Aplicativo para rastreio de fragilidade: ferramenta de cuidado ao idoso na Atenção Primária à Saúde / Application for screening frailty: elderly care tool in Primary Health Care

Objetivo: Desenvolver aplicativo de rastreio de fragilidade em idosos na Atenção Primária à Saúde e validar, semanticamente, com profissionais de saúde. Método: Estudo metodológico, realizado de fevereiro a março de 2021, por meio de validação semântica, com 75 enfermeiros e 44 médicos da Estratégia Saúde da Família dos 25 municípios da 2ª Região de Saúde do Estado da Paraíba e construção de aplicativo móvel denominado APS para Idosos Frágeis, para uso em sistema Android, com linguagem de programação HTML, Java Script, CSS, PHP, Framework IONIC e modelo de produção MVC. Resultado: Entre as 42 variáveis presentes no instrumento de validação semântica foram selecionadas 20 variáveis para compor o aplicativo, formado por quatro Dimensões: Fisiológica, Funcional, Biopsicossocial, Cognitiva. Conclusão: O aplicativo possibilita a avaliação multidimensional do idoso na Atenção Primária à Saúde. Entende-se que o diagnóstico precoce da fragilidade proporciona estabilização do quadro clínico, diminuindo risco de hospitalização, morte e encaminhamentos para atenção especializada.

Objectives: To develop an application for screening frailty in the elderly in Primary Health Care and to validate it semantically with health professionals. Methods: Methodological study, carried out from February to March 2021, through semantic validation. With the participation of 75 nurses and 44 doctors of the Family Health Strategy from the 25 Municipalities of the Second Health Region of the State of Paraíba. In addition to the construction of a mobile application called Primary Health Care for frail elderly, for use on an Android system, with the programming language HTML, Java Script, CSS, PHP, Framework IONIC and MVC production model. Results: Among the 42 variables present in the semantic validation instrument, 20 variables were selected to compose the application, formed by four Dimensions: Physiological, Functional, Biopsychosocial, Cognitive. Conclusion: The application enables the multidimensional assessment of the elderly in primary health care. It was identified that the early diagnosis of frailty provides stabilization of the clinical condition, reducing the risk of hospitalization, death and referrals to specialized care.

Long-term participation in community-based group resistance exercises delays the transition from robustness to frailty in older adults: a retrospective cohort study

BACKGROUND@#How community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises.@*METHODS@#We analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0-3, 4-7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: <3 times, short-term participation group; 4-6 times; mid-term participation group; and 7-13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51).@*RESULTS@#The participants' mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (p<0.001) and changed by - 0.93 points for long-term participate group (p<0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (p=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (p<0.001) and mid-term (p=0.002) participation groups.@*CONCLUSION@#Participation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline.

Síndrome da fragilidade e o uso de tecnologias assistivas em idosos / Syndrome of frailty and the use of assistive technologies in elderly / Síndrome de la fragilidad y el uso de tecnologías asistas en idosos

Objetivo: Analisar a associação entre a síndrome da fragilidade e o uso de tecnologias assistivas em idosos de um ambulatório. Método: Pesquisa transversal, com 374 idosos, entre fevereiro de 2016 a fevereiro de 2017. A coleta de dados contemplou instrumento estruturado e Escala de Fragilidade de Edmonton. Para análise utilizou-se o Stata®12, verificou-se a associação por meio dos testes F de Fisher e t de Student (p≤0,05). Resultados: Predomínio de mulheres (67,4%), média de idade de 67,9 anos, casados (56,4%), baixa escolaridade (55,1%). Dos participantes, 4,5% utilizavam bengala, 1,3% muleta e 0,3% andador, 29,4% faziam uso de lentes corretivas, 40,1% dos idosos apresentaram algum grau de fragilidade. As análises bivariada e multivariada apontaram associação positiva entre a fragilidade e bengala (p=0,001). Conclusão: Importante do profissional de saúde, realize o rastreio precoce da fragilidade com destaque para os idosos em uso de tecnologias assistivas, pois podem indicar o comprometimento e perda funcional

Objective: To analyze the association between the fragility syndrome and the use of assistive technologies in the elderly in an outpatient clinic. Method: Cross-sectional research with 374 elderly individuals, between February 2016 and February 2017. Data collection included structured instrument and Edmonton Fragility Scale. Stata®12 was used for analysis, the association was verified through Fisher's F test and Student's t test (p≤0.05). Results: Predominance of women (67.4%), mean age of 67.9 years, married (56.4%), low educational level (55.1%). Of the participants, 4.5% used bengal, 1.3% crutch and 0.3% walker, 29.4% used corrective lenses, 40.1% of the elderly presented some degree of fragility. The bivariate and multivariate analysis showed a positive association between fragility and bengal (p=0.001). Conclusion: Important for the health professional, perform the early screening of the fragility, highlighting the elderly using assistive technologies, as they may indicate impairment and functional loss

Objetivo: Analizar la asociación entre el síndrome de fragilidad y el uso de tecnologías asistivas en ancianos de un ambulatorio. Método: Investigación transversal, con 374 ancianos, entre febrero de 2016 a febrero de 2017. La recolección de datos contempló instrumento estructurado y Escala de Fragilidad de Edmonton. Para el análisis se utilizó el Stata®12, se verificó la asociación por medio de las pruebas F de Fisher y t de Student (p≤0,05). Resultados: Predominio de mujeres (67,4%), promedio de edad de 67,9 años, casados (56,4%), baja escolaridad (55,1%). De los participantes, el 4,5% utilizaba bengala, el 1,3% muleta y el 0,3% andador, el 29,4% hacía uso de lentes correctivas, el 40,1% de los ancianos presentaron algún grado de fragilidad. Los análisis bivariados y multivariados apuntaron una asociación positiva entre la fragilidad y el bengala (p=0,001). Conclusión: Importante del profesional de salud, realice el rastreo precoz de la fragilidad con destaque para los ancianos en uso de tecnologías asistivas, pues pueden indicar el compromiso y pérdida funcional

Frailty and mortality among older patients in a tertiary hospital in Nigeria

Background: This study determined the frailty status and its association with mortality among older patients. Design: A prospective cohort design. Setting: Study was conducted at the medical wards of University College Hospital, Ibadan, Nigeria. Participants and study tools: Four hundred and fifty older patients (>60 years) were followed up from the day of admission to death or discharge. Information obtained includes socio-demographic characteristics and clinical frailty was assessed using the Canadian Study of Health and Aging (CSHA) scale. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05. Results: Overall, frailty was identified in 285 (63.3%) respondents. Mortality was significantly higher among frail respondents (25.3%) than non-frail respondents (15.4%) p=0.028. Logistic regression analysis showed factors associated with frailty were: male sex (OR=1.946 [1.005­3.774], p=0.048), non-engagement in occupational activities (OR=2.642 [1.394­5.008], p=0.003), multiple morbidities (OR=4.411 [1.944­10.006], p<0.0001), functional disability (OR=2.114 [1.029­4.343), p=0.042], malnutrition (OR=9.258 [1.029­83.301], p=0.047) and being underweight (OR=7.462 [1.499­37.037], p=0.014). Conclusion: The prevalence of frailty among medical in-hospital older patients is very high and calls for its prompt identification and management to improve their survival

Fragilidad y sarcopenia en adultos mayores / Fragility and sarcopenia in older adults

En las últimas décadas se está presentando un incremento de la población adulta mayor en todo el mundo y sobre todo en los países latinoamericanos, los cuales no están preparados para enfrentar a este aumento poblacional, ya que este grupo presenta problemas frecuentes de incapacidad funcional para la realización de las actividades de la vida diaria y muchas veces presentando problemas de morbimortalidad incrementada. No debemos olvidar, que la capacidad de vivir independientemente es crucial para la calidad de vida en todas las edades y este estado de independencia a su vez, depende del buen estado físico y mental, así como del psicológico y de las condiciones socio-económicas de la persona...(AU)

In recent decades there has been an increase in the older adult population throughout the world and especially in Latin American countries, which are not prepared to face this population increase, since this group presents frequent problems of functional disability for carrying out activities of daily living and often presenting problems of increased morbidity and mortality. We must not forget that the ability to live independently is crucial for the quality of life in all ages and this state of independence, in turn, depends on the good physical and mental state, as well as the psychological and socio-economic conditions of the person ... (AU)