Examining the factors associated with functional capacity of community-dwelling older adults using the ICF framework: a cross-sectional study from the Frailty in Brazilian Older Adults Study (FIBRA).

BACKGROUND: There are many factors associated with functioning and disability in older adults and these relationships are not clear. OBJECTIVE: To explore the factors associated with functional capacity of older adults using the framework of the International Classification of Functioning, Disability, and Health (ICF). METHODS: This is a cross-sectional study with a dataset from a survey of 1 377 community-dwelling older adults (≥ 65 years) in a middle-income country. Three functional outcomes were selected to represent the functioning domains: 1) muscle strength for body function; 2) walking speed for activity; and 3) advanced activities of daily living (ADL) for participation. Demographic, clinical, and social information was selected to represent the domains of health conditions and contextual factors (i.e. personal and environmental factors). Multivariate models tested the impact of these factors on each outcome. RESULTS: Depressive symptoms, age, and physical activity were associated with the three outcomes. Muscle strength was also associated with urinary incontinence, visual deficits, female sex, and employment. Walking speed was also associated with urinary incontinence, obesity, fractures due to falls, female sex, health professionals' visits, and walking aid devices. Advanced ADL were also associated with stroke, visual deficits, education, employment, health perception, social support, and walking aid devices. CONCLUSION: Functional capacity of older adults is associated with some non-modifiable factors, such as age and sex. The modifiable factors must be addressed by health professionals and policymakers in the geriatric area, especially depression, obesity, physical inactivity, and social support.

Periodontal Disease in the Brazilian Population: A Retrospective Analysis on the 2013 National Health Survey to Identifying Risk Profiles.

Periodontal disease (PD) is a global public health problem with prevalence varying according to social and economic contexts; however, few studies have investigated the distribution of PD worldwide. PD is the host response to an infection or progression of a clinical condition, and the identification of modifiable risk factors for adequate clinical management of patients should be a priority in health policies directed to vulnerable population groups. In this context, we investigated the characteristics and risk factors for PD using the Brazilian National Health Survey 2013 (PNS-2013). A cluster analysis using the interdependence technique was applied to explore data on the risk of periodontitis. The presence or absence of a risk factor was analyzed using five variables (ten categories), while ordinal regression assessed risk profiles based on sociodemographic aspects of the Brazilian population. Individuals were classified as low (26.33%), medium (23.34%), or high risk (50.32%) for PD. Age, educational level, ethnicity, and Brazilian regions (except the North region) were significantly associated with risk for PD in the adjusted final regression model. Individual and social contexts were factors related to the high risk of PD in the Brazilian population. Our results highlight the need for public policies on healthy habits to prevent systemic diseases affecting oral health.

Frailty and life course violence: The international mobility in aging study.

OBJECTIVE: To estimate the prevalence of frailty in older adults in the IMIAS population, to examine associations between lifelong domestic violence and frailty and possible pathways to explain these associations. METHODS: A cross-sectional study with 2002 men and women in the International Mobility in Aging Study, aged between 65 and 74 years old living in five cities of Tirana (Albania), Natal (Brazil), Kingston and Saint-Hyacinthe (Canada), and Manizales (Colombia). Domestic physical and psychological violence by family and intimate partner was assessed by the Hurt, Insult, Threaten and Scream (HITS) scale. Fried's phenotype was adopted to define frailty. Logistic regressions were fitted to estimate between frailty and lifelong violence. Mediation analyses using the Preacher and Hayes method was used to examine potential health pathways. RESULTS: Frailty prevalence varies across cities, being lowest in Saint-Hyacinthe and Kingston, and highest in women in Natal. Women had a higher prevalence in Tirana and Natal. Adjusting for age, sex, education and research city, those reporting childhood physical abuse (CPA) had higher odds of frailty (OR = 1.68; 95% CI: 1.01; 2.78); those who had been exposed to psychological violence by their intimate partner had also higher odds of frailty (OR = 2.07; 95% CI: 1.37; 3.12). CPA effect on frailty was totally mediated by chronic conditions and depression symptoms. Effects of psychological violence by intimate partner were partially mediated by chronic conditions and depression symptoms. CONCLUSIONS: Childhood physical abuse and psychological violence during adulthood leave marks on life trajectory, being conducive to adverse health outcomes and frailty in old age.

Sleep and frailty syndrome in elderly residents of long-stay institutions: a cross-sectional study.

AIM: Aging changes sleep patterns in most elderly people. Frailty shares a number of characteristics with sleep disorders and leads to similar results. However, their relationship in residents of long-stay institutions remains unclear. Thus, the present study aimed to evaluate the relationship between sleep and frailty syndrome in residents of long-stay institutions. METHODS: This was a cross-sectional study of 69 institutionalized elderly in the city of João Pessoa, Brazil. The Pittsburg Sleep Quality Index, actimetry and specific tests for frailty phenotype variables were used. Pearson's χ(2)-test, one-way anova and multiple linear regression were applied in statistical analysis. RESULTS: The sample was characterized as predominantly frail (49.3%), mainly women (62.3%), with a mean age of 77.52 years (± 7.82). Frail elderly exhibited poor sleep quality, when compared with non-frail individuals (P = 0.02). In the multiple linear regression analysis, sleep latency (R(2) = 0.11, P = 0.003) and sleep quality (R(2) = 0.08, P = 0.013) had an influence on frailty, especially sleep quality. No differences were found between rest-activity pattern and frailty phenotype. CONCLUSION: Sleep alterations, including poor sleep quality and prolonged latency, were related to frailty in institutionalized elderly.

Factores asociados al riesgo de desnutrición en mujeres mayoresen comunidades de bajos ingresos / Factors associated to risk of malnutrition amongst elderly women in low-income communities

Objective: The present study aimed to identify the prevalence and the factors associated with the risk ofmalnutrition in elderly women.Methods: The study deals with a cross-sectional design, with a sample of 222 women in the age group from 60to 96 years of age. An interview was carried out containing socio-demographic variables, clinical conditions, and behavioral aspects. The statistical analysis was accomplished via calculation of the respective prevalence ratios (PR) in the Poisson regression, p<0.05. Results: A prevalence of 33.8% (n=75) of women, considered with a malnutrition risk or undernourished, which started from the hierarchical multivariate analysis, was identified. A significant association with the age group ranging from 70 to 79 years of age (PR=2.1; CI 95%: 1.3-6.7), low education level (PR=3.1; CI 95%: 1.0-11,6), living with otherpeople (PR=2.0; CI 95%: 1.0-4.6), the presence of depressive symptomatology (PR=2.1; CI 95%: 1.0-7.1), absenceof administration of medication (PR=3.0; CI 95%: 1.1-7.6), having had some food privation along their lives (PR=3.1; CI 95%: 1.3-9.6), and with less than 75% of the time of physical activity in their leisure time (PR=2.0; CI 95%: 1.0-4.7) were found.Conclusion: There is a high percentage of elderly women in situation of malnutrition risk, and the associatedfactors to the condition suggests a complex causal net in the determination of the nutritional state.

Influence of biopsychosocial factors on the survival of the elderly in northeast Brazil-a prospective study.

Background. Identifying the risk factors peculiar to each population has a great relevance, because it enables health policy formulators to analyze information accurately and by doing so, define objectives and action programs aimed at a qualitative and economically feasible solution to the problem. Thus, this study aimed at identifying the risk factors for survival in elderly in a city in the state of Rio Grande do Norte (RN), Brazil. Methods. A prospective study was carried out, where 310 elderly persons were selected to form a baseline. The follow-up was 53 months. The predictive variables were divided into sociodemographic, physical health, neuropsychiatric and functional capacity. Statistical analysis was performed using bivariate analysis, survival analysis, followed by Cox regression in the multivariate analysis. Results. A total of 60 (19.3%) elderly individuals died during the follow-up. The survival mean was 24.8 months. In the Cox analysis, dependence in basic activities of daily living (HR = 3.55), cognitive deficit (HR = 4.22) and stroke (HR = 3.35) continued as independent risk factors for death. Discussion. The risk factors found in the study can be interpreted as the primary predictors for death among elderly members of the community.

[Concurrent validity of self-reported weight and height for diagnosing elderly women's nutritional status]. / Validade concorrente do peso e estatura auto-referidos no diagnóstico do estado nutricional em mulheres idosas.

OBJECTIVE: The present study was aimed at assessing the concurrent validity of selfreported weight and height measurements when diagnosing low-income elderly women's nutritional state. METHODS: The sample consisted of 181 women (average age being 70 + or - 7.2) taken from groups running activities for elderly people in the city of Jequié, Bahia, Brazil. Reported weight and height measurements were collected through individual interviews preceding direct measurements being taken. Central tendency and dispersion measurements were used during data analysis for characterising the sample and Student's t-test was used for evaluating the differences between the averages for the reported and real measurements. The intraclass correlation coefficient and the Kappa index were used for checking agreement between measurements (p<0.05). RESULTS: The results highlighted a tendency to underestimate reported weight and height anthropometric measurements. Satisfactory agreement indexes were noted for the reported weight measurements (varying from r(icc) = 0.74 to r(icc) = 0.97 in eutrophic people) when considering economic class and the absence of cognitive deficit. On the other hand, concordance indexes for the reported height measurements were low (varying from r(icc) = 0.03 to 0.28). CONCLUSIONS: Data analysis results led to concluding that the reported weight measurements could be considered to be valid in elderly, low-income, low scholastic level populations. However, the same cannot be said about the reported height measurements, or about the use of the nutritional state indicator, based on combined reported weight and height measurements.

Validade concorrente do peso e estatura auto-referidos no diagnóstico do estado nutricional em mulheres idosas / Validez de las medidas auto-referidas y combinadas de peso y altura en el diagnostico del estado nutricional en mujeres de edad avanzada / Concurrent validity of self-reported weight and height for diagnosing elderly women's nutritional status

Objetivo Analisar a validade concorrente de medidas auto-referidas de peso e estatura para o diagnóstico do estado nutricional em mulheres idosas de baixa renda. Métodos A amostra foi composta de 181 mulheres, com média de idade de 70±7,2 anos, pertencente a grupos de atividades para idosos na comunidade no município de Jequié, Bahia. As medidas referidas de peso e estatura corporal foram coletadas através de entrevista individual que antecederam as aferições. Na análise dos dados foram utilizadas medidas de tendéncia central e dispersao para caracterizaçao da amostra, utilizou-se o test t Student para avaliar as diferenças entre as médias das medidas referidas com as aferidas; o coeficiente de correlaçao intraclasse e o índice Kappa foram utilizados para verificaçao da concordáncia entre as medidas; p<0,05. Resultados Os resultados indicam haver uma tendéncia para a subestimaçao das medidas antropométricas de peso e estatura referidas. Foram observados índices satisfatórios de concordáncia para as medidas referidas de peso corporal variando de ricc=0,74 em pessoas eutróficas, até ricc=0,97 considerando as variáveis, classe económica e auséncia de déficit cognitivo. Porém, em medidas referidas de altura os índices de concordáncia foram baixos variando de ricc=0,03 a ricc=0,28. Conclusões Os dados analisados permitem concluir que em populações idosas de comunidades de baixa renda e escolaridade, as medidas referidas de peso corporal podem ser consideradas de validade assegurada. No entanto, o mesmo nao se pode afirmar das medidas reportadas de estatura, assim como do indicador do estado nutricional baseado em medidas referidas de peso e estatura conjugados.

Objective The present study was aimed at assessing the concurrent validity of selfreported weight and height measurements when diagnosing low-income elderly women's nutritional state. Methods The sample consisted of 181 women (average age being 70±7.2) taken from groups running activities for elderly people in the city of Jequié, Bahia, Brazil. Reported weight and height measurements were collected through individual interviews preceding direct measurements being taken. Central tendency and dispersion measurements were used during data analysis for characterising the sample and Student's t-test was used for evaluating the differences between the averages for the reported and real measurements. The intraclass correlation coefficient and the Kappa index were used for checking agreement between measurements (p<0.05). Results The results highlighted a tendency to underestimate reported weight and height anthropometric measurements. Satisfactory agreement indexes were noted for the reported weight measurements (varying from ricc = 0.74 to ricc = 0.97 in eutrophic people) when considering economic class and the absence of cognitive deficit. On the other hand, concordance indexes for the reported height measurements were low (varying from ricc=0.03 to 0.28). Conclusions Data analysis results led to concluding that the reported weight measurements could be considered to be valid in elderly, low-income, low scholastic level populations. However, the same cannot be said about the reported height measurements, or about the use of the nutritional state indicator, based on combined reported weight and height measurements.

Objetivo El objetivo del estudio fue evaluar la validez de las medidas auto-referidas de peso y la altura combinadas para el diagnóstico del estado nutricional en mujeres de edad avanzada con bajos ingresos. Métodos La muestra consistió de 181 mujeres, con una edad media de 70±7,2 años, pertenecientes a grupos de actividades para personas mayores en la comunidad, en el municipio de Jequié, Bahia. Las medidas auto-reporte de peso corporal y la altura fueron obtenidas por medio de entrevistas individuales que precedieron las mediciones directas. En el análisis de los datos se utilizaron medidas de tendencia central y dispersión para caracterizar la muestra, la prueba t de Student para evaluar diferencias entre medias; el coeficiente de correlación intraclase y el índice Kappa fueron utilizados para comprobar la concordancia entre las medidas, con un p <0,05. Resultados Los resultados indican que hay una tendencia a subestimar las medidas antropométricas de peso y altura reportadas. Se encontraron índices satisfactorios de concordancia en las medidas de peso corporal, con una variación de Ricc=0,74 en personas eutróficas hasta Ricc=0,97, considerando los aspectos de clase económica y déficit cognitivo. Sin embargo, medidas de altura e índices de concordancia fueran bajos con la variación de Ricc=0,03 hasta Ricc=0,28. Conclusiones Los datos analizados muestran que en la población de ancianos en las comunidades de bajos ingresos y educación, las medidas de peso corporal pueden considerarse validas. Sin embargo, lo mismo no puede afirmarse de las medidas de estatura, ni en cuanto al indicador de estado nutricional, con base en medidas de peso y altura combinadas.

[Impact of cognitive deficit on survival among elderly residents in the community]. / Impacto del déficit cognitivo en la supervivencia de ancianos residentes en la comunidad.

OBJECTIVE: To analyze cognitive deficit as a risk factor for death in elderly residents in the community and its relationship with variables related to sociodemographic factors, physical health, and functional capacity. MATERIAL AND METHODS: A prospective study was carried out in the city of Santa Cruz, Brazil, in 310 randomly selected elderly individuals who were followed-up for 53 months. Predictive factors were sociodemographic and neuropsychiatric variables, physical health, and functional capacity. The statistical methods used were bivariate analysis (survival analysis), and Cox regression (multivariate analysis) with respective hazard ratios (HR). A value of P<.05 was considered statistically significant and 95% confidence intervals (CI) were calculated. RESULTS: A total of 60 (20.5%) elderly residents died during the study. The main cause of death was cardiovascular disease. The mean time until death was approximately 24.8 months. The main risk factors identified in Cox analysis were cognitive deficit (HR=4.22), stroke (HR=3.08) and dependency for basic activities of daily living (HR=3.55). CONCLUSIONS: Cognitive deficit is an independent risk factor for death. The results of the present study could be useful in formulating future health policies aiming to reduce mortality in the elderly.

Caracterización del nivel de aptitud funcional de mujeres mayores residentes en comunidades de bajos ingresos / Characterizing the level of functional fitness of female senior-citizens residing in low-income communities

Objetivo Desarrollar una tabla descriptiva con el nivel de desempeño en parámetros de aptitud funcional en mujeres de 60 a 92 años, residentes en comunidades de bajos ingresos. Métodos La muestra se conformó con 222 mujeres de 16 grupos de convivencia para personas mayores en el municipio de Jequié, Bahia (IC=95 por ciento), Brasil. Se analizaron los parámetros de aptitud funcional (fuerza, resistencia aeróbica, flexibilidad, agilidad/equilibrio dinámico y el índice de masa corporal como estimación de la composición corporal), correspondientes a tres grupos etarios. Para el análisis de los datos se utilizaron procedimientos de estadística descriptiva (media, desviación media y distribución de percentiles) y análisis de varianza comparando las tres franjas etarias, categorizadas de acuerdo con los parámetros de aptitud funcional, por intermedio del test de Kruskal Wallis, con p<0.05. Resultados Se observaron diferencias entre los grupos de edad en cuanto a la aptitud funcional, excepto para la composición corporal. Sin embargo, en comparación con otros estudios que enfocaron la temática, se constató que los cambios ocurridos en el desempeño físico, al avanzar la edad cronológica, ocurren de manera más lenta. Conclusiones Los resultados alcanzados proveen una escala normativa específica a ser utilizada en poblaciones con características similares, la cual puede servir como parámetro para la elaboración de programas más efectivos en el mantenimiento de la aptitud funcional de personas mayores, residentes en comunidades de bajos ingresos.

Objective Developing a descriptive table regarding functional fitness parameters for women aged 62 to 92 residing in low-income communities. Methods The samples consisted of 222 women divided into 16 senior-citizen social groups in Jequié, Bahia, (95 percentCI) Brazil. Functional fitness parameters (force, aerobic resistance, flexibility, agility, dynamic equilibrium and body mass index for evaluating body composition) were analysed in women divided into three age-groups. Descriptive statistics (mean, standard deviation and percent distribution) were used for data analysis and analysing variance by comparing the three age-groups classified in accordance with functional fitness parameters (Kruskal Wallis test, p<0.05). Results There was an expressed standard decline in the age-groups' ability classified in relation to the functional fitness parameters being evaluated (except for body composition). However, compared to other studies dealing with the subject, changes occurring in physical performance happened more gradually with advanced age. Conclusions The results achieved provide a specific normative scale which may be used on populations having similar characteristics in such a way that they can be used as a parameter for preparing more effective programmes for maintaining the functional fitness of senior-citizens living in low-income communities.

Impacto del déficit cognitivo en la supervivencia de ancianos residentes en la comunidad / Impact of cognitive deficit on survival among elderly residents in the community

Objetivo: analizar el déficit cognitivo como factor de riesgo para la defunción en ancianos residentes en la comunidad y su relación con variables sociodemográficas, de salud física y capacidad funcional. Material y métodos: hemos realizado un estudio prospectivo en la ciudad de Santa Cruz, Brasil, con 310 ancianos, seleccionados de forma aleatoria, que fueron seguidos durante 53 meses. Las variables predictoras fueron: sociodemográficas, de salud física, neuropsíquicas y de capacidad funcional. El tratamiento estadístico se efectuó por medio de un análisis bivariado (análisis de supervivencia) y regresión de Cox (análisis multivariado) con las respectivas hazard ratios (HR), considerando p < 0,05 y un intervalo de confianza (IC) del 95%. Resultados: un total de 60 (20,5%) ancianos murieron durante el período de seguimiento; la causa principal de la defunción fueron las enfermedades cardiovasculares. El tiempo medio hasta el fallecimiento fue de aproximadamente 24,8 meses y los principales factores de riesgo identificados en el análisis de Cox fueron: la dependencia para realizar actividades básicas de la vida diaria (odds ratio [OR] = 3,55) y el accidente cerebrovascular (HR = 3,08), además del déficit cognitivo (HR = 4,22). Conclusiones: el déficit cognitivo constituye un factor de riesgo de defunción. Consideramos que los resultados del presente estudio podrán utilizarse en el futuro para la formulación de políticas de salud y contribuir a reducir la mortalidad en los ancianos

Objective: to analyze cognitive deficit as a risk factor for death in elderly residents in the community and its relationship with variables related to sociodemographic factors, physical health, and functional capacity.Material and methods: a prospective study was carried out in the city of Santa Cruz, Brazil, in 310 randomly selected elderly individuals who were followed-up for 53 months. Predictive factors were sociodemographic and neuropsychiatric variables, physical health, and functional capacity. The statistical methods used werebivariate analysis (survival analysis), and Cox regression (multivariate analysis) with respective hazard ratios (HR). A value of P<.05 was considered statistically significant and 95% confidenceintervals (CI) were calculated.Results: a total of 60 (20.5%) elderly residents died during the study. The main cause of death was cardiovascular disease. The mean time until death was approximately 24.8 months. The main risk factors identified in Cox analysis were cognitive deficit (HR =4.22), stroke (HR = 3.08) and dependency for basic activities of daily living (HR = 3.55).Conclusions: cognitive deficit is an independent risk factor for death. The results of the present study could be useful in formulating future health policies aiming to reduce mortality in the elderly

[Characterizing the level of functional fitness of female senior-citizens residing in low-income communities]. / Caracterización del nivel de aptitud funcional de mujeres mayores residentes en comunidades de bajos ingresos.

OBJECTIVE: Developing a descriptive table regarding functional fitness parameters for women aged 62 to 92 residing in low-income communities. METHODS: The samples consisted of 222 women divided into 16 senior-citizen social groups in Jequié, Bahia, (95 %CI) Brazil. Functional fitness parameters (force, aerobic resistance, flexibility, agility, dynamic equilibrium and body mass index for evaluating body composition) were analysed in women divided into three age-groups. Descriptive statistics (mean, standard deviation and percent distribution) were used for data analysis and analysing variance by comparing the three age-groups classified in accordance with functional fitness parameters (Kruskal Wallis test, p<0.05). RESULTS: There was an expressed standard decline in the age-groups' ability classified in relation to the functional fitness parameters being evaluated (except for body composition). However, compared to other studies dealing with the subject, changes occurring in physical performance happened more gradually with advanced age. CONCLUSIONS: The results achieved provide a specific normative scale which may be used on populations having similar characteristics in such a way that they can be used as a parameter for preparing more effective programmes for maintaining the functional fitness of senior-citizens living in low-income communities.