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Background: A conservative physiotherapy service development addressed to treat urinary incontinence for older women was studied using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Design: We conducted a pragmatic case study design based on RE-AIM. Settings/participants: Included women ≥ 60 years of age, with self-reported UI symptoms. Results: A total of 34 older women were enrolled in the service with a mean age of 61.53 years. There was a significant improvement in the strength of the pelvic floor muscles, power, endurance, and fast contraction capacity after the intervention, however, it was observed a high dropout rate. Program implementation was supported by Physical Therapy teams who engaged in care coordination. The program has been maintained for over 4 years. Conclusion: Our findings demonstrate that UI patients would benefit from physiotherapy treatment and that this intervention is feasible. This RE-AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of a Physical Therapy pelvic service.

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Objetivo: avaliar a capacidade institucional de cuidado ao paciente hipertenso nos serviços de saúde destinados aos idosos, a partir da percepção das equipes de saúde. Método: estudo transversal, com 53 profissionais de saúde das instituições ambulatoriais especializadas no cuidado ao idoso na cidade de Manaus, Amazonas, Brasil. Aplicou-se a Avaliação da Capacidade Institucional para Atenção às Condições Crônicas (ACIC). Os dados são apresentados em valores de média. Resultados: as potencialidades foram nas dimensões: autocuidado apoiado (6,1 ± 2,7), organização da atenção à saúde (5,5 ± 2,1) e desenho do sistema de prestação de serviços (5,1 ± 2,6). As fragilidades foram: sistema de informação clínica (3,9 ± 2,7), recursos da comunidade (4,0 ± 2,9), integração dos componentes do modelo de atenção (4,1 ± 2,7) e suporte às decisões (4,4 ± 2,9). Conclusão: de acordo com o ACIC, as instituições apresentaram capacidade básica na prestação de cuidado ao paciente hipertenso.

Objective: To evaluate the institutional capacity to care for hypertensive patients in health services for older adults, based on the perception of health teams. Method: A cross-sectional study with 53 health professionals from outpatient institutions specializing in the care of older adults in the city of Manaus, Amazonas, Brazil. The Institutional Capacity Assessment for Attention to Chronic Conditions (ACIC) was applied. Data are presented in mean values. Results: The strengths were in the dimensions: supported self-care (6.1 ± 2.7), organization of health care (5.5 ± 2.1), and design of the service delivery system (5.1 ± 2.6). The weaknesses were: clinical information system (3.9 ± 2.7), community resources (4.0 ± 2.9), integration of the components of the care model (4.1 ± 2.7), and support for decisions (4.4 ± 2.9). Conclusion: According to the ACIC, the institutions presented a basic capacity to provide care to hypertensive patients.

Objetivo: evaluar la capacidad institucional para la atención de hipertensos en los servicios de salud del anciano, a partir de la percepción de los equipos de salud. Método: estudio transversal, con 53 profesionales de la salud de instituciones ambulatorias especializadas en el cuidado de ancianos en la ciudad de Manaus, Amazonas, Brasil. Se aplicó la Evaluación de la Capacidad Institucional para la Atención de Condiciones Crónicas (ACIC). Los datos se presentan como valores medios. Resultados: las potencialidades estuvieron en las dimensiones: autocuidado apoyado (6,1 ± 2,7), organización de la atención en salud (5,5 ± 2,1) y diseño del sistema de prestación de servicios (5,1 ± 2,6). Las debilidades fueron: sistema de información clínica (3,9 ± 2,7), recursos comunitarios (4,0 ± 2,9), integración de los componentes del modelo de atención (4,1 ± 2,7) y apoyo a las decisiones (4,4 ± 2,9). Conclusión: según la ACIC, las instituciones tenían una capacidad básica para brindar atención a los pacientes hipertensos.

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This study aimed to verify the association of physical activity, behaviors, and health conditions with stress among a sample of older adults from Manaus, Brazil, during the COVID-19 outbreak. This is a cross-sectional analysis of 79 older adults (76% female; age: 68.24 ± 6.82 years) from Fundação Universidade Aberta da Terceira Idade (FUnATI). The perceived stress (PS) was assessed by the Per-ceived Stress Scale, while a questionnaire via telephone call. The variables also included physical ac-tivity, sleep quality, sociodemographic, and health condition variables. Linear Bayesian mixed-effects regression models were applied to verify the association between these correlates with PS. Older people who met the recommendations before the COVID-19 outbreak but did not meet the same recommendations during the COVID-19 outbreak have a higher PS score compared to those older people who did not meet the PA recommendations at either time. In contrast, those elderly people who met PA recommendations before and during the COVID-19 outbreak had a lower PS score compared to their peers who did not meet physical activity recommendations at either time. Those older people who did not meet the PA recommendations before the COVID-19 outbreak, but did meet the PA recommendations during the COVID-19 outbreak, did not have significant differences in the PS score compared to their peers who did not meet the PA recommendations in either mo-ment. Sleep changes and high BMI were negatively associated with PS. The maintenance of physical activity during the pandemic was associated with lower levels of stress in older people

Este estudo teve como objetivo verificar a associação de atividade física, comportamentos e condições de saúde associadas ao estresse em uma mostra de idosos de Manaus, Brasil, durante o surto COVID-19. Trata-se de uma análise transversal (n = 79 idosos; 76% mulheres; idade: 68,24 ± 6,82 anos) da Fundação Universi-dade Aberta da Terceira Idade (FUnATI). O estresse percebido (EP) foi avaliado utilizando a Escala de Estresse Percebido, aplicado via ligação telefônica. O questionário também incluiu atividade física, quali-dade do sono, variáveis sociodemográficas e de condição de saúde. Modelos de regressão linear Bayesiana de efeitos mistos foram aplicados para verificar a associação entre esses correlatos com EP. Idosos que atendiam às recomendações de AF antes do surto de COVID-19 mas não mantiveram a prática durante o surto apre-sentaram pontuação de EP mais alta em comparação com os idosos que não atendiam às recomendações em nenhum dos momentos. Em contraste, os idosos que mantiveram os níveis de AF tiveram uma pontuação de EP mais baixa. Idosos que não atenderam às recomendações de AF antes do surto de COVID-19, mas atenderam às recomendações de PA durante o surto de COVID-19 não tiveram diferenças significativas na pontuação de EP. Mudanças no sono e alto IMC foram associados negativamente com o EP. A manutenção da atividade física durante a pandemia foi associada a níveis mais baixos de estresse em pessoas mais velhas

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Objective To ascertain whether modifiable physical performance-based measurements predicted 5.5-year mortality in a riparian elderly cohort in the Amazon rainforest region. Methods A longitudinal study evaluating the impact of functional determinants on 5.5-year mortality in a riparian elderly cohort from Maués City in the state of Amazonas, Brazil, was performed. The study was a follow-up of a previous observational investigation that evaluated various fitness tests in 630 Amazonian riparian elderly (291 males and 339 females) aged 72.3 ± 8.0 (60-99) years old. The cohort was selected for its adverse environmental conditions, which increased the risk of falls yet required maintenance of good physical condition for carrying out relatively rigorous daily activities, and restricted access to specialized health services. Official death records were obtained from the Maués Municipal Health Department. Results A total of 80 study participants (12.7%) died over the 5.5-year study period. Kaplan-Meier regression analysis showed significant association between Timed Up and Go (TUG) test scores ≥ 14 seconds and mortality risk, independent of sex, age, and other health variables. Conclusions The study results suggest that the TUG test can be used as an indicator for initiating therapeutic and preventive actions, including conducting exercises or physical activities adapted to the health and functional conditions of the elderly, by identifying elderly people with a higher relative risk of mortality.

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ABSTRACT Objective To ascertain whether modifiable physical performance–based measurements predicted 5.5-year mortality in a riparian elderly cohort in the Amazon rainforest region. Methods A longitudinal study evaluating the impact of functional determinants on 5.5-year mortality in a riparian elderly cohort from Maués City in the state of Amazonas, Brazil, was performed. The study was a follow-up of a previous observational investigation that evaluated various fitness tests in 630 Amazonian riparian elderly (291 males and 339 females) aged 72.3 ± 8.0 (60–99) years old. The cohort was selected for its adverse environmental conditions, which increased the risk of falls yet required maintenance of good physical condition for carrying out relatively rigorous daily activities, and restricted access to specialized health services. Official death records were obtained from the Maués Municipal Health Department. Results A total of 80 study participants (12.7%) died over the 5.5-year study period. Kaplan-Meier regression analysis showed significant association between Timed Up and Go (TUG) test scores ≥ 14 seconds and mortality risk, independent of sex, age, and other health variables. Conclusions The study results suggest that the TUG test can be used as an indicator for initiating therapeutic and preventive actions, including conducting exercises or physical activities adapted to the health and functional conditions of the elderly, by identifying elderly people with a higher relative risk of mortality.

RESUMEN Objetivo Evaluar si los parámetros modificables del rendimiento físico permiten predecir la mortalidad a 5,5 años en una cohorte de ancianos de las zonas ribereñas de la selva tropical del Amazonas. Métodos En este estudio longitudinal se evaluó la influencia de los determinantes de la capacidad funcional sobre la mortalidad a 5,5 años en una cohorte de ancianos de la ciudad ribereña de Maués del estado de Amazonas (Brasil). El estudio consistió en un seguimiento de una investigación observacional anterior en la que se efectuaron diversas pruebas para determinar el estado físico de 630 ancianos de las zonas ribereñas del Amazonas (291 hombres y 339 mujeres) de 72,3 años de edad ± 8,0 (60-99) años. La cohorte fue seleccionada en función de las condiciones ambientales adversas, que aumentan el riesgo de caídas pero exigen un buen estado físico para llevar adelante las actividades relativamente rigurosas de la vida cotidiana, así como del acceso limitado a servicios de salud especializados. Los certificados de defunción oficiales se obtuvieron del Ministerio de Salud del Municipio de Maués. Resultados En el transcurso del estudio, que tuvo una duración de 5,5 años, fallecieron 80 participantes (12,7 %). El análisis de regresión de Kaplan-Meier reveló una relación significativa entre los valores de la prueba cronometrada de levantarse y caminar (TUG) ≥ 14 segundos y el riesgo de mortalidad, que fue independiente del sexo, la edad y demás variables de salud. Conclusiones Los resultados de este estudio indican que la prueba TUG puede emplearse como indicador de la necesidad de instituir medidas terapéuticas y preventivas, como ejercicios o actividades físicas adaptadas a la salud y el estado funcional de los ancianos, dado que permite detectar a aquellos que están expuestos a un riesgo relativo de muerte más alto.

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Objective. To ascertain whether modifiable physical performance–based measurements predicted 5.5-year mortality in a riparian elderly cohort in the Amazon rainforest region. Methods. A longitudinal study evaluating the impact of functional determinants on 5.5-year mortality in a riparian elderly cohort from Maués City in the state of Amazonas, Brazil, was performed. The study was a follow-up of a previous observational investigation that evaluated various fitness tests in 630 Amazonian riparian elderly (291 males and 339 females) aged 72.3 ± 8.0 (60–99) years old. The cohort was selected for its adverse environmental conditions, which increased the risk of falls yet required maintenance of good physical condition for carrying out relatively rigorous daily activities, and restricted access to specialized health services. Official death records were obtained from the Maués Municipal Health Department. Results. A total of 80 study participants (12.7%) died over the 5.5-year study period. Kaplan- Meier regression analysis showed significant association between Timed Up and Go (TUG) test scores ≥ 14 seconds and mortality risk, independent of sex, age, and other health variables. Conclusions. The study results suggest that the TUG test can be used as an indicator for initiating therapeutic and preventive actions, including conducting exercises or physical activities adapted to the health and functional conditions of the elderly, by identifying elderly people with a higher relative risk of mortality.

Objetivo. Evaluar si los parámetros modificables del rendimiento físico permiten predecir la mortalidad a 5,5 años en una cohorte de ancianos de las zonas ribereñas de la selva tropical del Amazonas. Métodos. En este estudio longitudinal se evaluó la influencia de los determinantes de la capacidad funcional sobre la mortalidad a 5,5 años en una cohorte de ancianos de la ciudad ribereña de Maués del estado de Amazonas (Brasil). El estudio consistió en un seguimiento de una investigación observacional anterior en la que se efectuaron diversas pruebas para determinar el estado físico de 630 ancianos de las zonas ribereñas del Amazonas (291 hombres y 339 mujeres) de 72,3 años de edad ± 8,0 (60-99) años. La cohorte fue seleccionada en función de las condiciones ambientales adversas, que aumentan el riesgo de caídas pero exigen un buen estado físico para llevar adelante las actividades relativamente rigurosas de la vida cotidiana, así como del acceso limitado a servicios de salud especializados. Los certificados de defunción oficiales se obtuvieron del Ministerio de Salud del Municipio de Maués. Resultados. En el transcurso del estudio, que tuvo una duración de 5,5 años, fallecieron 80 participantes (12,7 %). El análisis de regresión de Kaplan-Meier reveló una relación significativa entre los valores de la prueba cronometrada de levantarse y caminar (TUG) ≥ 14 segundos y el riesgo de mortalidad, que fue independiente del sexo, la edad y demás variables de salud. Conclusiones. Los resultados de este estudio indican que la prueba TUG puede emplearse como indicador de la necesidad de instituir medidas terapéuticas y preventivas, como ejercicios o actividades físicas adaptadas a la salud y el estado funcional de los ancianos, dado que permite detectar a aquellos que están expuestos a un riesgo relativo de muerte más alto.

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The aim of the present study was to evaluate the associations of metabolic disorders and anthropometric and biochemical biomarkers of lipid, glucose and oxidative metabolism and the habitual ingestion of guaraná (Paullinia cupana, Mart. Var. sorbilis) by an elderly population residing in the Amazon Riverine region of the Maués municipality (Brazil). A case-controlled study was performed that included 637 elderly (≥60 years of age) patients classified as either those who habitually drank guaraná (GI, n = 421) or those who never drank guaraná (NG, n = 239) based upon their self-reported intake of guaraná. Indeed, the prevalence of various metabolic disorders was associated with guaraná ingestion. The prevalence of hypertension, obesity and metabolic syndrome in the GI group was lower than the prevalence found in the NG group. The NG group exhibited lower systolic and diastolic blood pressure values. The males in the GI group exhibited a lower waist circumference, on average, than the circumference found in the NG group, whereas the females in the GI group had lower cholesterol (total and LDL-c) levels than the control cohort. Additionally, a significant association was found between lower levels of advanced oxidative protein product (AOPP) and habitual guaraná consumption. The results constitute the first epidemiological study to suggest a potentially protective effect of habitual guaraná ingestion against metabolic disorders in elderly subjects.

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