Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data.

Background: Previous findings suggest that apathy symptoms independently of depressive symptoms measured using the Geriatric Depression Scale (GDS) are associated with cardiovascular disease (CVD) in older individuals. Aims: To study whether apathy and depressive symptoms in older people are associated with future CVD, stroke, and mortality using individual patient-data meta-analysis. Methods: Medline, Embase, and PsycInfo databases up to September 3, 2013, were systematically searched without language restrictions. We sought prospective studies with older (mean age ≥65 years) community-dwelling populations in which the GDS was employed and subsequent stroke and/or CVD were recorded to provide individual participant data. Apathy symptoms were defined as the three apathy-related subitems of the GDS, with depressive symptoms the remaining items. We used myocardial infarction (MI), stroke, and all-cause mortality as main outcomes. Analyses were adjusted for age, sex, and MI/stroke history. An adaptation of the Newcastle-Ottawa scale was used to evaluate bias. Hazard ratios were calculated using one-stage random-effect Cox regression models. Results: Of the 52 eligible studies, 21 (40.4%) were included, comprising 47,625 older people (mean age [standard deviation] 74 [7.4] years), over a median follow-up of 8.8 years. Participants with apathy symptoms had a 21% higher risk of MI (95% confidence interval [CI] 1.08-1.36), a 37% higher risk of stroke (95% CI 1.18-1.59), and a 47% higher risk of all-cause mortality (95% CI 1.38-1.56). Participants with depressive symptoms had a comparably higher risk of stroke (HR 1.36, 95% CI 1.18-1.56) and all-cause mortality (HR 1.44, 95% CI 1.35-1.53), but not of MI (HR 1.08, 95% CI 0.91-1.29). Associations for isolated apathy and isolated depressive symptoms were comparable. Sensitivity analyses according to risk of bias yielded similar results. Conclusion: Our findings stress the clinical importance of recognizing apathy independently of depressive symptoms, and could help physicians identify persons at increased risk of vascular disease.

Gender Differences in the Incidence and Determinants of Components of the Frailty Phenotype Among Older Adults: Findings From the SABE Study.

OBJECTIVE: To analyze gender differences in incidence and determinants of the components of the frailty phenotype. METHOD: A total of 1,413 older adults were selected in 2006. To estimate the incidence of each frailty component, only individuals who did not exhibit a given component at baseline (independently of the presence of other components) were included in the study. The variables of interest were socioeconomic, behavioral, clinical, anthropometric factors and physical performance. The incidence of each component in 2010 was the outcome. RESULTS: Unintentional weight loss and slowness were more incident in men up to 74 years of age. The other frailty components were more incident in women at all age groups, except weakness. Besides age, the determinants of incidence of the components of frailty were different between genders. DISCUSSION: Strategies for preventing or delaying the installation of frailty need to address gender differences, considering the greater complexity in the network determinants among women.

Similarities among factors associated with components of frailty in elderly: SABE Study.

OBJECTIVE: To analyze similarities among factors associated with the components of frailty in elderly. METHOD: We studied 1,413 elderly from the second wave of the SABE Study in 2006. Each of the five components of the frailty phenotype was considered a dependent variable in the hierarchical logistic regression models. RESULTS: In both genders, age, schooling, sedentary lifestyle, and screening positive for depression were associated similarly with more than one component of frailty. Other similarities were also observed with stroke and screening positive for cognitive decline in men, and number of diseases and gait speed in women. The most similar associations happened between weakness and slowness; weakness, slowness, and LPAL; or weakness, slowness, and exhaustion. DISCUSSION: Encouraging physical activity, screening for and treating depression and treating both diseases of the central nervous system and chronic diseases must be the focus of strategies to avoid, delay, or even remedy frailty.

Relação entre estado nutricional e força de preensão manual em idosos do município de São Paulo, Braisil: Dados da Pesquisa SABE / The relationship between nutrirional status and handgrip strenght of elderly of the city of São Paulo. Brasil: Data from Sabe survey

O objetivo do estudo foi avaliar a relação do estado nutricional (EN) com a força de preensão manual (FPM)em idosos, do município de São Paulo, Brasil. Estudo epidemiológico transversal, de base populacional e domiciliar, parte de estudo multicêntrico (Pesquisa SABE), coordenado pela Organização Pan-Americana de Saúde. A Pesquisa SABE abrangeu 2143 idosos (> 60 anos), de ambos os sexos, no período de janeiro/2000 a março/2001, selecionados por amostragem probabilística; sendo que 1894 (88,4%), participaram deste estudo. O EN foi verificado pelo Índice de Massa Corporal (IMC) e Área Muscular do Braço (AMB), variáveis independentes. A FPM (variável dependente) foi verificada por meio de dinamômetro. Foram feitas análises de regressão linear (simples) para homens e mulheres, segundo grupo etário (60-64, 65-69, 70-74, 75-79 e ³ 80 anos). As mulheres apresentaram valores médios de IMC (kg/m2) superiores e AMB (cm2) e FPM (kg) inferiores aos dos homens. Ambos os sexosmostraram redução significativa do IMC, AMB e FPM com a idade. A FPM foi positivamente correlacionada como IMC (r = 0,135, em mulheres e r = 0,287, em homens) e AMB (r = 0,149, em mulheres e r = 0,421 , emhomens). Nas análises por grupo etário observou-se correlação entre FPM e : IMC para homens ( eõ 70 anos);AMB para homens (todos os grupos etários) e mulheres (eõ 80 anos). Os resultados permitem concluir queexiste uma relação linear entre estado nutricional e força de preensão manual é específica ao sexo, grupo etárioe indicador nutricional...

The study aimed to evaluate the relationship between nutritional status (NS) and handgrip strength (HS) ofelderly of the city of São Paulo, Brazil. This cross-sectional epidemiological study, population- and householdbased,is part of a multi-center study (SABE Survey), which was coordinated by the Pan-American Health Organization. The SABE survey reached 2143 elderly (³ 60 yrs old), from both sexes, from january/2000 to march/ 2001, and for the present analysis a group of 1894 (88.4%) was selected by probabilistic sampling. NS was determined by Body Mass Index (BMI) and arm muscle area (AMA) as independent variables. HS (dependent variable) was measured by dynamometer. Linear regression analyses were used to correlate the NS and HS, for both men and women, according to the age group (60-64, 65-69, 70-74, 75-79 and ³ 80 years). The mean BMI (kg/m2) was higher while AMA (cm2) and HS (kg) were smaller for women than for men. There was a significant decline in BMI, AMA and HS with age in both sexes. HS was positively correlated to the BMI (r = 0.135 for females and r = 0.287 for males) and to AMA (r = 0.149 for females and r = 0. 421 for males). The analyses by age group showed correlation between HS and BMI for men (eõ 70 years) and with AMA for men (all age groups) and women ( eõ 80 years). These results allowed to the conclusion that the relationship between NS and HS is specific to the sex, age group and nutritional indicator...

Anthropometry of elderly residents in the city of São Paulo, Brazil

The article presents gender and age-specific selected anthropometric data for a representative sample of elderly Brazilians in the city of São Paulo. This was a cross-sectional, population-based household survey. A total of 1,894 older adults (men and women, > 60 years) were examined from January to March 2001. Data were presented as means and percentiles for body mass (BM); height or stature (ST); body mass index (BMI); waist (WC), hip (HC), arm (AC), and calf (CC) circumferences; triceps skinfold thickness (TST); and arm muscle circumference (AMC), and differences were described according to age (all variables) and gender (BMI). Except for HC (men), all anthropometric variables were lower in the oldest than in the youngest individuals (p < 0.01) in both genders. BMI was significantly higher (p < 0.01) in women than men (all age groups). The observations suggest that there is loss of muscle mass and redistribution and reduction of fat mass with age (both genders). The data can be used in clinical practice and epidemiological studies based on interpretation of anthropometric measurements in the elderly in São Paulo.

Functional limitations of Brazilian elderly by age and gender differences: data from SABE Survey

Em amostra representativa de idosos residentes no Município de São Paulo, Brasil, foram utilizados testes de desempenho motor (TDM) com objetivo de verificar a proporção de indivíduos, de acordo com sexo e grupo etário, quanto à limitação funcional. Trata-se de estudo epidemiológico transversal, de base populacional e domiciliar, parte de pesquisa multicêntrica (SABE), coordenada pela Organização Pan-Americana da Saúde. A SABE abrangeu 2.143 idosos (> 60 anos), de ambos os sexos, no período de janeiro/2000 a março/ 2001; sendo que 1.894 (88,4 por cento) participaram deste estudo. Os seguintes TDM foram utilizados: força de preensão manual; "sentar e levantar" e "agachar e pegar uma caneta" (avaliados por tempo) e; teste de equilíbrio estático. A prevalência quanto ao desempenho (qui-quadrado) foi específica para sexo, grupo etário e teste utilizado. O percentual de homens e mulheres com melhor escore foi menor (p = 0,000) nos grupos etários mais avançados. Quando comparados às mulheres, os homens, em todos os grupos etários, apresentaram melhores resultados nos testes. O presente estudo fornece evidências de que a limitação funcional é mais freqüente no sexo feminino e nos indivíduos mais idosos.

Functional limitations of Brazilian elderly by age and gender differences: data from SABE Survey.

This study provides the prevalence, by gender and age-groups, of observed physical performance test (PPT) assessing functional limitation for representative samples of elderly Brazilian subjects living in São Paulo city. This cross-sectional epidemiological study, both population- and household-based, is part of a multicenter survey (SABE) undertaken in seven Latin American and Caribbean countries and coordinated by the Pan-American Health Organization. From January 2000 to March 2001, 2,143 elderly individuals (>or= 60 years) of both sexes were examined. Of this total, 1,894 participated in the study. PPT included handgrip strength, standing balance, timed repeated "chair stand", and "pick up a pen". Results have shown (based on chi-square) that the prevalence relating to the performance differed according to sex, age group, and from one test to another. With increasing age, there was a reduction (p = 0.000) in both males and females in the proportion of individuals that had better results on the tests. The male group, on every test, when compared to women from the same age group, had a more individuals with better scores. Data suggest that older individuals and women have more functional limitations.

Anthropometry of elderly residents in the city of São Paulo, Brazil.

The article presents gender and age-specific selected anthropometric data for a representative sample of elderly Brazilians in the city of São Paulo. This was a cross-sectional, population-based household survey. A total of 1,894 older adults (men and women, > 60 years) were examined from January to March 2001. Data were presented as means and percentiles for body mass (BM); height or stature (ST); body mass index (BMI); waist (WC), hip (HC), arm (AC), and calf (CC) circumferences; triceps skinfold thickness (TST); and arm muscle circumference (AMC), and differences were described according to age (all variables) and gender (BMI). Except for HC (men), all anthropometric variables were lower in the oldest than in the youngest individuals (p < 0.01) in both genders. BMI was significantly higher (p < 0.01) in women than men (all age groups). The observations suggest that there is loss of muscle mass and redistribution and reduction of fat mass with age (both genders). The data can be used in clinical practice and epidemiological studies based on interpretation of anthropometric measurements in the elderly in São Paulo.