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Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.

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ABSTRACT BACKGROUND: A bibliometric analysis covering only the production of original studies or considering world production until 2022 has yet to be conducted. The creation and advancement of vaccines have also influenced research priorities, demonstrating the need for a new approach to this subject. OBJECTIVES: To analyze worldwide scientific production related to coronavirus disease 2019 (COVID-19) and the aged and to describe what has already been produced. DESIGN AND SETTING: Bibliometric analysis with a quantitative approach. METHOD: The search terms "COVID-19," "SARS-CoV-2," "Aged," and "Elderly" were used to retrieve articles from the Web of Science database. A total of 684 articles were included in the analysis. Data were imported into RStudio Desktop Software and linked to R Software. The Bibliometrix R package and VOSviewer software were used for analysis. RESULTS: Most articles were published in 2020. These were produced by 4,937 authors and published in 379 journals. The keyword most used by the authors was "COVID-19." Publications from 77 countries were obtained. China had the highest article production ranking, and Spain collaborated the most. The articles addressed the implications of the pandemic on the aged, the relationship between vaccination in the aged, and the implications for the disease itself. CONCLUSION: Further research should be conducted, mainly concerning vaccines and vaccination of the aged, owing to the need for and importance of immunization in this risk group, including assessing the long-term effects of vaccines.

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Resumen Objetivo: Estimar la prevalencia del maltrato y de la multimorbilidad, así como, analizar si el maltrato con la presencia de multimorbilidad está asociado con la autopercepción de la calidad de vida relacionada con la salud en personas mayores de Xalapa, Veracruz. Material y métodos: Este es un estudio transversal a partir de datos recolectados en una encuesta representativa de las personas mayores (≥60 años) de Xalapa, Veracruz. La encuesta se realizó de septiembre de 2018 a enero de 2019 (n = 993). Se utilizó un cuestionario para recolectar datos demográficos, socioeconómicos y de salud. El maltrato se evalúo mediante la Escala Geriátrica de Maltrato (EGM-22 ítems) y la calidad de vida relacionada con la salud mediante el cuestionario de salud Short Form 36 (SF-36). Se realizaron análisis descriptivos para estimar las prevalencias y modelos de regresión logística para analizar la asociación. Resultados: La prevalencia del maltrato de personas mayores fue 16,2%. Los tipos de maltrato fueron: psicológico (13,6%), económico (4,8%), físico (3,2%), negligencia (2,3%) y abuso sexual (0,5%). La prevalencia de multimorbilidad fue 43.2%. Las personas mayores con maltrato y multimorbilidad presentaron menor calidad de vida en las dimensiones de rol físico (OR 2,362 IC: 1,254-4,452), dolor corporal (OR 2,278 IC: 1,277-4,065) y salud mental (OR 2,94 IC: 1,499-5,766). Conclusiones: El maltrato y la multimorbilidad son problemas comunes en las personas mayores de Xalapa, Veracruz, la presencia de estos dos eventos se asocia con una menor calidad de vida relacionada con la salud. La investigación futura debería concentrarse en mejorar la comprensión de las relaciones familiares de las personas mayores con multimorbilidad y, los servicios sociales y de atención médica deben tomar en cuenta estos hallazgos para atender el maltrato de personas mayores con multimorbilidad antes de que ocurran más situaciones adversas que impacten en su calidad de vida.

Abstract Objective: To estimate the prevalence of elder abuse and multimorbidity, as well as to analyze if elder abuse in the presence of multimorbidity is associated with self-perceived health-related quality of life in older adults from Xalapa, Veracruz. Material and methods: Material and methods: This is a cross-sectional study based on data collected in a representative survey of older people (≥60 years) from Xalapa, Veracruz. The survey was conducted from September 2018 to January 2019 (n = 993). A questionnaire was used to collect demographic, socioeconomic, and health data. Elder abuse was assessed using the Geriatric Mistreatment Scale (GMS-22 items) and health-related quality of life using the short form 36 health survey questionnaire (SF-36). Descriptive analyzes were performed to estimate the prevalence and logistic regression models to analyze the association. Results: The prevalence of elder abuse was 16.2%. The types of elder abuse were psychological (13.6%), economic (4.8%), physical (3.2%), neglect (2.3%) and sexual abuse (0.5%). The prevalence of multimorbidity was 43.2%. Older people with both elder abuse and multimorbidity presented lower health-related quality of life in the dimensions of physical role (OR 2,362 IC: 1,254-4,452), body pain (OR 2,278 IC: 1,277-4,065) and mental health (OR 2,94 IC: 1,499-5,766). Conclusions: Elder abuse and multimorbidity are common problems in the older population in Xalapa, Veracruz, Mexico; the presence of these two events is associated with lower health-related quality of life. Future research should focus on improving understanding of the family relationships of older people with multimorbidity, and health care and social services should take these findings into account to address the elder abuse with multimorbidity before further adverse situations occur that impact their health-related quality of life.

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Resumo O objetivo é estimar prevalência de componentes da sarcopenia e associações com variáveis socioeconômicas em idosos de população rural do Ceará. Estudo transversal com 274 idosos. Massa muscular foi determinada por Índice de Massa Muscular (IMM) por bioimpedância elétrica e por circunferência da panturrilha; força muscular (FM) por teste de preensão palmar; e desempenho físico por testes da caminhada (VC) e Timed-up-and-go. Provável sarcopenia foi caracterizada por diminuição da FM, sarcopenia quando associada a diminuição do IMM, e sarcopenia grave quando estes dois foram acompanhados de baixa VC. Foram estimadas associações entre condições sociodemográficas, hábitos de vida e componentes da sarcopenia. Na regressão logística, foi observada frequência mais elevada: i) no sexo masculino, idade>69 anos, e nos que não trabalham, entre os idosos com FM diminuída; ii) com idade>69 anos, nos que não moram com o cônjuge, e nos que não praticam atividade física num nível adequado, entre os idosos com IMM diminuído; iii) com idade>69 anos, nos que residem na zona rural há menos que 30 anos, e nos que não trabalham, entre os idosos com VC diminuída.

Abstract The aim is to determine the prevalence of sarcopenia components and associations with socioeconomic variables in older persons living in rural areas in the state of Ceará, Brazil. We conducted a cross-sectional study with 274 older adults. Muscle mass was assessed using muscle mass index (MMI), measured by bioelectrical impedance analysis and calf circumference. Muscle strength (MS) was assessed using the handgrip test. Physical performance was measured using the walk test to calculate gait speed (GS) and the timed up-and-go test. Probable sarcopenia was defined as the presence of low MS, while confirmed sarcopenia was defined as the presence of low MS and low MMI. Severe sarcopenia was defined as the presence of the latter two criteria and slow GS. We tested for associations between sociodemographic characteristics and lifestyle habits and the components of sarcopenia. The logistic regression produced the following results: i) prevalence of low MS was higher among men, individuals aged >69 years, and in those not working at the time of the study; ii) the prevalence of low MMI was higher in individuals aged >69 years, those not living with a spouse, and those with an inadequate level of physical activity; iii) the prevalence of slow GS was higher in individuals aged >69 years, those who had lived in rural areas for less than 30 years, and those not working at the time of the study.

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BACKGROUND: The anti-saccadic (AS) error-rate is used to diagnose neurological disorders. The natural aging process could generate difficulty in carrying out parallel neural processes of conscious motor inhibition and eye movement. Therefore, if balance control is imposed on an elderly person in biped positions during an AS movement, an increase in the AS error-rate is expected. OBJECTIVE: To study the effects of postural control on the AS error-rate in older people. METHODS: An intra and intergroup comparison was made of AS error-rate in an experimental group of older people (PM) and another control group of young people (PJ). For this, blocks of AS and pro-saccadic movements (control) were used randomly in four different postures: (1)sitting (SENT), (2)standing normally (NORMAL), (3)feet together (REDUC), and (4)feet in line (TANDEM). RESULTS: The PM group, compared to the PJ group, showed a progressive increase in the AS error-rate from the sitting position to all standing positions, with the maximum AS error-rate in more complex vertical postures. In contrast, the PJ group did not present significative variability of this AS error-rate in all positions. CONCLUSIONS: It is confirmed that the aging process is associated with an increase in the AS error-rate. This study reveals for the first time a significant increase in the AS error-rate when control of body balance is required for PM, implying a decrease in the multiple processing capacity in PM for the execution of complex and parallel tasks.

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Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

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Family relationships play a central role in wellbeing among older adults in Chile. Based on the theory of social production functions, this study examined the relationship between perceived social support from children, partners and relatives, family functioning, self-perceived health and quality of life (QoL) among Chilean older adults. The study used a multi-ethnic sample of Chilean older adults living in rural areas in the regions of Arica and Parinacota (north) and Araucanía (south). A model was analyzed that emphasizes relationships differentiated by the source of support, family functioning and self-perceived health in the explanation of QoL. The results obtained from the structural equation modelling (SEM) analysis showed the existence of indirect relationships of social support from children, partners and other family members via family functioning, while self-perceived health was directly associated with QoL. The findings indicate that family functioning is a main variable in the contrasted model, in addition to confirming the importance of distinguishing the role of the various sources of support. Research is needed to examine in detail intergenerational relationships and other relationships with family members who are significant in the wellbeing of older adults. This research corroborates that family relationships have a specificity that needs to be addressed in gerontological social intervention, as well as continuing along the lines of strengthening or improving existing family ties (more quality) over the quantity of social relationships.

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This study follows up on the article 'Walkability Index for Elderly Health: A Proposal', published in 2020, as well its validation in the Historic Center of Porto, published in 2021. The 2020 article presented the theoretical and methodological bases relating qualities of public spaces, the walkability of older adults, and the direct benefits on health. The 2021 article validated the applicability of the index in the Historic Center of Porto, Portugal. Both articles incorporated the factor 'slope', solving a criticism evidenced in related literature about the slope being ignored in older adults' walking conditions studies. The present study, however, aims to validate the conceptual design of the Walkability Index for Elderly Health (WIEH) in the Brazilian context at the historic center of Vitória. The methodology included the analysis and evaluation of public spaces regarding the pedestrian network-urban fabric, urban scene, and safety-and the presence of slopes and/or stairways. Subsequently, these spaces were classified according to the WIEH, ascertaining their level of adequacy for older adults' walkability. The results show that paths friendly to older adults are rare and that the problems encountered focus primarily on the low quality of the pedestrian network and not on the existence of slopes and stairways.

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Resumo O objetivo deste artigo é avaliar o risco nutricional e cardiovascular segundo medidas antropométricas em idosos quilombolas do estado do Maranhão. Trata-se de estudo transversal realizado em 11 comunidades remanescentes de quilombolas do município de Bequimão, Maranhão, Brasil. Realizou-se censo da população idosa que representou 205 pessoas. Foram estimados os riscos nutricional e cardiovascular por meio dos indicadores antropométricos segundo sexo e idade. Realizou-se Testes de Qui-quadrado de Pearson ou Exacto de Fisher e análises de variância. Diferenças foram consideradas estatisticamente significantes quando p<0,05. Idosos quilombolas vivem em precárias condições de moradia e de infraestrutura sanitária, com elevado risco nutricional e cardiovascular, mas com diferenças entre sexo e idade. O excesso de peso foi mais prevalente em mulheres e idosos mais jovens, enquanto os homens e idosos com 80 ou mais anos apresentaram-se mais desnutridos e com maior perda de massa corporal. O risco cardiovascular foi maior entre as mulheres e em todas as faixas etárias. Idosos quilombolas vivem em vulnerabilidade socioeconômica e apresentaram alta prevalência de baixo peso, perda de massa muscular e alto risco cardiovascular, sendo maior risco entre mulheres e idosos do grupo de maior idade.

Abstract This article aims to assess nutritional and cardiovascular disease (CVD) risk based on anthropometric measures among older persons living in Quilombola communities in the state of Maranhão, Brazil. We conducted a cross-sectional study with 205 older persons living in 11 Quilombola communities in Bequimão, Maranhão. Nutritional and CVD risk were estimated according to sex and age group based on anthropometric indicators using Pearson's chi-square or Fisher's exact tests and analysis of variance, adopting a significance level of p<0.05. The study participants suffer precarious housing, basic sanitation and social conditions. Prevalence of nutritional and CDV risk was high across the sample, showing differences between sexes and age groups. Prevalence of excess weight was higher in women and the youngest age group, while prevalence of malnourishment and loss of muscle mass was higher in men and individuals aged 80 years and over. Prevalence of CVD risk was high across all age groups and higher in women than men. The older persons living in the Quilombola communities investigated by this study are socially vulnerable and showed high prevalence of low weight, loss of muscle mass and CDV risk. The prevalence of CVD risk was higher among women and the oldest age group.

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Given the expected increase in the proportion of older persons and evidence of poverty among persons with disabilities in general, well-being among older persons with disabilities is an important issue. Using Sen's capability approach, this article examines well-being among older persons with disabilities in Trinidad. A multiphase mixed-methods design with three phases was employed. In the initial exploratory phase, functionings which are things people value doing or being were identified via 11 interviews. These functionings were used in the subsequent phase to develop an instrument with both closed- and open-ended questions. The instrument was then administered in the third phase to measure well-being and to identify its hindering factors. Responses from 31 participants revealed moderate-to-severe deprivations among older persons with disabilities in Trinidad including for functionings related to food, healthcare, information and transportation. The integrated findings suggested changes to social care and healthcare systems to promote well-being among older persons with disabilities in Trinidad, as well as the need to develop community interactions and public services regarding transportation, supportive devices, and therapy.

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O cenário nacional dos programas de promoção da saúde e prevenção de riscos e doenças para a pessoa idosa na saúde suplementar é descrito em pesquisa com dados secundários de 1999 a 2019, fornecidos pela Agência Nacional de Saúde Suplementar. Para análise qualitativa, utilizou-se a técnica de análise de conteúdo com apoio do software IRaMuTeQ® e, para a quantitativa, do software RStudio. Encontraram-se 87 programas exclusivos para a pessoa idosa. As motivações apresentadas foram: aumento da população-alvo no Brasil; aumento do número de beneficiários da população-alvo; mudanças nos padrões de morbimortalidade; e necessidades de adoção de um novo modelo assistencial. As principais atividades foram: rede multidisciplinar de atenção; ações multidisciplinares; e desenvolvimento de um plano de cuidado individualizado. O número de programas mostra-se insuficiente em relação à demanda. Esperam-se atitudes mais rígidas na regulamentação do setor e mudanças no modelo assistencial vigente.(AU)

This article provides a national panorama of health promotion and risk and disease prevention programs for older persons in the private health sector using secondary data from 1999 to 2019 provided by the Supplemental Health Agency. Content analysis was performed using the software IRaMuTeQ® and a quantitative analysis was conducted using RStudio. We found 87 programs targeting older persons. The reasons found were: an increase in the target audience; an increase in the number of beneficiaries among the target audience; changes in patterns of morbidity and mortality; and the need to adopt a new care model. The main activities were: multidisciplinary care network; multidisciplinary actions; and development of individualized care plans. The number of programs is insufficient to meet demand. A more stringent approach is expected in the regulation of the sector and changes need to be made to the current care model.(AU)

Se describe el escenario nacional de los programas de promoción de la salud y prevención de riesgos y enfermedades para los ancianos en la salud suplementaria, en investigación con datos secundarios de 1999 a 2019, suministrados por la Agencia Nacional de Salud Suplementaria. Para el análisis cualitativo se utilizó la técnica de análisis de contenido con apoyo del software IRaMuTeQ® y para el cuantitativo el software RStudio. Se encontraron 87 programas exclusivos para los ancianos. Las motivaciones encontradas fueron: aumento de la población-objetivo, cambios en los estándares de morbimortalidad y necesidades de adopción de un nuevo modelo asistencial. Las principales actividades fueron: red multidisciplinaria de atención, acciones multidisciplinarias, desarrollo de un plan de cuidado individualizado. El número de programas se muestra insuficiente con relación a la demanda. Se esperan actitudes más rígidas en la reglamentación del sector y cambios en el modelo asistencial vigente.(AU)

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Resumo Avaliar e correlacionar o estado funcional (EF) e a força muscular (FM) em adultos jovens, adultos e idosos em Unidade de Terapia Intensiva (UTI). Coorte prospectiva com 48 pacientes avaliando EF por meio do Functional Status Score for the Intensive Care Unit (FSS-ICU) e FM pelo Medical Research Council Sum-Score (MRC-SS) e força de preensão palmar (FPP), no despertar e na alta da UTI. Dados analisados pelos testes Kruskall-Wallis, Qui-quadrado, Wilcoxon e Correlação de Sperman. Na comparação do despertar em relação à alta, o EF e o MRC-SS foram maiores na alta em todos os grupos, com menor ganho nos idosos. A FPP aumentou bilateralmente na alta, exceto no grupo de adultos, pois apresentavam valores maiores no despertar. Na comparação dos grupos, o FSS-ICU foi maior nos adultos no despertar e alta, e a FPP-D menor nos idosos. O EF apresentou forte associação com a FM em adultos jovens e adultos, pois ambos apresentam progressiva melhora durante a permanência na UTI. Os idosos apresentam menor ganho do estado funcional, além de apresentarem menor força muscular desde o despertar. Estas variáveis apresentam importante associação apenas nos adultos jovens e adultos, considerando a natureza multifatorial do processo de adoecimento e incapacidade nos idosos.

Abstract The aim of this study was to analyze and assess the association between functional status (FS) and muscle strength (MS) in young adults, adults and older adults in an intensive care unit (ICU). We conducted a prospective cohort study with 48 patients. FS was assessed using the Functional Status Score for the Intensive Care Unit (FSS-ICU) and MS was measured using the Medical Research Council Sum-Score (MRC-SS) and by testing handgrip strength (HS). The assessments were performed on awakening and ICU discharge. The data were analyzed using the Kruskall-Wallis, chi-squared, Wilcoxon and Spearman's correlation tests. FS and MRC-SS scores were higher on ICU discharge in all groups. Gains were lowest in the older adult group. HS was greater in both hands on ICU discharge in all groups except the adults. FSS-ICU on both awakening and ICU discharge was highest in the adults; HS-R was lowest in the older adults. There was a strong association between FS and MS in the young adults and adults. FS and MS showed progressive improvement during ICU stay. Gains in FS and MS on awakening and ICU discharge were lowest among the older adults. Important associations were found between these variables in all groups except the older adults. This can be explained by the multifactorial nature of illness and incapacity in this group.

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OBJECTIVE: The objective of this study was to determine and characterize caregiver burden among caregivers of community-dwelling older persons in Jamaica. METHOD: A nationally representative cross-sectional study was done among persons providing noninstitutional care for a single person (≥60 years). The Zarit Burden Interview (ZBI) and a structured questionnaire were administered to 180 caregivers from four geographic health regions. RESULTS: The ZBI scores ranged from 0 to 56 (median = 15). Independently associated factors were relationship to care recipient and age. Children/grandchildren had higher caregiver burden scores than formally employed caregivers (odds ratio = 2.9: 95% confidence interval: [1.02, 8.34]). Compared with caregivers 35 to 44 years, those aged 45 to 65 were almost 5 times more likely to report higher caregiver burden scores. CONCLUSION: Caregiver burden as identified by the ZBI was low. Age (45-65 years) and being the child/grandchild of the care recipient were independently associated with greater caregiver burden. Interventions to address caregiver burden must embrace strategies that recognize that these factors.

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A partir de que Argentina y Colombia reconocen la salud como un derecho esencial y se comprometen, entre otras cuestiones, a brindar prestaciones sanitarias para garantizar su ejercicio sin discriminación, se propone indagar, comparativamente, acerca de los desafíos que estos países enfrentan para cumplir con este compromiso en las personas de sesenta años y más. Para ello, se calculan y analizan, para los trienios 2000-2002 y 2013-2015, tasas de mortalidad por causas consideradas sensibles a la atención de la salud según país, sexo y edad, con base en información de la Organización de las Naciones Unidas, y se calculan proporciones específicas sobre encuestas oficiales de cada país. Los resultados evidencian, en ambos países y para el conjunto de causas referidas, una mayor mortalidad en hombres, que crece con la edad hasta los 74 años y con tendencia al descenso, principalmente en Colombia. Un análisis más detallado por causas revela una situación similar en este último caso, a diferencia de Argentina, donde aumenta la mortalidad asociada a enfermedades respiratorias. Independientemente de estas diferencias, las tasas obtenidas al final del período investigado acusan, en los dos países, la necesidad de redoblar los esfuerzos para continuar su reducción (o revertir su incremento), con especial foco en las personas mayores que menos recursos tienen y su valor en tanto ciudadanos con iguales derechos al resto de la población.

Tendo em vista que a Argentina e a Colômbia reconhecem a saúde enquanto um direito essencial e comprometem-se, entre outras questões, a fornecer benefícios à saúde para garantir seu exercício sem discriminação, propõe-se investigar, comparativamente, os desafios enfrentados para o cumprimento desse compromisso para pessoas com 60 anos ou mais. Para esse fim, as taxas de mortalidade por causas consideradas sensíveis aos cuidados de saúde de acordo com país, sexo e idade, com base em informações da Organização das Nações Unidas, são calculadas e analisadas para os períodos 2000-2002 e 2013-2015, sendo que proporções específicas são calculadas em pesquisas oficiais de cada país. Os resultados mostram, nos dois países e por todas as causas referidas, uma maior mortalidade em homens, aumentando com a idade de 74 anos e com tendência a declinar, principalmente na Colômbia. Uma análise mais detalhada por causas revela uma situação semelhante no último caso, ao contrário da Argentina, onde a mortalidade por doenças respiratórias aumenta. Independentemente dessas diferenças, as taxas obtidas no final do período investigado acusam, em ambos os países, a necessidade de redobrar esforços para continuar a redução da mortalidade (ou reverter seu aumento), com foco especial nos idosos que têm menos recursos e em seu valor enquanto cidadãos com direitos iguais ao resto da população.

Since Argentina and Colombia recognize health as a fundamental right, and undertake, among other issues, to provide healthcare services to guarantee its exercise without discrimination, our aim is to inquire, comparatively, about the challenges these countries face in fulfilling this commitment for population aged 60 and older. Thus, mortality rates from causes considered sensitive to health care by country, sex and age are calculated and analysed for trienniums 2000-2002 and 2013-2015, based on information from the United Nations. Besides, specific proportions are calculated based on each country's official surveys. Results show, in both countries and for all groups of causes considered, a higher mortality in men, increasing with age up to 74 years and with a tendency to decline, mainly in Colombia. A more detailed analysis by causes reveals a similar situation in the latter case, unlike Argentina where mortality from respiratory diseases increases. Regardless of these differences, the rates associated to period 2013-2015 reveal, in both countries, the need to increase efforts to continue their reduction (or reverse their increase), with a special focus on those who have fewer resources and on their value as citizens with the same rights as the rest of the population.

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PURPOSE: Aging research in Mexico has significantly increased in the past decades, however, little is known on health related quality of life (HRQoL) of older adults. The aim of this study was to expand this field by examining HRQL in a representative sample of Jewish older adults in Mexico, and to investigate its association with different factors. METHODS: This was a cross-sectional survey of a random sample of community dwelling Jewish men and women aged 60 years and older. HRQoL was measured using the Short Form Health Survey (SF-36). Bivariate analysis was performed to estimate the association of scores of HRQoL and different characteristics of the study sample and multiple linear regression models were estimated using ordinary least squares (OLS), to explore determinant factors associated to HRQoL in this sample, for the eight domains of the SF-36 sub-scales separately. RESULTS: Two hundred ninety-five older persons were interviewed. Mean age was 72.7 years (SD 7.9), men made up 57% of the sample, 67% were married and 52% reported living with another person, mostly the spouse. Higher HRQoL was associated with higher educational attainment, being married, and having higher social support, while lower HRQoL was associated with being widowed, in worse financial situation, having chronic diseases and being in the oldest age groups. CONCLUSIONS: Findings show that gender, socioeconomic level, educational attainment, marital status as well as social support & community participation are relevant factors influencing HRQoL in our study sample. With respect to the SF-36 subscales, HRQoL of Jewish older adults in Mexico present higher scores than that of adults and older adults previously found in other studies in Mexico. Further studies comparing other characteristics among them could help bring further understanding of these differentiated ageing processes.

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OBJECTIVE: Frailty is a multifactorial syndrome characterized by social, physical, and psychological stressors. Network analysis is a graphical statistical technique that can contribute to the understanding of this complex, multifactorial phenomenon. The aim of this study was to investigate the relationships between social, physical, and psychological factors and frailty in older persons. DESIGN: A cross-sectional study. SETTINGS AND PARTICIPANTS: A total of 2588 community-dwelling older persons from the FIBRA (Frailty in Brazilian Older Persons) 2008 to 2009 study. MEASURES: Participants were assessed for sociodemographic variables, physical and mental health, and the frailty phenotype. Partial correlation network analysis with the Graphical Least Absolute Shrinkage and Selection Operator (glasso) estimator was performed to determine the relationships between social, physical, and psychological factors and frailty. RESULTS: Mean participant age was 72.31 years, 7.0% were frail, and 50.6% were prefrail. In the network structure, frailty correlated most strongly with physical and psychological factors such as diabetes and depression and exhibited greater proximity to physical factors such as disability, urinary incontinence, and cardiovascular risk as measured by waist-to-hip ratio. CONCLUSIONS AND IMPLICATIONS: The analytical strategy used can provide information for specific subpopulations of interest and here confirmed that frailty is not uniformly determined but associated with different psychological and physical health factors, thereby allowing better understanding and management of this condition.

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Resumo Queda recorrente representa alto risco de morbidade e mortalidade em idosos, principalmente institucionalizados, dado ao seu quadro de fragilidade e declínio funcional evidentes. O objetivo deste estudo é determinar a incidência e os fatores de risco relacionados a quedas recorrentes em idosos institucionalizados. Estudo longitudinal tipo coorte no período de um ano. Foram avaliados indivíduos com 60 anos ou mais residentes em 10 Instituições de Longa Permanência para Idosos, que deambulassem e possuíssem capacidade cognitiva preservada. Foi questionada a ocorrência de quedas nos últimos doze meses, considerando recorrentes a ocorrência de dois ou mais episódios neste período. Foram ainda coletadas variáveis referentes à instituição, condições sócio demográficas e de saúde do idoso através de questionários. Do total de 364 idosos, 130 foram incluídos. A incidência de quedas recorrentes foi de 26.9% (IC 95% = 22.4 - 31.5). A partir do Qui-quadrado e Regressão Logística, considerando o nível de significância de 5%, foi encontrada fadiga como fator de risco (p = 0.001; RR = 2.9) e uso de betabloqueadores como fator de proteção (p = 0.010; RR = 0.1). Conclui-se que queda recorrente é comum nas Instituições de Longa Permanência para Idosos e a fadiga representa fator de risco.

Abstract Recurrent falls constitute a high risk for morbidity and mortality among older people, especially institutionalized individuals, due to greater frailty and functional decline in this group. The aim of this study was to identify risk factors associated with recurrent falls among institutionalized older persons. A longitudinal cohort study was conducted over a one-year period with a study sample consisting of individuals aged 60 years and over living in 10 Nursing homes (NH) who were able to walk and had preserved cognitive ability. The older persons and carers were asked about the occurrence of falls over the last twelve months. The older persons were considered recurrent fallers if they had had two or more falls during this period. Institutional, sociodemographic and health data was also collected using questionnaires and the residents' medical records. One hundred and thirty individuals were included in the sample out of a total of 364 older people living in the NH. The incidence of recurrent falls was 26.9% (CI95% = 22.4 - 31.5). The results of the chi-square test and logistic regression adopting a significance level of 0.05 showed that fatigue was a risk factor for recurrent falls(p = 0.001; RR = 2.9) and that the use of beta blockers was a protective factor (p = 0.010; RR = 0.1). It was concluded that recurrent falls are common in NH and that fatigue constitutes an important risk factor.

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ABSTRACT Objective: To describe the sociodemographic and health characteristics and implied needs of caregivers to older persons in Jamaica. Method: This was a community-based, nationally representative study in which a sample of 180 caregivers to older persons was interviewed. Findings: Caregivers were aged between 18 and 88 years (mean 50.5; s = 14.7) and most (77%) were informal compared to 23% who were paid to care. There were no differences between urban and rural caregivers with respect to gender, union status, residing with care recipients and holding a regular job while giving care. Urban caregivers were significantly more likely to report attaining secondary education than those in rural communities (χ2 (2) = 7.40, p < 0.05). Over 90% reported they had not received any formal training in caregiving and those ≤ 45 years were more likely than those in age groups ≥ 46 years to say they want to get caregiver training (χ2 (4) = 27.1, p < 0.001). Male caregivers were significantly more likely to report being the 'child/grandchild/in-law' of care recipients than female caregivers, among whom almost one in four reported their relationship as employee (Fisher's Exact test: p = 0.002). Most caregivers (51.7%) reported being diagnosed with one or more medical condition and 89% of those diagnosed reported being prescribed medications for their illnesses. Forty-five per cent of caregivers reported that they performed one or more activity of daily living (ADL) for their care recipients daily. Conclusion: Carers of older persons in Jamaica are predominantly family members, most have not received caregiving training and most have been diagnosed with a medical condition.

RESUMEN Objetivo: Describir las características sociodemográficas y de salud, así como las necesidades implícitas de los cuidadores de las personas mayores en Jamaica. Método: Se trata de un estudio comunitario representativo a nivel nacional, en el que se entrevista una muestra de 180 cuidadores de personas de edad. Resultados: Los cuidadores tenían entre 18 y 88 años (media 50.5; s.d. = 14.7) y la mayoría (77%) eran informales en comparación con el 23% que recibían pago por el cuidado. No hubo diferencias entre los cuidadores urbanos y rurales con respecto a género, estado civil, residir con las personas objeto del cuidado, y mantener un trabajo regular a la par con la atención a los ancianos. Los cuidadores urbanos presentaban una probabilidad significativamente mayor de haber alcanzado educación secundaria en comparación con aquellos de las comunidades rurales (χ2 (2) = 7.40, p < 0.05). Más del 90% reportó no haber recibido ninguna capacitación formal en cuidados, y aquellos con ≤ 45 años eran más propensos que los de los grupos de edad ≥ 46 años a decir que deseaban recibir entrenamiento como cuidadores (χ2 (4) = 27.1, p < 0.001). Los cuidadores hombres presentaban una probabilidad significativamente mayor de ser "hijo/nieto/yerno" de personas receptoras de cuidados, que las mujeres cuidadoras, entre las cuales casi una de cada cuatro reportó su relación como empleado (Prueba exacta de Fisher: p = 0.002). La mayoría de los cuidadores (51.7%) reportaron estar diagnosticados con una o más condiciones médicas, y el 89% de los diagnosticados reportaron recibir prescripciones de medicamentos para sus enfermedades. Cuarenta y cinco por ciento de los cuidadores informó realizar una o más actividades de la vida diaria (AVD) para las personas bajo su cuidado diariamente. Conclusión: Los cuidadores de personas mayores en Jamaica son en su mayoría miembros de la familia; la mayor parte de ellos no ha recibido capacitación como cuidadores; y la mayoría han sido diagnosticados con alguna condición médica.

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ABSTRACT Objectives: To describe the prevalence of tooth loss, denture use and dental care utilization among older persons by age, gender, union, residence, education, chronic illness and health insurance status and to identify independent predictors of dental service use and tooth loss. Methods: A cross-sectional survey utilizing a nationally representative sample of 2943 older persons in Jamaica was conducted. Data related to tooth loss, dental care use and sociodemographic data were obtained. Relationships between variables were assessed in bivariate analyses and logistic regression models subsequently developed to identify predictors of tooth loss and dental care use. Results: Tooth loss (any) prevalence was 94% and among those who reported tooth loss, 61.1% had dentures: the majority of those with dentures reported using them. Non-use was mainly related to damaged denture or discomfort. Only 35% of persons reported a dental visit within the last 12 months. Age, union status and educational level were significant predictors of both tooth loss and dental visit within the past year. Additionally, gender, residence and having health insurance predicted dental care utilization. Conclusion: Dental health issues are important in the care of older persons and assume increasing relevance given rapid ageing of the population. Jamaica must craft strategies to address emergent needs in its response to the challenges of oral healthcare for older persons.

RESUMEN Objetivos: Describir la prevalencia de la pérdida de dientes, el uso de prótesis dentales, y la utilización de la atención dental entre las personas mayores por edad, género, estado civil, residencia, educación, enfermedad crónica, y posesión de seguro médico, e identificar predictores independientes de la utilización de la atención dental, así como de la pérdida de dientes. Métodos: Se realizó una encuesta transversal utilizando una muestra representativa de 2943 personas de edad a nivel nacional en Jamaica. Se obtuvo datos sobre la pérdida de dientes, el uso de los servicios dentales, y la demografía. Las relaciones entre las variables se evaluaron en análisis bivariados y modelos de regresión logística desarrollados posteriormente para identificar los predictores de la pérdida de dientes y la utilización de la atención dental. Resultados: La prevalencia de la pérdida de dientes (cualesquiera) fue 94%, y entre los que informaron pérdida de dientes, un 61.1% utilizaban prótesis dentales: la mayoría de los que utilizaban prótesis dentales reportaron su uso. El no uso se relacionó principalmente con prótesis dentales dañadas o molestias. Sólo el 35% de las personas reportaron una visita dental en los últimos 12 meses. La edad, el estado civil, y el nivel educacional fueron predictores significativos de la pérdida de dientes y la visita dental el año anterior. Además, el género, la residencia y la posesión del seguro médico fueron predictores de la utilización de la atención dental. Conclusión: Los problemas de salud dental son importantes en el cuidado de las personas de edad y adquieren una relevancia creciente dado el rápido envejecimiento de la población. Jamaica debe elaborar estrategias para abordar las necesidades emergentes en su respuesta a los desafíos de la salud oral de las personas mayores.

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ABSTRACT Objective: To ascertain the level of care and the predisposing, enabling and need factors associated with care received by older adults using Andersen's framework. Methods: The 2012 Jamaica Survey of Living Conditions was used to conduct descriptive, bivariate and binary logistic analyses for the receipt of care among older adults defined by activities of daily living (ADL) and the instrumental activities of daily living (IADL) measures. The ADL sample comprised 3152 older adults and the IADL sample comprised 3141 older adults. Results: Approximately 16% of older adults received ADL care and significant binary logistic associations with age, area of residence, living arrangements, source of financial support, disability, and perceived health status were found. Approximately 69% received IADL care and significant binary logistic associations with gender, age, employed, living arrangements, wealth status, source of financial support, satisfaction with life accomplishments, disability and perceived health status were found for those receiving IADL care. Conclusion: Predisposing, enabling and need factors of the Andersen framework predict ADL and IADL care. Therefore, plans for care of older adults must address those 70 years or older who live alone, have a disability, a chronic illness and rate their health poorly.

RESUMEN Objetivo: Determinar el nivel de cuidados y los factores predisponentes, capacitantes y de necesidad asociados con el cuidado recibido por los adultos mayores, usando el modelo de Andersen. Métodos: La Encuesta de Condiciones de Vida en Jamaica 2012 fue utilizada para realizar análisis descriptivos, bivariantes y logísticos binarios en relación con el recibimiento de cuidados entre los adultos mayores, definidos por las medidas de las actividades de la vida diaria (AVD) y las actividades instrumentales de la vida diaria (AIVD). La muestra de AVD abarcó 3152 adultos mayores y la muestra de AIVD abarcó 3141 adultos mayores. Resultados: Aproximadamente el 16% de los adultos mayores recibieron cuidados de AVD, y en su análisis se hallaron asociaciones logísticas binarias significativas con la edad, el área de residencia, la situación de vivienda, la fuente de apoyo financiero, la discapacidad y el estado de salud percibido. Aproximadamente el 69% recibió cuidados de AIVD, y en su análisis se hallaron asociaciones logísticas binarias con el género, la edad, los empleados, la situación de vivienda, la situación económica, la fuente de apoyo financiero, la satisfacción con los logros de vida, la discapacidad, y el estado de salud percibido. Conclusión: Los factores predisponentes, capacitantes y de necesidad del modelo de Andersen predicen los cuidados de AVD y AIVD. Por lo tanto, los planes para el cuidado de adultos mayores tienen que abarcar a aquellas personas de 70 años o más que viven solas, tienen una discapacidad, una enfermedad crónica, y valoran su salud como pobre.

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