Frailty in kidney transplant candidates and recipients: pathogenesis and intervention strategies / 中华医学杂志(英文版)

With the rapid aging of the global population posing a serious problem, frailty, a non-specific state that reflects physiological senescence rather than aging in time, has become more widely addressed by researchers in various medical fields. A high prevalence of frailty is found among kidney transplant (KT) candidates and recipients. Therefore, their frailty has become a research hotspot in the field of transplantation. However, current studies mainly focus on the cross-sectional survey of the incidence of frailty among KT candidates and recipients and the relationship between frailty and transplantation. Research on the pathogenesis and intervention is scattered, and relevant review literature is scarce. Exploring the pathogenesis of frailty in KT candidates and recipients and determining effective intervention measures may reduce waiting list mortality and improve the long-term quality of life of KT recipients. Therefore, this review explains the pathogenesis and intervention measures for frailty in KT candidates and recipients to provide a reference for the formulation of effective intervention strategies.

Association of hs-CRP with frailty and its components among the elderly over 65 years old in 9 longevity areas of China / 中华预防医学杂志

Objective: To investigate the association of the levels of high sensitivity C-reactive protein (hs-CRP) with frailty and its components among the elderly over 65 years old in 9 longevity areas of China. Methods: Cross-sectional data from the Health Ageing and Biomarkers Cohort Study (HABCS, 2017-2018) were used and the elderly over 65 years old were included in this study. Through questionnaire interview and physical examination, the information including demographic characteristics, behavior, diet, daily activity, cognitive function, and health status was collected. The association between hs-CRP and frailty and its components in the participants was analyzed by multivariate logistic regression model and restrictive cubic spline. Results: A total of 2 453 participants were finally included, the age was (84.8±19.8) years old. The median hs-CRP level was 1.13 mg/L and the prevalence of frailty was 24.4%. Compared with the low-level group (hs-CRP<1.0 mg/L), the OR (95%CI) value of the high-level group (hs-CRP>3.0 mg/L) was 1.79 (1.35-2.36) mg/L. As for the components, the hs-CRP level was also positively associated with ADL disability, IADL disability, functional limitation and multimorbidity. After adjusting for confounding factors, compared with the low-level group, the OR (95%CI) values of the high-level group for the four components were 1.68 (1.25-2.27), 1.88 (1.42-2.50), 1.68 (1.31-2.14) and 1.39 (1.12-1.72), respectively. Conclusion: There is a positive association between the levels of hs-CRP and the risk of frailty among the elderly over 65 years old in 9 longevity areas of China. The higher hs-CRP level may increase the risk of frailty by elevating the risk of four physical functional disabilities, namely ADL disability, IADL disability, functional limitation and multimorbidity.

Association of sleep duration and risk of frailty among the elderly over 80 years old in China: a prospective cohort study / 中华预防医学杂志

Objective: To explore the association between sleep duration and the risk of frailty among the elderly over 80 years old in China. Methods: Using the data from five surveys of the China Elderly Health Influencing Factors Follow-up Survey (CLHLS) (2005, 2008-2009, 2011-2012, 2014, and 2017-2018), 7 024 elderly people aged 80 years and above were selected as the study subjects. Questionnaires and physical examinations were used to collect information on sleep time, general demographic characteristics, functional status, physical signs, and illness. The frailty state was evaluated based on a frailty index that included 39 variables. The Cox proportional risk regression model was used to analyze the correlation between sleep time and the risk of frailty occurrence. A restricted cubic spline function was used to analyze the dose-response relationship between sleep time and the risk of frailty occurrence. The likelihood ratio test was used to analyze the interaction between age, gender, sleep quality, cognitive impairment, and sleep duration. Results: The age M (Q1, Q3) of 7 024 subjects was 87 (82, 92) years old, with a total of 3 435 (48.9%) patients experiencing frailty. The results of restricted cubic spline function analysis showed that there was an approximate U-shaped relationship between sleep time and the risk of frailty. When sleep time was 6.5-8.5 hours, the elderly had the lowest risk of frailty; Multivariate Cox proportional risk regression model analysis showed that compared to 6.5-8.5 hours of sleep, long sleep duration (>8.5 hours) increased the risk of frailty by 13% (HR: 1.13; 95%CI: 1.04-1.22). Conclusion: There is a nonlinear association between sleep time and the risk of frailty in the elderly.

Frailty prevalence and its associations in a subacute geriatric ward in Singapore

INTRODUCTION@#Our aim was to study the prevalence of frailty and its associated factors in a subacute geriatric ward.@*METHODS@#This was a cross-sectional study of 167 participants between June 2018 and June 2019. Baseline demographics and participants' Mini Nutritional Assessment, Geriatric Depression Scale, Mini Mental State Examination, Charlson's Comorbidity Index and LACE index scores were obtained. Functional measurements such as modified Barthel's Index scores and hand grip strength (HGS) were taken. Frailty was assessed using the Clinical Frailty Scale (CFS) and the FRAIL scale. Data on history of healthcare utilisation, medications, length of stay, selected blood investigations and presence of geriatric syndromes were also collected.@*RESULTS@#The prevalence of pre-frailty (CFS 4) and frailty (CFS ≥ 5) was 16.2% and 63.4%, respectively. There were significant associations between CFS and age (pre-frail vs. non-frail: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.25, P = 0.006; frail vs. non-frail: OR 1.08, 95% CI 1.01-1.15, P = 0.021), HGS at discharge (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.025), serum albumin (frail vs. non-frail: OR 0.90, 95% CI 0.82-0.99, P = 0.035) and the presence of urinary incontinence (frail vs. non-frail: OR 3.03, 95% CI 1.19-7.77, P = 0.021).@*CONCLUSION@#Frailty is highly prevalent in the subacute geriatric setting and has many associated factors. In this study, independent factors associated with frailty were age, HGS at discharge, serum albumin and urinary incontinence. This has implications for future resource allocation for frail older inpatients and may help direct further research to study the effectiveness of frailty-targeted interventions.

Relationships between self-reported dyspnea, health conditions and frailty among Brazilian community-dwelling older adults: a cross-sectional study

ABSTRACT CONTEXT: Dyspnea is a symptom present in several chronic diseases commonly seen among older adults. Since individuals with dyspnea tend to stay at rest, with consequently reduced levels of physical activity, they are likely to be at greater risk of developing frailty, especially at older ages. DESIGN AND SETTING: Cross-sectional study at community level, Brazil. OBJECTIVE: To analyze the relationships between self-reported dyspnea, health conditions and frailty status in a sample of community-dwelling older adults. METHOD: Secondary data from the follow-up of the Frailty in Brazilian Elderly (FIBRA) study, involving 415 community-dwelling older adults (mean age: 80.3 ± 4.68 years), were used. The variables analyzed were sociodemographic characteristics, reported dyspnea, clinical data and frailty phenotype. Associations between dyspnea and other variables (age, sex, education and body mass index) were verified through the crude (c) and adjusted (a) odds ratios. RESULTS: The prevalence of dyspnea in the entire sample was 21.0%. Dyspnea was more present in individuals with pulmonary diseases, heart disease, cancer and depression. Older adults with multimorbidities (adjusted odds ratio, ORa = 2.91; 95% confidence interval, CI = 1.41-5.99) and polypharmacy (ORa = 2.02; 95% CI = 1.15-3.54) were more likely to have dyspnea. Those who reported dyspnea were 2.54 times more likely to be frail (ORa = 2.54; 95% CI = 1.08-5.97), and fatigue was their most prevalent phenotype component. CONCLUSION: Dyspnea was associated with different diseases, multimorbidities, polypharmacy and frailty. Recognizing the factors associated with dyspnea may contribute to its early identification and prevention of its negative outcomes among older adults.

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

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

Transition rules of cognitive frailty and influencing factors in the elderly in China / 中华流行病学杂志

Objective: To understand the transition rules of cognitive frailty and its influencing factors in the elderly in China and provide evidence for the early intervention of cognitive frailty. Methods: Data were retrospectively collected from China Health and Retirement Longitudinal Study with 3 round consecutive survey (2011, 2013, 2015) and the state of the subjects were classified into four categories: robust-normal cognitive, cognitive impairment, physical frailty, and cognitive frailty. A multi-state Markov model was established to explore the transition rules of cognitive frailty and its influencing factors. Results: A total of 3 470 older adults were included, and 350 (10.09%) had cognitive frailty at baseline. After two years, the probability of cognitive frailty in the cognitive impairment population was higher than that in people with physical frailty (31.6% vs. 7.6%). Persons with cognitive frailty were more likely to become physical frailty (29.7% vs. 15.6%). Being women (HR=1.599, 95%CI: 1.058-2.417), comorbidity (HR=3.035, 95%CI: 1.090-8.450), and depression (HR=1.678, 95%CI: 1.153-2.441) were the risk factors associated with cognitive frailty in the elderly, while being educated (HR=2.367, 95%CI: 1.567-3.575) was a protective factor for the transition of cognitive frailty to physical frailty. Conclusions: The prevalence of cognitive frailty is relatively high in the elderly in China. Those with cognitive impairment have a higher probability of cognitive frailty. Gender, education level, comorbidity, and depression are the main influencing factors for the occurrence and transition of cognitive frailty.

Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis / Fragilidade e delirium em idosos hospitalizados: revisão sistemática com metanálise / Fragilidad y delirium en adultos mayores hospitalizados: revisión sistemática con metanálisis

Abstract Objective: to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults. Method: a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes. Results: initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01). Conclusion: 34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.

Resumo Objetivo: estimar a prevalência e sintetizar evidências sobre a relação entre fragilidade e delirium em idosos hospitalizados. Método: revisão sistemática com metanálise na qual foram selecionados estudos observacionais realizados com idosos sobre fragilidade, delirium e hospitalização, sem recortes temporais e de idioma. A busca foi realizada nas bases de dados MEDLINE, EMBASE, CINAHL, Scopus, Web of Science e CENTRAL durante o mês de agosto de 2021. Foram seguidos os preceitos estabelecidos pelo Joanna Briggs Institute (JBI) - Grupos de Síntese de Evidências.. O modelo de metanálise estimou risco relativo da prevalência de fragilidade e delirium. Utilizou-se método da variância inversa para proporções para estimar as prevalências e risco relativo para desfechos binários. Resultados: identificaram-se, inicialmente, 1.244 artigos, 26 incluídos na metanálise (n=13.502 participantes), sendo a prevalência de fragilidade 34% (IC 95% 0,26 a 0,42; I 2=99%; t 2= 0,7618, p=0) e delirium 21% (IC 95% 0,17 a 0,25; I 2=95%; t 2= 0,3454, p<0,01). O risco do idoso frágil hospitalizado desenvolver delirium foi de 66% (RR 1,66; IC 95% 1,23 a 2,22; I2=92%; t2=0,4154; p<0,01). Conclusão: prevalência de 34% de fragilidade e 21% de delirium em idosos hospitalizados, sendo a fragilidade um fator de risco independente para desenvolvimento de delirium, com um aumento de chance de 66% comparado aos não frágeis.

Resumen Objetivo: estimar la prevalencia y sintetizar evidencias sobre la relación entre fragilidad y delirium en adultos mayores hospitalizados. Método: revisión sistemática con metanálisis en el que se seleccionaron estudios observacionales realizados con adultos mayores sobre fragilidad, delirium y hospitalización, sin recorte temporal ni de idioma. La búsqueda se realizó en las bases de datos MEDLINE, EMBASE, CINAHL, Scopus, Web of Science y CENTRAL en agosto de 2021. Se siguieron los preceptos del Instituto Joanna Briggs (Joanna Briggs Institute, JBI) - Evidence Synthesis Groups. El modelo de metanálisis estimó el riesgo relativo de la prevalencia de fragilidad y delirium. Se utilizó el método de la varianza inversa para proporciones para estimar la prevalencia y el riesgo relativo de los desenlaces binarios. Resultados: inicialmente se identificaron 1.244 artículos, se incluyen en el metanálisis 26 (n=13.502 participantes), la prevalencia de fragilidad fue del 34% (IC 95% 0,26 a 0,42; I 2=99%; t 2= 0,7618, p=0) y de delirium del 21% (IC 95% 0,17 a 0,25; I 2=95%; t 2= 0,3454, p<0,01). El riesgo de que el adulto mayor frágil hospitalizado desarrolle delirium fue del 66% (RR 1,66; IC 95% 1,23 a 2,22; I2=92%; t2=0,4154; p<0,01). Conclusión: los adultos mayores hospitalizados tienen una prevalencia de fragilidad del 34% y de delirium del 21%, la fragilidad es un factor de riesgo independiente para el desarrollo de delirium, cuando se compara a los frágiles con los no frágiles, la probabilidad de delirium de los primeros es de un 66% más.

Relationship between frailty, social support and family functionality of hemodialysis patients: a cross-sectional study

ABSTRACT BACKGROUND: The population with chronic kidney disease (CKD) is more predisposed to early development of frailty. Although the concept of frailty is well established from a physical point of view, it is not an exclusively physical syndrome. It can be characterized as an interaction of physical, psychological and social factors. OBJECTIVE: To ascertain the relationship between frailty, social support and family functionality among CKD patients undergoing hemodialysis. DESIGN AND SETTING: Correlational, cross-sectional and quantitative study conducted at a service in the interior of the state of São Paulo. METHODS: This study included 80 patients with CKD who were on hemodialysis. The participants were interviewed individually, with application of the following instruments: sociodemographic and economic characterization, Tilburg Frailty Indicator, Medical Outcomes Study and Family APGAR. Females and white ethnicity predominated among the participants, and their mean age was 59.63 ± 15.14 years. RESULTS: There was high prevalence of frailty (93.8%). Although there was a difference in scores for the dimensions of social support between the frail group and the non-frail group, only family functionality reached a statistically relevant difference. There was a significant correlation between physical frailty, social support and family functionality. CONCLUSIONS: Presence of frailty is related to the social support and family functionality of patients with CKD undergoing hemodialysis.

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.

Fragilidad como factor de riesgo de demencia en adultos mayores / Frailty as a risk factor for dementia in older adults

El síndrome de fragilidad se caracteriza por una mayor vulnerabilidad y riesgo de deterioro funcional y cognitivo ante un mínimo estrés, siendo la demencia una de las principales causas de discapacidad y dependencia entre los adultos mayores a nivel global, con un impacto físico, psicológico, social y económico no solo en las personas que la padecen, sino también en sus cuidadores. El objetivo de este estudio fue determinar la prevalencia de demencia según fenotipos de fragilidad y estimar la asociación de fragilidad y demencia en adultos mayores. Se tomó como referencia la base de datos del estudio Envejecimiento y Alzheimer (10-66), realizándose una investigación descriptiva de corte transversal, en 2024 adultos mayores de 65 años pertenecientes a siete áreas de salud de La Habana, Cuba. Se efectuó un análisis univariado para los efectos independientes de cada una de las variables y la variable de respuesta o dependiente (demencia) considerando esta asociación significativa cuando (p≤0.001) o por criterio de expertos y un análisis multivariado a través de la Regresión de Poisson. Existió una alta prevalencia de demencia en los sujetos con fragilidad 30,6 %(IC 95 % 22,4 - 39,6), donde la relación entre las mismas mostró una asociación significativa. Las personas frágiles presentaron un riesgo mayor de padecer demencia, con un PR 2.74 (IC 95% 2,29-3,29). La fragilidad se comportó como un factor de riesgo para el desarrollo de demencia.

Frailty syndrome is characterized by a greater vulnerability and risk of functional and cognitive deterioration in the face of minimal stress, with dementia being one of the main causes of disability and dependency among older adults globally, with a physical, psychological, and social impact. and economic not only in the people who suffer from it, but also in their caregivers. The objective of this study was to determine the prevalence of dementia according to frailty phenotypes and to estimate the association of frailty and dementia in older adults. The database of the Aging and Alzheimer study (10-66) was taken as a reference, carrying out a descriptive cross-sectional investigation in 2024 adults over 65 years of age belonging to seven health areas in Havana, Cuba. A univariate analysis was carried out for the independent effects of each of the variables and the response or dependent variable (dementia), considering this significant association when (p≤0.001) or by expert criteria and a multivariate analysis through the regression of Poisson. There was a high prevalence of dementia in subjects with frailty 30.6% (95% CI 22.4 - 39.6), where the relationship between them showed a significant association. Frail people had a higher risk of suffering from dementia, with a PR 2.74 (CI 95% 2.29-3.29). Frailty behaved as a risk factor for the development of dementia.

Influence of foot pain on frailty symptoms in an elderly population: a case-control study

ABSTRACT BACKGROUND: Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty. OBJECTIVE: To determine whether foot pain can influence a greater degree of frailty. DESIGN AND SETTING: Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain. METHODS: A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS). RESULTS: There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS. CONCLUSIONS: These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.

Association between frailty syndrome and sedentary behavior among community-dwelling older adults in the Amazon region: a cross-sectional study

ABSTRACT BACKGROUND: Existence of an association between sedentary behavior and frailty among older adults has been suggested. However, there is a lack of studies conducted in Brazil, especially in areas of the Amazon region. OBJECTIVE: To analyze the association between frailty syndrome and sedentary behavior among community-dwelling older adults. DESIGN AND SETTING: Cross-sectional study carried out in Macapá, state of Amapá, Brazil. METHODS: Frailty status was assessed using Fried's frailty phenotype, and sedentary behavior was evaluated using two questions concerning time spent in a seated position, from the International Physical Activity Questionnaire (IPAQ). A multinomial logistic regression model was used to verify the association between frailty syndrome and sedentary behavior. RESULTS: The final study sample was made up of 411 older adults with a mean age of 70.14 ± 7.25 years and an average daily duration of sedentary behavior of 2.86 ± 2.53 hours. The prevalence of non-frailty was 28.7%, prevalence of pre-frailty was 58.4% and prevalence of frailty was 12.9%. The adjusted analysis showed that there were independent associations between sedentary behavior and pre-frailty (odds ratio, OR = 1.18; 95% confidence interval, CI: 1.03-1.34) and between sedentary behavior and frailty (OR = 1.20; 95% CI: 1.02-1.40). CONCLUSION: Frailty and pre-frailty status were associated with sedentary behavior among community-dwelling older adults.

Prevalencia de sarcopenia en población adulta mayor en Costa Rica / Prevalence of sarcopenia in the elderly population in Costa Rica

Resumen Sarcopenia es la progresiva disminución de la masa y la fuerza muscular. Su prevalencia varía en la literatura por los distintos métodos de medición. Costa Rica no cuenta con datos de su prevalencia. Objetivo: Determinar la prevalencia de sarcopenia y los factores asociados en adultos mayores de Costa Rica: Estudio de Longevidad y Envejecimiento Saludable. Métodos: Un subgrupo de 2516 personas adultas mayores. Se utilizaron los criterios diagnósticos del Grupo Europeo de Trabajo sobre la Sarcopenia en Personas Mayores, que incluye baja masa muscular y baja fuerza muscular. Para la masa muscular se utilizó la circunferencia de pantorrilla menor a 31 cm, y para la fuerza muscular una medición por dinamometría, siendo baja fuerza si los hombres tenían <27 kg en la prensión y las mujeres <16 kg. Resultados: La prevalencia de sarcopenia fue de 10.26%. La tendencia aumentó conforme aumentaba la edad y fue más prevalente en mujeres. La mayoría de los sarcopénicos tuvieron menos ingresos económicos, viven acompañados, se perciben como no saludables, y tienen primaria incompleta. El peso, la circunferencia braquial, abdominal y la circunferencia de pantorrilla fueron menores en las personas con sarcopenia. Asociaciones positivas se encontraron con sarcopenia la edad mayor de 70 años (OR=3,164; IC 1,962-5,101), el nivel educativo (OR 4,264; IC 1,547-11,753), percibirse poco saludable (OR 1,691; IC 1,133-2,525), tener antecedente de enfermedad vascular cerebral (OR 3,221; IC 1,566-6,628), artritis (OR 1,648; IC 1,044-2,601) y caídas (0R 1,676; IC 1,143-2,458). Conclusiones: La prevalencia de sarcopenia fue 10.26%, similar a otros países de Latinoamerica. Su presencia incrementa con la edad.

Abstract Background: Sarcopenia is the progressive loss of mass and skeletal muscle strength. Its prevalence varies in the different reviews carried out, this by the different measurement methods. Costa Rica does not have data on its prevalence. Objective: The aim of this study is to know the prevalence of sarcopenia and associated factors with it in older people from Costa Rican Study of Longevity and Healthy Ageing. Methods: A subgroup of 2516 people was analyze, using the European Working Group on Sarcopenia in Older People diagnostic criteria that include low muscle mass and low muscle strength. Muscle mass was assessed using calf circumference < 31 cm and grip strength using dynamometer, was low strength if <27 kg in men or <16 kg in women. Results: The prevalence of sarcopenia was 10.26%. There was an increasing trend of sarcopenia by age group, it was more prevalent in women. Some characteristics of Costa Ricans with sarcopenia was that most of them had less income, lived accompanied, perceived as unhealthy, had incomplete primary education. The weight, brachial, abdominal and calf circumference was lower in people with sarcopenia. Sarcopenia was positively associated with age (OR 3,164; IC 1,962-5,101), education (OR 4,264; IC 1,547- 11,753), perceived as unhealthy (OR 1,691; IC 1,133-2,525), antecedent of ischemic vascular event (OR 3,221; IC 1,566-6,628), arthritis (OR 1,648; IC 1,044-2,601), and falls (0R 1,676; IC 1,143-2,458). Conclusions: The prevalence of sarcopenia was 10.26%, similar to other countries of Latin America. It increase with age.

Mortality, sarcopenic obesity, and sarcopenia: Frailty in Brazilian Older People Study - FIBRA - RJ

ABSTRACT OBJECTIVE To investigate the risk of mortality associated with sarcopenic obesity (SO), obesity (OB), and sarcopenia in elderlies. METHODS We analyzed longitudinal data from 270 participants > 65 years of age of Phase III of the Study on Frailty in Brazilian Older People (FIBRA-RJ-2012). Socioeconomic, demographic, lifestyle, morbidity, and functional data were collected by home based interviews. DXA and body composition assessment was conducted in a laboratory. In women, OB was diagnosed when body fat percentage ≥ 38% and sarcopenia by an Appendicular Lean Mass Index (ALMI) < 6.00 kg/m2 and muscle strength < 16 Kgf. In men, OB was diagnosed when body fat percentage ≥ 27%, and sarcopenia was diagnosed with ALMI < 7.00 kg/m2 and muscle strength < 27 Kgf. SO was assessed by combining variables used to diagnose obesity and sarcopenia. The probabilistic linkage method was used to obtain deaths in the 2012-January 2017 period from the Brazilian Mortality Registry. Cox regression models were tested, and crude and adjusted hazard ratio calculations were conducted. RESULTS After adjusting for sex, age, race/skin color, walking as an exercise, and hypertension, individuals with sarcopenia were 5.7 times more likely to die (95%CI: 1.17-27.99) than others without sarcopenia and obesity. CONCLUSION A high risk of death was observed in individuals with sarcopenia. These results show the need for preventive strategies of early detection and treatment in order to increase survival employing multimodal interventions.

Fatores associados à fragilidade em idosos acompanhados na Atenção Primária à Saúde / Factores asociados a la fragilidad en ancianos acompañados en la Atención Primaria de Salud / Factors associated with frailty in elderly patients followed up in primary health care

Resumo Objetivo Verificar a associação entre os marcadores de fragilidade e as características sociodemográficas e clínicas em idosos na Atenção Primária à Saúde. Método Pesquisa transversal, realizada com 356 idosos cadastrados em unidades de saúde da família, no Nordeste do Brasil. Os instrumentos de coleta utilizados foram o Índice de Vulnerabilidade Clínico-Funcional e outro de perfil socioeconômico e de saúde. Analisaram-se os dados pela estatística inferencial, utilizando o teste do Qui-quadrado, com nível de significância 0,05. Resultados A média de idade foi de 72,85 anos (±8,965); 63,8% eram do sexo feminino, 39% apresentaram risco de fragilização e 22,5% demonstraram fragilidade. Houve associação entre fragilidade, sexo, faixa etária, estado civil, escolaridade, renda, presença de doença cardíaca e hipertensão. Conclusões e implicações para a prática Os marcadores de fragilidade nos idosos evidenciaram associação entre as características sociodemográficas e clínicas, indicando a necessidade de rastreio precoce no nível primário de atenção à saúde.

Resumen Objetivo Verificar la asociación entre los marcadores de fragilidad y las características sociodemográficas y clínicas en ancianos en Atención Primaria de Salud. Método Investigación transversal realizada con 356 ancianos registrados en unidades de salud familiar en Nordeste de Brasil. Los instrumentos de recolección utilizados fueron el Índice de Vulnerabilidad Clínico-Funcional y otro de perfil socioeconómico y de salud. Los datos se analizaron mediante estadística inferencial utilizando la prueba de Chi-cuadrado, con nivel de significancia de 0.05. Resultados La edad media fue de 72,85 años (± 8,965), el 63,8% eran mujeres, el 39% tenían riesgo de fragilidad y el 22,5% eran frágiles. Hubo asociación entre fragilidad, sexo, edad, estado civil, educación, ingresos, presencia de cardiopatía e hipertensión. Conclusiones e implicaciones para la práctica Los marcadores de fragilidad en ancianos se asociaron con características sociodemográficas y clínicas, lo que indica la necesidad de rastreo precoz en el nivel primario de atención a la salud.

Abstract Objective to verify the association between frailty markers and sociodemographic and clinical characteristics in elderly people in Primary Health Care. Method cross-sectional research, carried out with 356 elderly people registered in family health units in the Northeast of Brazil. The collection instruments used were the Index of Clinical-Functional Vulnerability and another of socioeconomic and health profile. The data were analyzed by inferential statistics, using the chi-square test, with a significance level of 0.05. Results the mean age was 72.85 years (±8.965); 63.8% were female, 39% were at risk of frailty and 22.5% were frail. There was an association between frailty, gender, age group, marital status, education, income, presence of heart disease and hypertension. Conclusions and implications for practice the markers of frailty in the elderly showed an association between sociodemographic and clinical characteristics, indicating the need for early screening at the primary health care level.

Percepção da qualidade de vida e condição de fragilidade entre idosos com diferentes situações de moradia / Perceived quality of life and frailty among older people living in different settings

OBJETIVO: Analisar a percepção de qualidade de vida de idosos residentes na comunidade e em residenciais de cuidados de longa permanência, correlacionando-a com a presença de fragilidade. METODOLOGIA: Trata-se de um estudo quantitativo e analítico do tipo transversal, no qual foram entrevistados 136 idosos, dos quais metade era residente na comunidade e a outra metade vivia em residenciais de cuidados de longa permanência. Utilizaram-se a escala de fragilidade de Edmonton para identificar fragilidade e os questionários World Health Organization Quality of Life - Bref e World Health Organization Quality of Life Assessment for Old Adults para mensurar qualidade de vida. Foram empregados o teste de análise de variância e a correlação de Pearson para análise intragrupos. RESULTADOS: Observou-se um maior número de idosos frágeis vivendo em residenciais de cuidados de longa permanência. A percepção de qualidade de vida foi melhor entre os residentes na comunidade, nos dois questionários, com destaque para os domínios relações sociais, meio ambiente e morte e morrer. O domínio autonomia apresentou a pior percepção, sobretudo entre os idosos que moravam em residenciais de longa permanência. Entre os idosos com fragilidade, estão as piores percepções de qualidade de vida na maioria dos domínios. CONCLUSÃO: A ausência de fragilidade favorece a melhor percepção dos domínios de qualidade de vida, bem como residir na comunidade. Pode-se, então, perceber que são os idosos residentes na comunidade os que se mantêm mais hígidos.

OBJECTIVE: To analyze the perceived quality of life of older people living in the community and in long-term care facilities and correlate it with the presence of frailty. METHODOLOGY: This is a quantitative, analytical, cross-sectional study in which 136 older people were interviewed, half were living in the community, and the other half of whom were living in long-term care facilities. The Edmonton Frail Scale was used to identify frailty and, the World Health Organization Quality of Life - Bref O (WHOQOL-BREF) and World Health Organization Quality of Life Assessment for Older Persons (WHOQOL-OLD) questionnaires were used to measure quality of life. Analysis of variance and Pearson correlation coefficients were used for intragroup analyses. RESULTS: A greater proportion of older people living in long-term care facilities were frail. Perceived quality of life was better among people living in the community, according to both questionnaires, particularly in the domains social relations, environment, and death and dying. The worst scores were observed in the autonomy domain, particularly among older people living in long-term care facilities. In the majority of domains, older people with frailty had worse perceived quality of life scores. CONCLUSIONS: The absence of frailty favors a better perception of the quality of life domains, as living in the community.

Fragilidade em idosos assistidos por equipes da atenção primária / Frailty among the elderly assisted by primary health care teams

Resumo Objetivou-se conhecer a prevalência e os fatores associados à fragilidade em idosos na Atenção Primária à Saúde. Trata-se de estudo transversal realizado com1750 idosos no Sudeste do Brasil. Utilizou-se para coleta o Brazilian Older Americans Resources and Services MultiDimensional Function Assessment Questionnaire (BOMFAQ) e o Índice de Vulnerabilidade Clínico-funcional (IVCF-20). Realizaram-se as análises descritivas e bivariadas, seguidas da análise regressão de Poisson, com variância robusta, para obtenção de razões de prevalência ajustadas. O IVCF-20 identificou 357 idosos frágeis (20,1%). As variáveis estatisticamente associadas à fragilidade após análise múltipla foram: estado civil (RP = 1,05; IC95% = 1,02-1,07), escolaridade (RP = 1,05; IC95% = 1,03-1,08), polipatologia (RP = 1,05; IC95% = 1,01-1,09), polifarmácia (RP = 1,21; IC95% = 1,17-1,26), transtorno mental (RP = 1,16; IC95% = 1,12-1,21), comprometimento cognitivo (RP = 1,71; IC95% = 1,57-1,86), comprometimento de atividades de vida diária (RP = 1,12; IC95% = 1,09-1,14), quedas (RP = 1,06; IC95% = 1,03-1,10), internação (RP = 1,39; IC95% = 1,27-1,52) e incontinência urinária, autopercepção da saúde. Concluiu-se que a significante prevalência de fragilidade do estudo reitera a necessidade de abordagem multidimensional do idoso.

Abstract The scope of this study was to assess the prevalence and factors associated with frailty among the elderly in Primary Health Care. It is a cross-sectional study carried out with 1750 elderly people in the Southeast of Brazil. The Brazilian Older American Resources and Services Multidimensional Functional Assessment Questionnaire (BOMFAQ) and the Clinical-Functional Vulnerability Index (CFVI) were used for data collection. Descriptive and bivariate analyzes were performed, followed by Poisson regression analysis, with robust variance, to obtain adjusted prevalence ratios (PR). The CFVI identified 357 frail elderly people (20.1%). The variables that remained statistically associated with frailty after multiple analysis were: single/widowed (PR = 1.05; 95%CI = 1.02-1.07); four years of schooling (PR = 1.05; 95%CI = 1.03-1.08); polypathology (PR = 1.05; 95%CI = 1.01-1.09); polypharmacy (PR = 1.21; 95%CI = 1.17-1.26); mental disorder (PR = 1.16; 95%CI = 1.12-1.21); cognitive impairment (PR = 1.71; 95%CI = 1.57-1.86); Daily Living Activity impairment (PR = 1.12; 95%CI = 1.09-1.14); falls (PR = 1.06; 95%CI = 1.03-1.10); hospitalization (PR = 1.39; 95%CI = 1.27-1.52); urinary incontinence and self-perception of health. The conclusion that a significant prevalence of frailty in the study reaffirms the need for a multidimensional approach to the elderly.

Evidence of association between the use of drugs and community-dwelling older people frailty: a cross-sectional study

ABSTRACT BACKGROUND: The scientific literature has shown that an association between polypharmacy and frailty exists. However, few studies have also considered drug interactions and the use of potentially inappropriate medications. OBJECTIVE: To evaluate the association between the use of drugs and frailty among community-dwelling older people. DESIGN AND SETTING: Cross-sectional study carried out among 580 older people in Uberaba (MG). METHODS: Data were collected at these older people's homes using instruments validated in Brazil. Descriptive, bivariate and binary logistic regression analyses were performed (P < 0.05). RESULTS: Most of these individuals were classified as pre-frail (55.7%), while 13.1% were frail. It was found that 31.7% of them presented polypharmacy, 41.7% had drug interactions and 43.8% were using potentially inappropriate medications. In the initial model, polypharmacy (odds ratio, OR = 1.91; confidence interval, CI = 1.27-2.86) and use of potentially inappropriate medications (OR = 2.45; CI = 1.68-3.57) increased the chance that these older people would be pre-frail or frail. In the final adjusted model, use of potentially inappropriate drugs remained associated with the outcome (OR = 2.26; CI = 1.43-3.57). CONCLUSION: Use of potentially inappropriate medications was the independent variable that explained the occurrence of frailty in a representative sample of community-dwelling older adults.

Análise do Índice de Vulnerabilidade Clínico-Funcional-20 dos idosos usuários do sistema único de saúde / Clinical-Functional Vulnerability Index-20 analysis of older people using the Brazilian Public Health System

Objetivo: Aplicar a versão do profissional de saúde do Índice de Vulnerabilidade Clínico-Funcional-20 em uma população-alvo idosa. Métodos: Foi conduzido um estudo de caráter transversal, observacional e individuado, em idosos cadastrados no Ambulatório Cruz Preta, em Alfenas (MG), sendo aplicado o Índice de Vulnerabilidade Clínico-Funcional-20 na amostra selecionada. Para tanto, foram selecionados 66 idosos, e os dados obtidos foram submetidos à análise multivariada. Resultados: Dentre os participantes, 29% apresentaram alto risco de vulnerabilidade, seguidos de 41% com risco moderado e 30% com baixo risco. Ao se considerar o ponto de corte para fragilidade, 70% da população de idosos classificou-se como frágil ou sob risco de fragilização. Houve correlação entre as características dos idosos com as variáveis do Índice de Vulnerabilidade Clínico-Funcional-20, que foram: redução da capacidade de exercer atividades de vida diária, declínio cognitivo, alteração de humor, dificuldade para caminhar e quedas. Conclusão: A população-alvo de idosos pode ser considerada frágil ou sob risco de fragilização, o que indica a necessidade de ampliação do atendimento geriátrico especializado estudado. Além disso, foi possível identificar os principais fatores que levam à fragilização da população idosa, o que permite delinear estratégias com o objetivo de prevenção da fragilidade e melhorar o atendimento da população fragilizada.

Objective: To apply the Medical Professional version of the Clinical-Functional Vulnerability Index-20 in the target population of older people. Methods: A cross-sectional, observational, and individual study was conducted with older patients enrolled in Ambulatório Cruz Preta, in the city of Alfenas (MG), and the Clinical-Functional Vulnerability Index-20 was applied to the selected sample. For this, 66 older people were selected and data were subjected to multivariate analysis. Results: Of the participants, 29% presented high risk of vulnerability, followed by 41% with moderate risk, and 30% with low risk. When considering the cut-off point for fragility, 70% of the elderly population were classified as frail or under risk of becoming frail. There was a correlation between the characteristics of the older people with Clinical-Functional Vulnerability Index-20 variables, which were: reduced ability to perform activities of daily life, cognitive decline, mood alteration, difficulty walking, and falls. Conclusion: the target population of older individuals may be considered frail or under risk of becoming frail, which indicates the need for expanded specialized geriatric care studied. In addition, it was possible to identify the main factors leading to older population frailty, which allows the development of strategies aimed at preventing frailty and improving care for the frail population.