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Effect of strength, aerobic, and concurrent training on the memory of cognitively preserved older adults: a randomized clinical trial protocol
No full textOBJECTIVES: To verify the effect of strength, aerobic, and concurrent training on the memory of cognitively preserved older adults.
METHODS: A randomized controlled clinical trial will be conducted. Sedentary older adults (aged 60 to 75 years) of both genders will participate. Outcome measures will include blood biomarkers, cognitive tests, depressive symptoms, socioeconomic data, and physical assessments. Participants will be randomized into the following groups: strength training, aerobic training, concurrent training, or control. Interventions will be conducted for 12 weeks, with adherence to training sessions monitored. Pre-training values will be compared between groups using a one-way ANOVA test. Training effects will be evaluated through two-way ANOVA (time × group). The research protocol was registered in The Brazilian Registry of Clinical Trials (ReBEC) (RBR-655vxdd).
EXPECTED RESULTS: We believe that concurrent training may yield greater efficacy in improving memory outcomes, combining the benefit of both training modalities.
RELEVANCE: Considering the increase in population aging and that few studies have evaluated the chronic effect of physical exercise on the memory of cognitively preserved older adults, this is a relevant topic, since much of the literature has focused on investigating older adults with some cognitive decline. Furthermore, our aim is to provide an alternative training option by combining the benefits of aerobic and strength training, thereby optimizing time and enhancing both physical capacity and memory.</p
Adaptation and reliability of tests of functional mobility and muscle strength using telehealth for older people with dementia
No full textOBJECTIVE: Adapt functional mobility and muscle strength tests for older people with dementia to be performed remotely in the home environment; determine intra-rater and inter-rater reliability of functional mobility and strength tests for older people with dementia; and correlate the performance on the physical tests executed remotely and the Timed Up and Go (TUG) test, which was validated remotely in healthy older people.
METHODS: We included 43 people with dementia. The Short Physical Performance Battery (SPPB), TUG, TUG Dual Task (TUG-DT), and 30-Second Sit-to-Stand Test (SST30s) were performed through videocalls. Test performance was documented to facilitate the subsequent determination of inter- and intra-rater reliability. The intra-rater reliability was determined at a 2-week interval from the real-time videocall to analysis of the recording.
RESULTS: Intra-rater reliability ranged from good to excellent for all tests performed (ICC 0.862–1.000). Inter-rater reliability values were fair for gait speed (ICC = 0.223), moderate for some of the SPPB items (ICC = 0.706–0.801), good for the SPPB two-foot balance (ICC = 0.860) and the SPPB total score (ICC = 0.831), and excellent for the rest of the tests.
CONCLUSION: Functional mobility and muscle strength tests proved reliable and feasible for remote, at-home assessments of older people with dementia when assisted by their respective caregivers, providing an additional alternative for assessment of this patient population.</p
Antimicrobial use in long-term care facilities: the participation of nurses
No full textObjective: To identify how antimicrobials are prescribed in long-term care facilities from the perspective of nurses.
Methods: This descriptive study was conducted using an online survey. Participants were selected through conventional sampling methods and online recruitment. Data were collected through a 2-section self-administered questionnaire: the first section characterized the respondent and the institution, while the second investigated the antimicrobial prescription and usage in the institution.
Results: Thirty-five responses were received, representing institutions from every state in Brazil. Sixty percent of the institutions had a part-time physician. More than 90% of the respondents said they contacted a prescriber to report signs and symptoms suggestive of infection, which led to subsequent antimicrobial use.
Conclusions: The opinion of nurses has a significant impact on the prescriber's decision to begin antibiotic therapy in long-term care facilities, which indicates that nurses need training about the rational use of antimicrobials.</p
Finding purpose in life: the way of the masters’ athletes
No full textIncreasing longevity poses major challenges for society and older persons, highlighting the importance of identifying factors that promote healthy aging and the maintenance of functional abilities. Among these factors, psychological well-being – particularly purpose in life – is crucial. Purpose in life (PL) is associated with a positive worldview and emotional well-being. The literature suggests that the perception of higher PL can act as a protective factor against conditions such as stress and depression, motivating older individuals to take better care of their physical and mental health. Furthermore, involvement in sports, especially among masters’ athletes, not only promotes physical health but also strengthens a sense of community and purpose. For these individuals, sport is not just a form of physical exercise, but a continuous source of challenges, social connection, and inspiration. Thus, discovering and cultivating purpose in older age not only improves individual quality of life, but also inspires others to adopt active and meaningful lifestyles, challenging conventional expectations of aging. </p
The effect of dyskinesia on postural control, balance, gait, and fall risk in people with Parkinson’s disease: a systematic review protocol
No full textDyskinesia affects the limbs, trunk, and head and is more prevalent in people with Parkinson’s disease (PD) and a history of falls. More evidence about the effects of dyskinesia on postural control, balance, gait, and fall risk could help improve the quality of life of individuals with PD. This review aims to examine associations between dyskinesia and postural control, balance, gait, and fall risk in individuals with PD. Such information could lead to new approaches to quality of life improvement among individuals with PD. PubMed, CINAHL, PsycInfo, Scopus, and SciELO will be searched for longitudinal, cohort, and case-control studies published in English or Portuguese in any year that investigated the association between dyskinesia and postural control, balance, gait, and fall risk in individuals with PD. Two reviewers will independently evaluate the titles, abstracts, and full texts according to PRISMA guidelines to select eligible studies for the review. Data on participants, dyskinesia, postural control, balance, gait, and fall risk will be extracted and summarized in tables. Two reviewers will independently assess the methodological quality of each study using the Newcastle Ottawa quality assessment scale. Meta-analysis will not be performed. The results of this systematic review will offer insight into the effects of dyskinesia on postural control, balance, gait, and fall risk. Such information could significantly contribute to informed decisions about early motor intervention in individuals with PD.</p
Cognitive impairment increases in older people living with HIV: a systematic review of cohort studies
No full textThe progressive increase in HIV infection among older adults requires constant research and monitoring, given that geriatric syndromes associated with HIV comorbidities have become an important public health problem. We reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and it has a central question: Is the incidence of cognitive impairment higher in older patients living with HIV than in their seronegative peers? The following databases were searched for this review: MEDLINE/PubMed, EMBASE, LILACS, Web of Science, and Scopus. The inclusion criteria were studies whose samples were ≥ 50% patients aged ≥ 50 years, with and without HIV, and a main outcome related to the incidence of cognitive impairment. Only cohort studies with follow-up lasting ≥ 24 months were considered. Three reviewers independently screened the documents for eligibility criteria, extracted the data, assessed the risk of bias (Newcastle-Ottawa Scale), and evaluated the quality of evidence. A narrative synthesis was prepared. In total, 10 798 trials were screened, 8884 were excluded, 14 were analyzed, and 5 were included in this review. Only 1 applied cognitive assessment tests; the rest used secondary data from the medical records. Most found that the incidence of cognitive disorders was higher among older people living with HIV, which highlights the need for public policies aimed at primary and secondary prevention strategies. Further research from other countries is still required. PROSPERO register (CRD42022321914).</p
Association between diet quality, nutritional status, and sarcopenia in people aged 80 years or older
No full textObjective: To investigate the association between diet quality, nutritional status, and sarcopenia in a sample of the oldest old.
Methods: Using a cross-sectional design, individuals aged ≥ 80 years were enrolled. To determine their energy and macronutrient intake, 24-hour dietary recall was used to calculate the Healthy Eating Index. Nutritional status was categorized based on Mini Nutritional Assessment (MNA) scores. Sarcopenia was diagnosed using both the 2010 and 2018 EWGSOP criteria. Electrical bioimpedance was used to calculate the muscle mass index. Muscle strength was measured through handgrip dynamometry, and muscle performance was determined with a 4-m gait speed test. To test the association between the HEI with sarcopenia, means of HEI scores were compared between sarcopenic and non-sarcopenic participants using indendent t-tests. Prevalence rate ratios were calculated using a Poisson Regression model with robust estimation of standard errors.
Results: The study population consisted of 119 participants, predominantly women (n = 67; 56.3%), with a mean age of 83.4 (SD, 3.0) years. The prevalence of sarcopenia varied significantly according to the classification criteria, being higher according to EWGSOP 2010 than EWGSOP 2018 criteria (46.7 vs. 17.6%), as expected. Female participants and those categorized as malnourished presented higher prevalence of sarcopenia. Nutrition quality, estimated by the Healthy Eating Index, was not associated with the outcome. Reduced total energy and high protein intake were independently associated with both sarcopenia and severe sarcopenia, regardless of the diagnostic criteria.
Conclusions: The Health Eating Index was not associated with sarcopenia in this sample of older adults ≥80 years. Sarcopenia prevalence, as defined by the EWGSOP 2018 criteria, was higher in those with MNA≤24 and with reduced daily total energy comsumption independently of age, sex and education attainment. Higher protein intake, oposed to expected, was indenpendently associated with sarcopenia, possibly due to protopathic bias. Large longitudinal studies are still required to investigate the relationship between nutrition quality and Sarcopenia in 80+ aged adults.</p
Quality improvement of the medication system in a long-term care facility: a hybrid effectiveness-implementation study
No full textOBJECTIVE: To describe the implementation of a quality improvement intervention for the medication system of a large not-for-profit long-term care facility (LTCF) and evaluate its effectiveness.
METHODS: A type 2 effectiveness-implementation hybrid longitudinal study was carried out. We first conducted a diagnosis of the existing medication system, which included the administration of a questionnaire to LTCF staff. Then, an individualized unit-dose dispensing system was implemented and the medication system’s flow was adjusted to the local reality. The effectiveness of the quality improvement intervention was assessed by comparing the following pre- and post-implementation factors: 1) time spent on each step of the medication system; 2) strengths and weaknesses observed.
RESULTS: The diagnosis demonstrated multiple points of failure in the medication system. However, the answers to the questionnaire ran counter to what was identified, indicating a lack of knowledge about patient safety. The quality improvement intervention was associated with the following improvements in the medication system: 1) reduction in the number of prescription transcriptions; 2) reduction of medication shortages; and 3) improvement of organization, dynamics, and traceability in distribution, preparation, and administration. An average reduction of 3 hours and 57 minutes in the time spent distributing, preparing, and administering medications was also identified.
CONCLUSIONS: The quality improvement intervention was effective, increased the providers’ available time, and improved the safety of medication use in the LTCF.</p
Enhancing older adults’ gait: a systematic review of multicomponent exercises for fall prevention
No full textPhysical capacity changes during the aging process and some of these changes are present in the daily lives of older people, such as decreased muscle mass, which can cause gait disorders and consequently increase the risk of falls. Age-related health issues contribute to a higher incidence of falls among older adults. This study investigated the effects of multicomponent physical exercise programs on the gait biomechanics of both fall-prone and non-fall-prone older adults. This systematic review was conducted according to the PRISMA guidelines and registered with PROSPERO (CRD42023442345). The research adhered to the PICO framework, and database search included PubMed, SciELO, Cochrane Library, Embase, Scopus, and Web of Science. Studies assessing the impact of multicomponent exercises on gait biomechanics in older adults were included. Of 949 articles identified, 6 met the inclusion criteria. These studies used various intervention models, including walking, combined aerobic and resistance training, and dance exercises using video games. The findings indicate that regular physical activity and muscle strength and flexibility enhancements can improve gait features, including speed, step length, and phases of foot-ground contact. Multicomponent exercises effectively enhanced gait biomechanics and reduced the risk of falls in older adults. Interventions combining aerobic and resistance training offer benefits to quality of life, highlighting the need for exercise programs tailored to diverse risk profiles. Future research should investigate longer-duration and more frequent interventions, as well as incorporate psychological components to promote healthy aging.</p
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