Prevalence of fragility in elderly in La Lisa municipality

Introducción: el síndrome de fragilidad es consecuencia de disminución de la resistencia y reservas fisiológicas del anciano, que los hace vulnerables a efectos adversos para la salud. Objetivo: estimar la prevalencia de fragilidad en adultos mayores, veteranos de la defensa, residentes en el municipio La Lisa. Método: estudio descriptivo, de corte transversal, puerta a puerta. Para el diagnóstico del síndrome se utilizaron criterios validados en una investigación previa, que aplicó el método Delphi. Resultados: edad promedio: 70,4 años. Predominó el sexo masculino (88,2 por ciento). El 47,6 por ciento fue miembro del Ejército Rebelde. Las comorbilidades estuvieron presentes en 61,6 por ciento, la polifarmacia en el 43,8 por ciento y 64,8 por ciento mostró alteraciones en la flexibilidad y movilidad. En 8,9 por ciento se halló déficit cognitivo y depresión leve en 13,7 por ciento. El 25,7 por ciento de la población sufrió discapacidad. El 7,6 por ciento autopercibió su salud de mala. La mayoría (81,0 por ciento) no necesitaba cuidador permanente y poseía apoyo familiar (81,0 por ciento). Se obtuvo una prevalencia de fragilidad de 42,9 por ciento. Conclusiones: la prevalencia de fragilidad es alta y se halló entre los valores esperados para ancianos que habitan en Latinoamérica y el Caribe(AU)

Introduction: The fragility syndrome is a consequence of a decrease in resistance and physiological reserves of the elderly, which makes them vulnerable to adverse health effects. Objective: Estimate the prevalence of frailty in elderly, veterans of the defense, living in La Lisa municipality. Method: A descriptive, cross-sectional, door-to-door study was conducted. Validated criteria in a previous investigation, which applied the Delphi method, were used for this syndrome diagnosis. Results: Mean age: 70.4 years. The male sex predominated (88.2 percent). 47.6 percent were members of the Rebel Army. Comorbidities were present in 61.6 percent, polypharmacy in 43.8 percent and 64.8 percent showed alterations in flexibility and mobility. 8.9 percent had cognitive deficit. 13.7 percent of the subject studied had mild depression were found. 25.7 percent of the population suffered disability. 7.6 percent self-perceived poor health. The majority (81.0 percent) did not need permanent caregivers and had family support (81.0 percent). A prevalence of fragility was 42.9 percent. Conclusions: The prevalence of fragility is high and was among the expected values for the elderly living in Latin America and the Caribbean(AU)

Síndrome de fragilidad y sus variables asociadas / Fragility Syndrome and associated variables

El síndrome de fragilidad es un síndrome geriátrico caracterizado por la disminución de la reserva funcional, resultando en un incremento de la vulnerabilidad de la persona y de una inadecuada respuesta a todo tipo de estrés, debido fisiopatológicamente a sarcopenia, ateroesclerosis, desnutrición y deterioro cognoscitivo. El diagnóstico es netamente clínico, descrito por 5 características, pérdida de peso involuntaria, autorreporte de agotamiento, enlentecimiento del movimiento, debilidad y baja actividad física, sin embargo no existe un gold estándar para la detección del mismo, y esta limitación para reconocer en una etapa temprana el síndrome, conduce a una progresión rápida hacia la muerte; comúnmente se observa relacionado a múltiples variables agrupadas en 4 categorías: factores sociodemográficos, factores biomédicos, factores psicosociales y factores funcionales y nutricionales. Se han realizado múltiples estudios en poblaciones latinoamericanas, donde destacan México, Colombia y Brasil, observándose que existe una alta prevalencia de fragilidad en los ancianos latinoamericanos y un alto porcentaje de ancianos prefrágiles. La fragilidad eleva el costo de la atención médica a nivel mundial, además de producir un alto impacto social y familiar por su fuerte asociación con comorbilidad, discapacidad, deterioro cognoscitivo y depresión(AU)

Fragility syndrome is a geriatric syndrome characterized by a decrease of functional reserve, resulting in an increased vulnerability of the person, and an inadequate response to all kinds of stress, pathophysiologically caused by sarcopenia, atherosclerosis, malnutrition and cognitive impairment. The diagnosis is clinical, described by 5 features, unintentional weight loss, self-reported exhaustion, slowness of movement, weakness and low physical activity, however there is no gold standard for detection and this limitation to recognize the syndrome at an early stage, leads to rapid progression to death; it is commonly observed related to multiple variables, grouped into 4 categories: socio-demographic factors, biomedical factors, psychosocial factors and functional and nutritional factors. Multiple studies have been realized in Latin American populations, especially Mexico, Colombia and Brazil, observing that there is a high prevalence of fragility in Latin American seniors and a high percentage of pre-fragile elderly. The fragility increases the cost of health care worldwide, in addition to producing a high social and family impact by its strong association with comorbidity, disability, cognitive impairment and depression(AU)