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Integrating intrinsic capacity into Latin American medical education: a comprehensive framework for future physicians
No full textThis study advocates the integration of the World Health Organization’s intrinsic capacity (IC) framework — encompassing physical, mental, and psychological well-being — into Latin American medical education to address the challenges associated with population aging. This region faces rapid demographic aging amid health inequities, fragmented systems, and social determinants such as poverty and limited access to health care services. Traditional medical training, focused on reactive disease management, often neglects preventive, person-centered approaches that are critical for healthy aging. Embedding IC into medical curricula equips practitioners to assess older adults’ mobility, cognition, vitality, and psychological health, allowing personalized interventions. This shift prioritizes early risk detection, autonomy preservation, and interdisciplinary collaboration across health care and social services. Effective implementation requires systemic reforms, including updated curricula, the training of educators, and partnerships between universities, governments, and non-governmental organizations. In resource-limited settings, IC-aligned care could reduce hospitalizations, promote aging in place, and alleviate strained systems. By addressing biological and socioenvironmental factors, this approach fosters more equitable models aligned with Latin America’s demographic realities. Integrating IC into medical education strengthens the connection between clinical practice and the complex needs of older adults, improving their quality of life and strengthening the health system.</p
Orienteering vs. hiking in older adults: a randomized trial of physical and functional aspects
No full textOBJECTIVE: To compare the effects of a dual-task orienteering exercise program vs single-task hiking on body composition, gait parameters, and fall incidence in independent older adults.
METHODS: Seventy-two older adults (mean age ~70 years; 91.6% female) were randomized into three groups: orienteering (OG, n = 24), hiking (HG, n = 23), and control (CG, n = 25). The interventions occurred over 24 weeks (2 60-min sessions per week). Primary outcomes included body composition (weight, body mass index), gait (cadence, stride length), and fall incidence.
RESULTS: At baseline, the groups were comparable in age, sex, education, and functional independence. After 24 weeks, body weight (-1.01 kg, p = 0.040) and body mass index (-0.40 kg/m2,
p = 0.036) were significantly reduced in the OG, while there was a trend toward weight reduction in the HG (p = 0.074). Both experimental groups also experienced significant gains in cadence (+7.1 and +5.4 steps/min, respectively) and stride length (+0.12 m and +0.06 m), which were superior in the OG (p < 0.001). Notably, neither experimental group reported falls during the intervention, in contrast to the CG, in which the fall incidence increased (p < 0.001).
CONCLUSION: Both orienteering and hiking improved gait and body composition in older adults while eliminating falls during a 24-week intervention. The dual-task nature of orienteering appeared to offer greater functional gains, suggesting its potential as a feasible, safe, and effective strategy for promoting mobility and fall prevention.</p
Predictors of probable sarcopenia and sarcopenia in older adults under outpatient geriatric care
No full textOBJECTIVES: Sarcopenia is a prevalent systemic skeletal muscle disease common among older adults and those with chronic diseases. It is associated with poor health outcomes and economic implications, including higher healthcare costs, increased need for long-term care, and reduced productivity. Therefore, a rapid identification of older adults at high risk for sarcopenia may be a priority in all public healthcare settings. This study investigated predictive factors for probable sarcopenia and sarcopenia in older adults in outpatient care.
METHODS: This cross-sectional study analyzed 511 Brazilian older adults (mean age=75.9±8.0 years, male-to-female ratio=1:1.62) followed at a public outpatient geriatrics clinic. Probable sarcopenia was defined by low skeletal muscle strength (SMS) as measured with a handgrip strength test. A diagnosis of sarcopenia was established when both SMS and calf circumference measurements were reduced. Variables were grouped according to demographic, body and appendicular anthropometric measurements, clinical, nutritional, and oral health status. Multinomial logistic regression analysis examined the relationship between independent variables and outcomes.
RESULTS: Probable sarcopenia was predicted by higher height (OR 1.06, 95%CI 1.03–1.08), lower mid-upper arm bone-free muscle area (OR 1.74, 95%CI 1.04–2.89), and diagnosis of edentulism (OR 2.03, 95%CI 1.32–3.14). In turn, sarcopenia diagnosis was predicted by lower mid-upper arm muscle circumference (OR 0.69, 95%CI 0.58–0.81), malnutrition (OR 3.24, 95%CI 1.25–8.40), and risk of sarcopenia (OR 7.98, 95%CI 3.04–20.99), and a reduced number of functional tooth units (OR 0.92, 95%CI 0.86–0.99). Advancing age predicted both probable sarcopenia (OR 1.05, 95%CI 1.02–1.08) and sarcopenia (OR 1.05, 95%CI 1.01–1.11).
CONCLUSION: Appendicular anthropometric measurements and nutritional and oral health exams using reliable, low-cost, and easy-to-apply assessment methods emerged as accessible predictors of both probable sarcopenia and sarcopenia.</p
Epidemiological profile of older people who were victims of repeated abuse
No full textOBJECTIVE: To describe the occurrence of repeated abuse against older people in Brazil between 2011 and 2021.
METHODS: We conducted a descriptive retrospective cross-sectional study using secondary data from the Brazilian Ministry of Health's Notifiable Diseases Information System. Cases of repeated abuse against people aged 60 years or over were included, while cases of self-directed violence were excluded. Data were analyzed using Tabwin.
RESULTS: Most victims were women (68.5%, 23.3 cases per 100 000 people), aged 60 to 69 years (47.7%), but the highest prevalence coefficient was found in those over 80 years of age (27.6 per 100 000 people). The highest coefficient was found in the South (31.4 per 100 000 people), self-identified as White (53.3%), living with a partner (51.3%), and with incomplete elementary school education (45.8%). The most common form of violence was physical (35.6%, 10.1 cases per 100 000 people), perpetrated by men (57.9%) who acted alone (63.3%) and were known to the victim (92.5%), with no suspected alcohol use (45.3%). An increasing trend was observed over the study period (331.9%).
CONCLUSION: The increasing prevalence of repeated elder abuse over the 11-year study period points to failures in the protection system. This reinforces the importance of ongoing monitoring of this issue.</p
Social, ethical, and epistemological aspects of dementia prevention: the three-country BEAD study
No full textOBJECTIVE: According to a 2024 Lancet report, there are at least 14 modifiable risk factors for dementia, the management of which could reduce dementia cases by almost 50%. Most of these risk factors are overrepresented among disadvantaged groups. This social etiology and its consequences, however, are not always acknowledged by stakeholders, with prevention often articulated as the responsibility of the individual. The objective of this study was to better understand how dementia prevention is articulated among stakeholders and how “the social” plays out in experts’ accounts.
METHODS: This exploratory study employed opportunistic and snowball sampling and was based on a total of 64 semi-structured interviews with dementia experts from three countries (Germany, Canada, and Switzerland).
RESULTS: In expert models of dementia prevention, social factors were often recognized, but recommendations for change were mostly limited to educational interventions rather than structural changes that would allow preventing risk factors.
CONCLUSION: Current public health campaigns targeting the “preventive individual” should be rethought.</p
Anorexia of aging: from diagnosis to treatment
No full textAnorexia of aging is characterized by reduced appetite and/or food intake in older adults, leading to negative outcomes such as malnutrition, frailty, sarcopenia, and increased mortality. Despite its high prevalence, anorexia of aging has often been underdiagnosed and undertreated due to a lack of consensus on diagnostic criteria and effective interventions. This narrative review provides an updated general perspective on anorexia of aging, highlighting its challenges and potential therapeutic approaches. Articles were selected from international databases over a 40-year period, focusing on biological mechanisms, clinical outcomes, and management strategies. The main factors associated with anorexia of aging in the literature include changes in appetite regulation, sensory decline, social isolation, depression, and comorbidities. The Simplified Nutritional Appetite Questionnaire is the most widely used screening tool to identify anorexia of aging risk. Early identification allows early interventions, including dietary modifications and nutritional supplementation. Pharmacological strategies, such as ghrelin receptor agonists, have shown promise. Given the significant impact of anorexia of aging, addressing this condition is essential to promote healthier aging and reduce health risks. It is essential for caregivers and professionals to receive updated knowledge so that effective measures can be implemented.</p
Identification of gaps in knowledge and professional practice in geriatric anorexia
No full textOBJECTIVE: To identify gaps in healthcare professionals' understanding and management of geriatric anorexia.
METHODS: Mixed methods, including discussions with experts through focus-group interviews and a digital survey distributed to healthcare professionals.
RESULTS: A total of 192 healthcare professionals completed the survey. Of these, 65.1% acknowledged a uniform definition of geriatric anorexia, defining it as a reduction in appetite and/or food intake; 93.2% identified depression as the most significant risk factor, and 91.1%, cognitive changes or dementia; 64.9% of respondents expressed confidence in providing nutritional recommendations, 57.8% in suggesting physical activity and 81.8% in involving caregivers (family members) in supporting older adults with anorexia; 76% of clinicians assessed appetite during each visit; the tools most often used to screen older adults for appetite loss included informal clinical interview (52.6%) and the Mini-Nutritional Assessment Short Form (40.1%); management focused primarily on recommending oral nutritional supplements (75%) and prescribing nutritional counseling (74.5%).
CONCLUSION: Our findings highlight the challenges in caring for older adults with or at risk of geriatric anorexia. Identifying differences in practices among healthcare professionals and within healthcare teams can inform future healthcare education efforts.</p
Fall calendar as a tracking and monitoring tool for older adults with a history of falls: a longitudinal study
No full textOBJECTIVE: To verify adherence to and the applicability of a fall calendar as a tracking and monitoring tool among older people with a history of falls, and to identify which factors influenced their use of the calendar in their daily lives.
METHODS: This longitudinal study is derived from a randomized clinical trial conducted remotely in 2021 and 2022. Older people with a history of falls included in the MAGIC Program (Brazil) took part in the study. After an initial assessment that collected sociodemographic, health, and functional data, 16-week and 12-month follow-ups on falls were performed. Fall data were collected through monthly phone calls and the use of a fall calendar. Adherence to the fall calendar was investigated through descriptive analysis, fall rates were compared between calendar and monthly telephone data, the calendar was analyzed for sensitivity and specificity, and possible influences on adherence to the fall calendar were identified through regression analysis.
RESULTS: In this sample of 56 older adults, adherence to the calendar was unsatisfactory. The fall calendar presented 21.2% sensitivity and 18.7% specificity compared to monthly phone calls. Moreover, sociodemographic, health, and functional factors did not influence adherence to the calendar.
CONCLUSION: There was low adherence to the fall calendar, and clinical and sociodemographic factors did not influence adherence. Further randomized clinical trials that screen falls through monthly phone calls are recommended in Brazil.</p
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