740 research outputs found
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Relationship between heart rate variability, peripheral muscle strength, functional ability, and nutritional status in hospitalized older adults with sarcopenia
No full textOBJECTIVES: To screen hospitalized older adults for sarcopenia and ascertain whether correlations exist between heart rate variability (HRV), peripheral muscle strength, functional ability, independence, and nutritional aspects in this population.
METHODS: Observational study of hospitalized adults aged > 60 years who were clinically stable and able to complete the study assessments. HRV, functionality, peripheral muscle strength, independence, level of physical activity, nutritional aspects, and risk of death were assessed. The Shapiro-Wilk, Kruskal-Wallis, and Mann-Whitney tests and Spearman correlations were used for statistical analysis; significance was accepted at p < 0.05.
RESULTS: The sample comprised 40 older adults, of whom only nine (22.50%) did not meet criteria for sarcopenia. HRV in participants with sarcopenia correlated positively with level of physical activity (rs 0.92, p = 0.001) and nutritional condition (rs 0.79, p = 0.001), and negatively with mortality (rs -0.59, p = 0.04) (rs 0.79, p = 0.001). In older adults without sarcopenia, HRV correlated positively with independence (rs 0.83, p = 0.001) and muscle strength (rs 0.67, p = 0.04).
CONCLUSION: Most hospitalized older adults meet criteria for sarcopenia. In this population, better autonomic control of the heart is associated with greater independence, muscle strength, physical activity level, and better nutritional status, while worse HRV is associated with a higher risk of mortality.</p
Acute kidney injury in adults aged 60 years or older hospitalized with COVID-19 and association with mortality
No full textOBJECTIVE: To analyze the presence of acute kidney injury (AKI) in hospitalized older patients with COVID-19 and its association with hospital mortality.
METHODS: This was a retrospective observational case-control study of patients over 60 years of age hospitalized from April 01, 2020, to April 30, 2021, at a ward or intensive care unit (ICU) dedicated to COVID-19. The severity of AKI was stratified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Binary logistic regression was used to determine the association of mortality in models with and without adjustment for previous comorbidities as risk factors.
RESULTS: Of 897 patients aged 19–107 years hospitalized with COVID-19, 398 aged ≥ 60 years were included. AKI was observed in 220 patients (55.27%), with stages 1, 2, and 3 in 25.87%, 5.52%, and 23.86%, respectively. Dialysis was required in 73 patients with AKI (33.18%), most of them were at stage 3 (91.89%). Fifty-four patients on dialysis died (73.97%). Increased AKI severity was associated with mortality even after removing the influence of associated risk factors (odds ratios 1.78, 2.35, and 3.51 at stages 1, 2, and 3, respectively).
CONCLUSION: AKI was highly common in patients aged 60 years or older hospitalized with COVID-19, and its severity showed a progressive association with hospital mortality.</p
Frailty does not affect prognostic markers in patients with acute coronary syndrome: results from a Brazilian university hospital
No full textOBJECTIVE: To evaluate frailty and its relationship with prognostic markers in hospitalized patients with acute coronary syndrome.
METHODS: This cross-sectional study with a prospective variable analysis (prognostic markers) involved adults of both sexes aged ≥ 50 years with acute coronary syndrome. Patients with ≥ 3 of the following criteria were considered frail: 1) unintentional weight loss; 2) exhaustion (assessed by self-reported fatigue); 3) low handgrip strength; 4) low physical activity level; and 5) low gait speed. The included prognostic markers were: metabolic changes (lipid and glycemic profile), changes in inflammatory status (C-reactive protein), thrombolysis in myocardial infarction risk score, troponin level, angioplasty or surgery, hospitalization in the intensive care unit, length of hospital stay, and hospital outcome.
RESULTS: The sample consisted of 125 patients, whose mean age was 65.5 (SD, 8.7) years. The prevalence of frailty was 48.00%, which was higher in women (PR = 1.55; 95%CI 1.08–2.22; p = 0.018) and patients with systemic arterial hypertension (PR = 2.18; 95%CI 1.01–5.24; p = 0.030). Frailty was not associated with age, cardiac diagnosis, or prognostic markers (p > 0.05).
CONCLUSIONS: Frailty was highly prevalent in patients with acute coronary syndrome, affecting almost half of the sample, particularly women and patients with hypertension, irrespective of age. However, despite its high prevalence, frailty was not associated with markers of metabolic change or poor prognosis.</p
Handgrip strength predicts disability in older emergency department patients: a prospective cohort study
No full textOBJECTIVE: This study assessed handgrip strength as a predictor of disability in activities of daily living in older emergency department patients 60 and 90 days after discharge.
METHODS: This prospective cohort study was conducted in the emergency department of a tertiary university hospital in Brazil. The sample consisted of 320 patients aged &ge; 65 years who were assessed within 48 hours of admission. The Katz Index was used to assess activities of daily living performance, and handgrip strength was measured with a hydraulic dynamometer. Participants were followed up 60 and 90 days after hospital discharge. The variables were entered into a bivariate regression analysis model.
RESULTS: A total of 177 (55.3%) patients had reduced handgrip strength according to EWGSOP2 criteria. After 60 days, disability occurred in 17.8% and 5.6% of those with reduced and normal HGS, respectively (OR 3.94; 95%CI 1.52 – 10.19, p = 0.005). After 90 days, disability occurred in 15.1% and 4.1% of those with reduced and normal HGS, respectively (OR 4.44; 95% CI 1.50 – 13.14, p = 0.007).
CONCLUSIONS: Dynamometric measurement of HGS should be performed in all older emergency department patients to detect those at greater risk of medium-term disability.</p
Prevalence of self-reported swallowing difficulties and associated factors among older Colombians
No full textOBJECTIVE: We aimed to determine the prevalence of self-reported swallowing difficulty (dysphagia) among older Colombians and to explore the factors associated with this condition.
METHODS: This study presents a secondary analysis of the SABE-Colombia survey, a cross-sectional study of community-dwelling older adults. The dependent variable was self-reported swallowing difficulty, assessed through the question: “How often do you have difficulty or discomfort swallowing?” Descriptive and bivariate analyses of the sample were performed, followed by multivariate analysis, adjusting for confounding variables.
RESULTS: The final sample included 19 004 older Colombians, whose mean age was 69 years (56% women). The overall prevalence of swallowing difficulty was 12.2%. In the multivariate analysis, significant associations were observed between swallowing difficulty and several factors, including male sex (OR 1.14, 95%CI 1.03 – 1.26), age > 80 years (OR 1.26, 95%CI 1.08 – 1.47), dependence in activities of daily living (OR 1.62, 95%CI 1.23 – 2.13), cognitive impairment (OR 1.49, 95%CI 1.30 – 1.70), depressive symptoms (OR 1.38, 95%CI 1.15 – 1.65), sarcopenia (OR 1.32, 95%CI 1.02 – 1.69), malnutrition (OR 1.35, 95%CI 1.23 – 1.49), and osteoarticular disease (OR 1.18, 95%CI 1.07 – 1.38).
CONCLUSION: There was a high prevalence of swallowing difficulty among older community-dwelling Colombians. Our results showed a strong correlation between swallowing difficulty and risk factors such as cognitive impairment, depressive symptoms, osteoarticular disease, and dependence in activities of daily living, but not with malnutrition or sarcopenia.</p
Use of potentially inappropriate medications and medications of concern in older adults with multiple myeloma
No full textOBJECTIVES: To analyze the use of potentially inappropriate medications (PIMs) and medications used in supportive therapy that require caution in older adults with cancer, in addition to determining associated factors the agreement between criteria sets used to identify PIMs.
METHODS: This cross-sectional study included individuals with multiple myeloma aged ≥ 60 years who were undergoing outpatient treatment. PIMs were identified according to American Geriatric Society Beers 2019, PRISCUS 2.0, and Brazilian Consensus on Potentially Inappropriate Medicines criteria. Medications of concern were defined according to National Comprehensive Cancer Network criteria. Factors associated with the use of PIMs and medications of concern were identified using multiple logistic regression. The degree of agreement between the 3 criteria sets was measured using Cohen's kappa coefficient.
RESULTS: The frequency of PIM use was 52.29% according to American Geriatric Society Beers criteria, 62.74% according to Brazilian Consensus criteria, and 65.36% according to PRISCUS criteria, while 52.29% of the patients were using medications of concern. Agreement between American Geriatric Society Beers, PRISCUS, and Brazilian Consensus criteria was high, while it was excellent between Brazilian Consensus and PRISCUS criteria. In the final logistic regression model, polypharmacy was associated with PIM use according to each criteria set, as well as the use of medications of concern.
CONCLUSIONS: The frequency of PIMs and medications of concern was high. Agreement about PIM use between the American Geriatric Society Beers, Brazilian Consensus, and PRISCUS criteria was high or excellent. There was an independent association between polypharmacy and the use of PIMs and medications of concern by older patients with multiple myeloma.</p
Obesity versus underweight: the prognostic impact of body mass phenotypes in hospitalized older patients
No full textOBJECTIVE: To compare the frequency of underweight and obesity among previously hospitalized older adults and analyze their association with malnutrition, sarcopenia, frailty, inflammatory markers, and adverse outcomes both during hospitalization and after discharge.
METHODS: This secondary analysis of a prospective study, conducted at Hospital das Clínicas da Universidade Federal de Pernambuco, Brazil, included hospitalized older patients (age ≥ 60 y). Nutritional status, body composition, sarcopenia, frailty, and outcomes were assessed. Cox regression was performed to evaluate the impact of the body mass phenotypes on clinical outcomes.
RESULTS: This secondary analysis included one hundred patients. The prevalence of obesity was 22.10%, while that of underweight was 34.60%. Individuals with underweight had a higher frequency of weaker immune response, worse inflammatory profile, higher nutritional risk, higher frequency of sarcopenia and malnutrition, longer hospital stay, and a higher incidence of mortality when compared to those with obesity. Being underweight was independently associated with higher mortality rates, even after adjustment for age, sex, muscle mass, malnutrition, and diagnosis of malignancy [adjusted HR = 2.82 (95% confidence interval 1.03– 7.72), p = 0.044].
CONCLUSION: The underweight phenotype represented a worst-case scenario in hospitalized older patients. </p
Physical activity, protein consumption, and loss of muscle mass in older adult participants of the ELSA-Brazil study
No full textOBJECTIVE: The objective was to evaluate the relationship between protein consumption, physical activity, and muscle mass in individuals aged ≥ 60 years.
METHODS: This prospective study was based on the baseline and second wave of the ELSA-Brazil study. Protein consumption was assessed using a semiquantitative food frequency questionnaire. Physical activity was measured using the International Physical Activity Questionnaire. Muscle mass was estimated using a prediction equation, and the difference in MM between the first and second waves was calculated. Bivariate analyses were performed, with p < 0.05 considered significant. Multivariate analysis consisted of 4 Poisson regression models including covariates with p < 0.20. The statistical analysis was performed in IBM SPSS Statistics 21.
RESULTS: The sample included 2216 older adults, 55.10% of whom were women, with a mean age of 65.20 (SD, 4.15). Participants whose muscle mass decreased between the waves were in the first quartile of protein consumption. Mean physical activity significantly differed between the groups, while leisure-time physical activity differed only for women (p < 0.05). After adjusting for sociodemographic, health, and lifestyle variables, participants with lower protein intake had a 1.45 (1.29–1.63) relative risk of muscle mass loss.
CONCLUSIONS: Lower protein consumption and higher physical activity were associated with decreased muscle mass, and those with protein consumption in the first and second quartiles are at higher risk of muscle mass loss.</p
Orienteering and hiking programs for older adults as a model of healthy aging: a randomized clinical trial
No full textOBJECTIVES: To compare the effects of orienteering vs hiking on the physical fitness and quality of life of older adults.
METHODS: A 24-week randomized controlled trial was conducted with 96 participants who were assigned to orienteering (OG), hiking (HG), or a control group (CG) with no intervention. Physical fitness was assessed with the handgrip strength, chair stand, 6-minute walk, sit-and-reach, and balance tests, with monitoring of blood pressure (BP) and resting heart rate. Generalized Estimating Equations were used for within- and between-group comparisons, with effect sizes (ES) calculated. Baseline and post-intervention differences were assessed using unpaired and paired tests.
RESULTS: Significant improvement in balance were observed, with OG reducing their time by -6.23 seconds (29.1%; ES = 0.83) and HG by -2.12 seconds (9.9%; ES = 0.49), p = 0.017. For paired effects, hemodynamic parameters showed a reduction in systolic (p = 0.014) and diastolic (p < 0.001) BP in the OG and in diastolic BP (p < 0.004) in the HG. Interaction effects were significant for all physical fitness and hemodynamic parameters compared with the CG (p < 0.001), with effect sizes ranging from medium to large. Quality of life significantly improved in the intervention groups (p < 0.001) compared with the CG (p = 0.571).
CONCLUSION: Older adults participating in orienteering and hiking experienced improvement in their physical fitness and quality of life, with orienteering showing a greater effect on balance. These activities are valuable for healthy aging programs, as sedentary behavior should be prevented.
This trial was registered at the Brazilian Clinical Trials Registry (REBEC): RBR-99jmmpf.</p
The ICOPE-WHO and the IVCF-20: a critical view of the <i>Handbook for Multidimensional Geriatric Assessment in Primary Care</i>
No full textRapid population aging is driving initiatives aimed at optimizing the health of older populations worldwide. In Brazil, the National Council of State Secretaries of Health (CONASS) recently published the Handbook for Multidimensional Geriatric Assessment in Primary Care, which proposes the combined, large-scale adoption of the World Health Organization (WHO) ICOPE screening tool and the Clinical-Functional Vulnerability Index-20 (IVCF-20) instrument to define care pathways for older people. Although there is a pressing need for initiatives of this nature, the proposed instruments have not yet been adequately validated in the Brazilian population, and their use for the purpose of establishing countrywide health guidelines appears hasty and risky. Therefore, we propose a broad, urgent debate among experts in the field with the aim of planning effective and safe public health policies for the Brazilian older population.</p
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