RESUMO
BACKGROUND: The measurement of physical performance constitutes an indicator of the physical functional capacity of older adults with and without frailty. AIM: To present a synthesis of knowledge on the effect of exercise programs on physical performance in older adults with and without frailty in the community. METHOD: A systematic review was carried out in accordance with the PRISMA-2020 criteria. The search for articles was made until 4 May 2023 in PubMed, Scopus, Web of Science, Cochrane Library, SciELO and LILACS. The outcome variable was physical performance, measured through the SPPB (Short Physical Performance Battery). The mean difference (MD) was estimated to evaluate the effect. RESULT: We found 2483 studies, of which 12 met the eligibility criteria for the systematic review and 9 for the meta-analysis. The effect of exercise on SPPB scores was significantly higher in the exercise group compared to control in non-frail older adults with MD = 0.51 [95% CI, 0.05 to 0.96, p < 0.05]. Likewise, in older adults with frailty, the effect of exercise on the global SPPB score was significantly higher in the exercise group compared to the control with MD = 0.66 [95% CI, 0.09 to 1.24, p < 0.05]. CONCLUSION: Our findings suggest that exercise programs are effective in increasing and/or maintaining physical performance in older adults with and without frailty, whose effect is more evident in older adults with frailty, probably due to the greater margin of recovery of intrinsic capacity. This systematic review shows the differentiated effect of exercise training on physical performance in older adults with and without frailty. Scientific evidence reinforces the importance of implementing physical exercise programs in all older adults, including those who are frail. However, it is necessary to specify the types and doses (duration, frequency and intensity), for individualized groups, previously grouped according to the SPPB score.
RESUMO
BACKGROUND: Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. METHODS: This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. RESULTS: A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). CONCLUSION: Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.
Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Masculino , Vida Independente , Estudos Retrospectivos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Fatores de RiscoRESUMO
Abstract Background Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. Methods This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. Results A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). Conclusion Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.
RESUMO
Background: Polypharmacy is common among older adults and is of public health concern, since pharmacological therapy influences the quality of care for older individuals. Few studies have addressed its prevalence and correlates in low or middle-income countries. Objective: To evaluate the prevalence of polypharmacy in a representative sample of the Brazilian older population and its association with sociodemographic conditions and factors related to access to health services. Methods: Cross-sectional study with data from the last National Health Survey, conducted in 2019. The dependent variable was polypharmacy (five or more medications) and independent variables were: sociodemographic characteristics, general health conditions and access to health services indicator. Results: The prevalence of polypharmacy was 19.2%. Polypharmacy was higher among those aged 80 years and over compared to those aged 60-69 years (prevalence ratio (PR) 1.47; 95% CI: 1.30; 1.66); individuals with complete elementary education (PR 1.35; 95% CI: 1.13; 1.60) versus those who did not go to school; with 3+ chronic diseases (PR 11.14; 95% CI: 7.94; 15.63); those with limitations in basic activities of daily life (PR 1.49; 95% CI: 1.35; 1.63) and possession of private medical health insurance (PR 1.32; 95% CI 1.19; 1.46). Being in a marital relationship was inversely associated with polypharmacy (PR 0.88; 95% CI: 0.80; 0.96). Conclusion: Polypharmacy affects a significant proportion of the Brazilian older population and is associated with sociodemographic factors and access to health services.
RESUMO
ABSTRACT Objective: This study evaluated Jamaican community dwelling older adults' levels of anxiety and the predictors of such anxiety. Methods: For this cross-sectional study, participants aged 65 years and over were selected from urban lower-middle and working-class communities. Data collection tools were the geriatric anxiety scale (GAS) and a demographic questionnaire. Using the statistical package for the social sciences (SPSS), data were analysed using descriptive and inferential statistics. The GAS data was skewed, hence a log transformation was performed to obtain a normal distribution prior to analysis. Cronbach's alpha indicated a high level of internal consistency for the GAS in this group of participants. Results: One hundred and fourteen persons participated in the study. Results overall showed a low level of anxiety (GAS mean score = 9.2 ± 8.3). Persons who were female (p = 0.01), had primary level education only (p = 0.02), unemployed (p = 0.01), were lonely (p = 0.00) and had poor relationships with their adult children (p = 0.05) had higher mean GAS scores, indicating higher levels of anxiety. Predictor variables for anxiety were identified as, loneliness, gender and education. Together, these variables predicted 23% of the variability in GAS scores (R2 = 0.233, R = 0.48, p = 0.04). Conclusion: Anxiety levels are low in Jamaican older adults. Females with primary level education who are lonely are at greatest risk. Investigation of other factors such as religion is necessary, as the factors explored in this study, accounted for only 23% of the variance in GAS scores.
RESUMEN Objetivo: El presente estudio evaluó los niveles de ansiedad y los predictores de dicha ansiedad en los adultos mayores residentes en la comunidad urbana jamaicana. Métodos: Para este estudio transversal, se eligieron participantes de 65 años o más de comunidades urbanas de clase media baja y clase trabajadora. Los instrumentos de la recolección de datos fueron la Escala de Ansiedad Geriátrica (EAG) y un cuestionario demográfico. Utilizando el paquete estadístico para las ciencias sociales (SPSS), se analizó el conjunto de datos mediante estadísticas descriptivas e inferenciales. Los datos de EAG eran asimétricos. Por lo tanto, se realizó una transformación logarítmica con el propósito de obtener una distribución normal antes del análisis. El Alfa de Cronbach indicó un alto nivel de consistencia interna para EAG en este grupo de participantes. Resultados: Ciento catorce personas participaron en el estudio. Los resultados en general mostraron un bajo nivel de ansiedad (puntuación promedio de EAG = 9.2 ± 8.3). Las mujeres (p = 0.01), los que tenían sólo nivel de educación primaria (p = 0.02), los desempleados (p = 0.01), los que estaban solos (p = 0.00), y los que tenían malas relaciones con sus hijos adultos (p = 0.05), tuvieron puntuaciones promedio de EAG más altas, indicando niveles más altos de ansiedad. Se identificaron variables predictoras de ansiedad como la soledad, el género y la educación. En conjunto, estas variables predijeron el 23% de la variabilidad en las puntuaciones de EAG (R2 = 0.233, R = 0.48, p = 0.04). Conclusión: Los niveles de ansiedad son bajos en los adultos mayores jamaicanos. Las mujeres con nivel de educación primaria que están solas presentan un mayor riesgo. Se necesita la investigación de otros factores tales como la religión, ya que los factores explorados en este estudio representaron solamente el 23% de la variación en las puntuaciones de EAG.