Screening for vulnerable older people: Is the Probability of Repeated Admission scale an accurate tool?

AIM: To evaluate the Probability of Repeated Admission (Pra) scale performance in predicting healthcare utilization and death in a community sample of Rio de Janeiro city, Brazil. METHODS: This was a prospective longitudinal study. The sample was composed of community-dwelling older people who participated in the research network Frailty in Brazilian Older People Study, Rio de Janeiro section. It analyzed data from the baseline and the follow up. At the baseline, 764 older adults were stratified by the Pra, and, 3 years later, data on health services utilization and survival status were collected. The Pra accuracy, obtained by the area under the curve, the sensitivity and the specificity to predict hospitalization in 3 years; visits to the emergency department; and death were determined. Cox regression estimated the survival curves, according to the risk strata. RESULTS: The accuracy, the sensitivity and the specificity of Pra were 62% (95% CI 57-68%), 8.8% and 95.4% for hospitalization in 3 years; 59% (95% CI 53-64%), 8.3% and 94.8% for emergency room visits; 66% (95% CI 59-74%) and 68% (95% CI 63-73%), 15.0% and 96.0% for death. Survival curves showed that high-risk individuals were more likely to die compared with the low-risk individuals, adjusted to covariables (P < 0.001). CONCLUSIONS: The Pra presented low accuracy, low sensitivity and high specificity for all outcomes observed, indicating a poor performance to screen vulnerable older adults in Brazil. Therefore, this tool should not be used alone, as a case-finding instrument. Geriatr Gerontol Int 2020; 20: 360-365.

Prevalence of and factors associated with successful aging in Brazilian older adults: Frailty in Brazilian older people Study (FIBRA RJ).

AIM: We aimed to estimate the factors associated with the biomedical dimension of successful aging (SA) and its prevalence in older Brazilian individuals. The conceptual framework for this approach relies on the considerable variation in the biophysiological effects of aging and the need to understand the factors that influence this process. METHODS: Data from a total of 845 older adults were analyzed. SA operationalization included the following criteria: good physical and cognitive performance, absence of disabilities, and good health conditions. Descriptive analyses were used to estimate the prevalence of SA, and the factors associated with SA were assessed using multivariate logistic regressions. RESULTS: The overall prevalence of SA was 25%, and the associated factors were the absence of (OR 10.5, 95% CI 5.2-21.1) or fewer than two physical morbidities (OR,3.5, 95% CI 2.1-5.9), body mass index in the overweight range (OR 1.8, 95% CI 1.02-3.3), absence of depression (OR ,2.1, 95% CI 1.07 = 4.1), high levels of physical activity (OR 1.88, 95% CI 1.14-3.2), high levels of social participation (OR 2.07, 95% CI 1.16-3.4) and younger age (65-74 years, OR 4.27, 95% CI 1.79-10.1; 75-84 years, OR 2.7, 95% CI 1.18-6.41). CONCLUSIONS: A small proportion of older adults met the criteria defining successful aging. Despite the great impact of biological determinants, modifiable social and lifestyle factors predicted successful aging in this population, suggesting that health promotion targeting behavioral changes might lead to tangible benefits for health and well-being in old age. Geriatr Gerontol Int 2018; 18: 1280-1285.

[CAMDEX-R and dementia diagnosis in Brazil: translation and transcultural adaptation of the informant interview]. / O CAMDEX-R e o diagnóstico de demência no Brasil: tradução e adaptação transcultural de entrevista com acompanhante.

INTRODUCTION: The Cambridge Examination for Mental Disorders of the Elderly - revised (CAMDEX-R) is an instrument developed in England and used as an aid to the diagnosis of dementia, mainly in its initial forms. It contains nine sections (named from A to I), including a neuropsychological evaluation and an interview with an informant (section H). This kind of interview has proved to be useful in the detection of dementia. OBJECTIVE: To translate and transculturally adapt to Brazilian Portuguese the section H of CAMDEX-R. METHODS: The section under study is a structured interview, composed by 130 items, applied to an informant aiming at diagnosing a demential state. The study was conducted by the universalist approach, with evaluation of conceptual, item, semantic and operational equivalences. Two independent translations into Portuguese were done by two bilingual Brazilians. Those were backtranslated into English by two bilingual Americans, also independently, without knowing the original version. From the translations, backtranslations and original text, another bilingual Brazilian suggested a synthesis-version. Based on the synthesis-version, a multidisciplinary group of two geriatricians and two gerontologists made the test-version with the transcultural adaptations needed. The test-version was used in the pre-test in the geriatric outpatient department of <>, and it was carried out with twenty-five caregivers who were stimulated to comment and paraphrase the questions. The main focus was the items considered by the group of specialists to be of greater difficulty to adapt. The identified problems returned to the group of specialists, who produced the final-version then. RESULTS: The Portuguese version was made with some modifications to the literal translation, aiming at keeping a semantic equivalence to the original interview. DISCUSSION: The conceptual, item and semantic equivalences were considered established. The operational equivalence is in progress. The concern about our target population's low level of schooling was present during the whole transcultural adaptation process, leading us to choose more popular words. CONCLUSIONS: The Brazilian version of CAMDEX-R's Section H was considered suitable for daily clinical use.

[Mini-Mental State Examination: psychometric characteristics in elderly outpatients]. / Mini-Exame do Estado Mental: características psicométricas em idosos ambulatoriais.

OBJECTIVE: To assess the psychometric characteristics of the Mini-Mental State Examination in elderly outpatients who seek primary health care. METHODS: A total of 303 subjects (>65 years) underwent comprehensive geriatric assessment with functional tools, including Mini-Mental State Examination. Sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve were calculated. RESULTS: Sensitivity, specificity, positive and negative predictive values, and area under ROC curve were 80.8%, 65.3%, 44.7%, 90.7% and 0.807 respectively (cutoff point =23/24). The best cutoff point for illiterate was 18/19 (sensitivity =73.5%; specificity =73.9%); and for literate was 24/25 (sensitivity =75%; specificity =69.7%). CONCLUSIONS: While screening elderly outpatients for dementia, schooling must be considered in the choice of the best cutoff point in the Mini-Mental State Examination.

Mini-Exame do Estado Mental: características psicométricas em idosos ambulatoriais / Mini-mental state examination: psychometric characteristics in elderly outpatients

OBJETIVO: Avaliar as características de medida do Mini-Exame do Estado Mental em idosos atendidos em um ambulatório geral. MÉTODOS: O total de 303 indivíduos (>65 anos) foi submetido à avaliação geriátrica com vários instrumentos, inclusive o Mini-Exame do Estado Mental. Foram calculadas a sensibilidade, a especificidade, os valores preditivos positivo e negativo e a curva ROC. RESULTADOS: A sensibilidade, a especificidade, os valores preditivos positivo e negativo e a área sob a curva ROC foram 80,8 por cento, 65,3 por cento, 44,7 por cento, 90,7 por cento e 0,807, respectivamente (ponto de corte 23/24). O melhor ponto de corte para indivíduos analfabetos foi 18/19 (sensibilidade =73,5 por cento; especificidade =73,9 por cento), e para aqueles com instrução escolar foi 24/25 (sensibilidade =75 por cento; especificidade =69,7 por cento). CONCLUSÕES: Para o rastreamento cognitivo de idosos atendidos em ambulatórios gerais pelo Mini-Exame do Estado Mental, a escolaridade deverá ser considerada para a adoção do ponto de corte mais adequado.

OBJECTIVE: To assess the psychometric characteristics of the Mini-Mental State Examination in elderly outpatients who seek primary health care. METHODS: A total of 303 subjects (>65 years) underwent comprehensive geriatric assessment with functional tools, including Mini-Mental State Examination. Sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve were calculated. RESULTS: Sensitivity, specificity, positive and negative predictive values, and area under ROC curve were 80.8 percent, 65.3 percent, 44.7 percent, 90.7 percent and 0.807 respectively (cutoff point =23/24). The best cutoff point for illiterate was 18/19 (sensitivity =73.5 percent; specificity =73.9 percent); and for literate was 24/25 (sensitivity =75 percent; specificity =69.7 percent). CONCLUSIONS: While screening elderly outpatients for dementia, schooling must be considered in the choice of the best cutoff point in the Mini-Mental State Examination.

Avaliação do idoso pelo cuidador / Aged`s valuation by the caregiver

Objetiva delinear um amplo quadro de alterações que devem ser observadas por aqueles que cuidam de idosos, procurando no entanto, oferecer algumas explicações que dêem algum sentido para o cuidador frente à manifestações mórbidas

Hipertensäo arterial e outros fatores de risco de doença cardiovascular: prevalências em uma populaçäo de idosos / Arterial pressure and other risk factors of cardiovascular disease: prevalence in the age population

No Brasil, ao contrário do que aconteceu na maior parte dos países do mundo desenvolvido, o processo de envelhecimento da populaçäo iniciou-se há menos de 50 anos, caracterizando-se, porém, por uma dinâmica de intensas alterações em suas características demográficas

A hipertensão arterial em uma população de idosos: prevalência entre usuários de cursos universitários / Arterial hipertension in the elderly people

Objetiva determinar a prevalência de hipertensão arterial entre indivíduos com 60 anos ou mais, usuários dos cursos da Universidade Aberta da Terceira Idade