Risk stratification for frailty, impairment and assessment of sleep disorders in community-dwelling older adults.

BACKGROUND: Frailty is associated with an increased susceptibility to functional decline, impairment, hospitalization, and mortality among the older adults. However, the potential reversibility of frailty lies in identifying modifiable factors that could prevent, mitigate, or interrupt its progression. While there is a suggestion that sleep disorders may increase the risk of frailty and impairment, the risk stratification of this relationship remains inconclusive. OBJECTIVE: Stratify the risk of frailty and impairment and investigate potential connections with sleep quality, excessive daytime sleepiness, and the risk of obstructive sleep apnea in older adults dwelling in the community. METHODS: This was a quantitative cross-sectional investigation. Frailty risk and impairment were stratified using the Frail Non-disabled Questionnaire (for impairment) and the FRAIL Scale (for Frailty). The assessment of excessive daytime sleepiness, sleep quality, and the risk of obstructive sleep apnea involved the employment of the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and the STOP-BANG questionnaire, respectively. RESULTS: A total of 109 older adults living in the urban area (86 %, p = 0.010), females (61 %; p = 0.030), median age 68 (64-75) years, with overweight (36 %, p < 0.010) and self-identified as belonging to other racial or ethnic categories (71 %, p < 0.010). According to the impairment assessment, 32 % of participants were classified as disable (p < 0.01). Conversely, as per the frailty evaluation, 33 % were pre-frail and 25 % were identified as frail. Additionally, a substantial proportion experienced poor sleep quality (80 %, p = 0.010), exhibited a moderate risk of obstructive sleep apnea (49 %, p < 0.010), and showed no signs of excessive daytime sleepiness (62 %, p < 0.010). There was a modest correlation between frailty and impairment with poor sleep quality (rho = 0.39; p < 0.001) and the risk of obstructive sleep apnea (rho = 0.26; p = 0.000). However, the was no significant relationship was observed between frailty and impairment and excessive daytime sleepiness (rho = 0.04; p = 0.660). Similarly, a modest correlation was observed between sleep quality (rho = 0.33; p < 0.001), the risk of obstructive sleep apnea (rho = 0.27; p = 0.001), and frailty. Conversely, no correlation was found with excessive daytime sleepiness (rho = 0.05; p = 0.590). Also, the poor sleep quality and the risk of obstructive sleep apnea explain 14 % of the risk of frailty in the population of community-dwelling older adults (r2 = 0.14; p = 0.04). CONCLUSION: This study reveals a modest risk of frailty and impairment with sleep quality and the risk of obstructive sleep apnea, but not with excessive daytime sleepiness in community-dwelling older adults.

The impacts of visual Art Therapy for elderly with Neurocognitive disorder: a systematic review.

Aging is characterized by a reduction in physical, cognitive, and emotional functions, allowing multiple losses in the quality of life of the elderly. As a clinical situation that has a common association with pathological aging, neurocognitive disorder, previously named dementia, has become epidemiologically more relevant over the years. Thus, art therapy has recently emerged as an alternative technique for approaching these individuals, with the aim of improving cognitive, emotional, and quality of life aspects. Objective: The objective of this study was to analyze the effects of the application of art therapy based on visual creative processes on cognitive, emotional, and quality of life aspects in elderly people with neurocognitive disorder. Methods: This was a systematic review, carried out using CAPES, PubMed, SciELO, Bireme, PEDro, LILACS, and Scorpus databases between December 2020 and April 2021. Controlled and uncontrolled clinical trials were included in English, Spanish, French, and Portuguese, published between 1970 and 2021, with a focus on modalities of visual art production. The articles included at the end of the selection process were evaluated methodologically by the PEDro Scale of clinical trials. Results: A total of 14 articles were obtained at the end of the selection. Of note, 13 articles had a statistically significant outcome (p≤0.005) for quality of life, cognitive, and emotional functions after intervention with art therapy, being the most used interventions, such as drawing, paintings, and sculptures. Conclusions: The results show significant impacts after the application of art therapy in its visual modality. However, studies with greater methodological rigor are needed to strengthen the evidence presented.

O envelhecimento é caracterizado pela redução das funções físicas, cognitivas e emocionais, possibilitando múltiplas perdas na qualidade de vida do idoso. Como situação clínica que possui comum associação com o envelhecimento patológico, o transtorno neurocognitivo, anteriormente chamado de demência, vem-se tornando epidemiologicamente mais relevante com o passar dos anos. Desse modo, a terapia pela arte surgiu recentemente como técnica alternativa para a abordagem desses indivíduos, com o objetivo de melhorar o estado cognitivo e emocional e a qualidade de vida. Objetivo: Analisar os efeitos da aplicação da terapia pela arte baseada em processos criativos visuais nos aspectos cognitivos e emocionais e na qualidade de vida em idosos com transtorno neurocognitivo. Métodos: Trata-se de uma revisão sistemática, realizada nas bases de dados da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), PubMed, Scientific Electronic Library Online (SciELO), Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (Bireme), Physiotherapy Evidence Database (PEDro), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Scorpus, realizada entre dezembro de 2020 e abril de 2021. Foram incluídos ensaios clínicos controlados e não controlados em inglês, espanhol, francês e português, publicados entre 1970 e 2021, com enfoque em modalidades de produção de arte visual. Os artigos incluídos ao fim do processo de seleção foram avaliados metodologicamente pela escala PEDro de ensaios clínicos. Resultados: Catorze artigos foram obtidos ao fim da seleção. Treze tiveram desfecho estatisticamente significativo (p=<0,005) para qualidade de vida, funções cognitivas e emocionais após a intervenção com arte-terapia, sendo as intervenções mais usadas: elaboração de desenhos, pinturas e esculturas. Conclusões: Os resultados apontam para impactos significativos após a aplicação da arte-terapia em sua modalidade visual. No entanto, são necessários estudos com maior rigor metodológico para fortalecer as evidências apresentadas.

Percepção subjetiva de esforço e recuperação da fadiga pós-sessão fisioterapêutica em pacientes com paraparesia espástica tropical / Subjective effort perception and fatigue recovery after physical therapy session in patients with tropical spastic paraparesis

Introdução: Vírus Linfotrópico de Células T Humana do Tipo-1 (HTLV-1) é um retrovírus que afeta os linfócitos T humano e desencadeia inflamação na medula, levando à paraparesia espástica tropical/mielopatia associada ao HTLV-1 (PET/MAH) com prejuízos funcionais. Tais disfunções podem influenciar nos efeitos da fisioterapia, gerando diferentes níveis de fadiga. Objetivo: Avaliar a percepção subjetiva de esforço e de recuperação de indivíduos com PET/MAH após sessão única de fisioterapia. Métodos: Incluíram-se 12 participantes sintomáticos para PET/MAH, de ambos os sexos, que foram submetidos uma vez ao protocolo fisioterapêutico. Os instrumentos avaliativos foram: Escala Modificada de Borg, Escala de Percepção Subjetiva de Recuperação (1º, 5º e 10º minuto após a sessão) e Escala de Incapacidade Neurológica do Instituto de Pesquisa Clínica Evandro Chagas ­ 2 (EIPEC). Resultados: Encontrou-se correlação moderada entre idade e taxa de percepção subjetiva de recuperação ao 1º (r = - 0,4923) e 5º (r = - 0,4913) minuto e entre índice do EIPEC-2 e taxa de percepção subjetiva de recuperação ao 1º (r = 0,3592) e 5º (r = - 0,3772) minuto. Conclusão: Indivíduos deste estudo com maior idade e grau de incapacidade neurológica têm menor percepção subjetiva de recuperação. (AU)

Introduction: Human T-Cell Lymphotropic Virus Type-1 (HTLV-1) is a retrovirus that affects human T lymphocytes and triggers inflammation in the spinal cord, leading to tropical spastic paraparesis / HTLV-1 associated myelopathy (TSP/HAM) with functional impairments. Such dysfunctions can influence the effects of physical therapy, generating different levels of fatigue. Objective: To evaluate the subjective perception of effort and recovery of individuals with TSP/HAM after a single session of physical therapy. Methods: 12 symptomatic participants for TSP/HAM, of both sexes, who were submitted once to a physiotherapeutic protocol were included. The evaluative instruments were: Modified Borg Scale, Scale of Subjective Perception of Recovery (1st, 5th and 10th minute after the session) and Scale of Neurological Disability at the Evandro Chagas Clinical Research Institute - 2 (EIPEC). Results: A moderate correlation was found between age and subjective perception rate of recovery at the 1st (r = - 0.4923) and 5th (r = - 0.4913) minute and between the EIPEC-2 index and the subjective perception rate of recovery at the 1st (r = 0.3592) and 5th (r = - 0.3772) minute. Conclusion: Individuals in this study with older age and degree of neurological disability have less subjective perception of recovery. (AU)