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.

Propuesta de un modelo conceptual para el estudio de los ambientes alimentarios en Chile / Proposal for a conceptual model for the study of food environments in Chile / Proposta de um modelo conceitual para o estudo de ambientes alimentares no Chile

RESUMEN Objetivo Describir una propuesta de modelo conceptual para sistematizar los factores que condicionan los ambientes alimentarios y la forma en que estos se expresan en la conducta alimentaria de la población chilena. Métodos Estudio realizado en Chile que incluyó cuatro etapas secuenciales e iterativas: revisión de la literatura, apertura de discusión del modelo preliminar, generación de un segundo modelo y nueva discusión con expertos y elaboración de modelo conceptual definitivo. Resultados Se elaboró un modelo conceptual que incluye cinco ambientes alimentarios interrelacionados, aunque con características distintivas: ambiente doméstico, ambiente vía pública, ambiente institucional y organizacional, ambiente de restauración y ambiente de abastecimiento. Se sitúan al sistema alimentario y a la cultura como las variables más amplias del modelo. Los determinantes sociales de los ambientes alimentarios y alimentación constituyen los factores estructurales e intermedios de estos ambientes. En una relación más directa con los ambientes, se hallan la industria alimentaria y las políticas en alimentación y nutrición. Por último, se incluye al individuo y la cohesión social como parte del modelo, ya que son los individuos o los grupos quienes transitan dentro de los ambientes alimentarios. Conclusiones Este modelo representa un conjunto de definiciones, conceptos y relaciones que tienen una interacción compleja y multidireccional, por lo que el modelo contribuye a comprender de forma integral el fenómeno de cómo son condicionados los ambientes alimentarios sobre la conducta alimentaria.

SUMMARY Objective Describe a proposal for a conceptual model to systematize the factors affecting food environments and the ways in which these factors are expressed in food behaviors in the Chilean population. Methods Study conducted in Chile, with four sequential and iterative stages: literature review, initial discussion of the preliminary model, development of a second model and further discussion with experts, and development of a definitive conceptual model. Results A conceptual model was developed, including five interrelated food environments with distinctive characteristics: domestic environment, street environment, institutional and organizational environment, restaurant environment, and food supply environment. The food system and food culture are considered the broadest variables in the model. The social determinants of the food environments and eating habits constitute structural and intermediate factors in these environments. The food industry as well as food and nutrition policies are more directly related to food environments. Finally, individuals and social cohesiveness are included in the model, since individuals and groups move within food environments. Conclusions This model presents a set of definitions, concepts and relationships with complex and multidirectional interactions. The model, therefore, contributes to a comprehensive understanding of how food environments condition food behavior.

RESUMO Objetivo Propor um modelo conceitual para sistematizar os fatores que condicionam os ambientes alimentares e como eles são expressos no comportamento alimentar da população chilena. Métodos Estudo realizado no Chile que compreendeu quatro etapas sequenciais e iterativas: revisão da literatura, abertura de discussão do modelo preliminar, geração de um segundo modelo e nova discussão com especialistas e elaboração do modelo conceitual definitivo. Resultados Foi elaborado um modelo conceitual que engloba cinco ambientes alimentares inter-relacionados, apesar de terem características distintas: ambiente doméstico, ambiente público, ambiente institucional e organizacional, ambiente de restauração e ambiente de abastecimento. O sistema alimentar e fatores culturais são as variáveis mais amplas do modelo. Os determinantes sociais dos ambientes alimentares e da alimentação constituem fatores estruturais e intermediários destes ambientes. A indústria alimentícia e políticas de alimentação e nutrição têm uma relação mais direta com os ambientes. Por último, são incluídos no modelo os indivíduos e a coesão social, visto que são os próprios indivíduos ou grupos de indivíduos que circulam dentro dos ambientes alimentares. Conclusões Este modelo representa um conjunto de definições, conceitos e relações com interações complexas e multidirecionais. Ele contribui para compreender como um todo o fenômeno de como os ambientes alimentares estão condicionados ao comportamento alimentar.