Carmen Lucía Curcio

Activity Restriction Related to Fear of Falling Among Older People in the Colombian Andes Mountains Are Functional or Psychosocial Risk Factors More Important

Objective: This study examines the associations between activity restriction related to fear of falling and sociodemographic and health factors among people aged 60 and older living in the Colombian Andes mountains. Method: The sample includes 1,668 community-living participants. Outcomes included no fear of falling, fear of falling alone, or activity restriction related to fear of falling. Results: Fear of falling was reported by 83.3%, and of these 52.2% reported activity restriction. Independent factors for activity restriction (vs. fear of falling alone) were low income, functional difficulty, falling or decreasing physical activity, polypharmacy, poor self-perceived health, and depression. Discussion: The prevalence of overall fear of falling and related activity restriction was surprisingly high because this is a physically active population. Participants with activity restriction related to fear of falling have decreased physical activity or functional status, poor self-perceived health, and worse depressive symptoms than those who have fear of falling alone.

Phenotype of Osteosarcopenia in Older Individuals With a History of Falling

OBJECTIVES In older persons, the combination of osteopenia/osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of institutionalization, falls, and fractures. However, the particular clinical, biochemical, and functional characteristics of the osteosarcopenic (OS) patients remain unknown. In this study, we used a clinical definition of osteosarcopenia aiming to determine the clinical, functional, and biochemical features that are unique to these patients within a population of older people who fall. DESIGN Cross-sectional study. SETTING Falls and Fractures Clinic, Nepean Hospital (Penrith, NSW, Australia). PARTICIPANTS A total of 680 people (mean age = 79, 65% women) assessed between 2009 and 2013. MEASUREMENTS Assessment included medical history, physical examination, bone densitometry and body composition by dual-energy X-ray absorptiometry, posturography, grip strength, gait parameters (GaitRITE), and blood tests for nutrition and secondary causes of sarcopenia and osteoporosis. Patients were divided into 4 groups: (1) osteopenic (BMD <-1.0 SD), (2) sarcopenic, (3) OS, and (4) nonsarcopenic/nonosteopenic. Difference between groups was assessed with 1-way ANOVA and χ(2) analysis. Multivariable linear regression evaluated the association between the groups and measures of physical function. Multivariable logistic regression evaluated risk factors for being in the OS group. RESULTS Mean age of the OS patients was 80.4 ± 7.0 years. Our analyses showed that OS patients are older, mostly women, are at high risk for depression and malnutrition, have body mass index lower than 25, and showed a higher prevalence of peptic disease, inflammatory arthritis, maternal hip fracture, history of atraumatic fracture, and impaired mobility. CONCLUSION We have reported a set of characteristics that are highly prevalent in OS patients. This study could be used to inform the design of future trials and to develop interventions to prevent institutionalization and poor outcomes in this particular set of high-risk patients.

Comprehensive nutritional status in sarco-osteoporotic older fallers

ObjectivesIn older persons, the combination of osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of falls and fractures. However, the particular nutritional status of the sarco-osteoporotic (SOP) patients remains unknown. The goal of this study was to obtain a comprehensive picture of nutritional status in SOP patients.DesignCross-sectional study.SettingFalls & Fractures Clinic, Nepean Hospital (Penrith, Australia).Participants680 subjects (mean age=79, 65% female) assessed between 2008–2013.MeasurementsAssessment included medical history, mini-nutritional assessment, physical examination, bone densitometry and body composition by DXA, and blood tests for nutritional status (albumin, creatinine, hemoglobin, vitamin D, vitamin B-12, calcium, phosphate and folate). Patients were divided in 4 groups: 1) osteopenia/osteoporosis (BMD<−1.0 SD); 2) sarcopenia; 3) SOP; and 4) normal (no sarcopenia/no osteoporosis). Difference between groups was assessed with one-way ANOVA and chi square analysis. Multivariable linear regression evaluated the association between the groups and measures of nutritional parameters.ResultsSarcopenia was present in 47.4% of those with osteopenia (167/352) and 62.7% in those with osteoporosis (91/145). Mean age of the SOP was 80.4±7 years. SOP patients showed significantly higher prevalence of falls and fractures. Univariate analyses showed that SOP were more likely than normal to have a BMI< 25 (OR 2.42 95%CI 1.45–4.041, p<0.001), a MNA score <12 (OR 2.0, 95%CI 1.15–3.49, p<0.05), serum folate <20 nmol/L (OR 4.0 95%CI 1.35–11.87, p<0.01) and hemoglobin <120g/L (OR 2.0 95%CI 1.28–3.30, p<0.01). Multivariate analysis showed that a MNA score <12 was independently associated with SOP compared to normal when adjusted for age and gender. Hemoglobin <120g/L, BMI <25, and GDS >6 remained independently associated with SOP after adjustment for all variables including inflammatory conditions. Hypoalbuminemia (<35 g/L) was associated with just osteopenia/osteoporosis (OR: 2.03, 95%CI 1.08–3.81, p<0.01) and just sarcopenia (OR: 1.77, 95%CI 1.0–3.0, p<0.01) compared to normal. No differences in vitamin D, glomerular filtration rate, albumin, corrected calcium, phosphate, red blood cells folate or vitamin B12 levels were found between the subgroups.ConclusionsIn approaching SOP patients, early prevention protocols directed to optimize their nutritional status would be a key strategy to prevent poor outcomes such as falls and fractures in this high risk population. Therefore, nutritional assessment and early nutritional supplementation should be essential domains in this strategy.

Sources of social support associated with health and quality of life: a cross-sectional study among Canadian and Latin American older adults.

Objectives To examine whether the association between emotional support and indicators of health and quality of life differs between Canadian and Latin American older adults. Design Cross-sectional analysis of the International Mobility in Aging Study (IMIAS). Social support from friends, family members, children and partner was measured with a previously validated social network and support scale (IMIAS-SNSS). Low social support was defined as ranking in the lowest site-specific quartile. Prevalence ratios (PR) of good health, depression and good quality of life were estimated with Poisson regression models, adjusting for age, gender, education, income and disability in activities of daily living. Setting Kingston and Saint-Hyacinthe in Canada, Manizales in Colombia and Natal in Brazil. Participants 1600 community-dwelling adults aged 65–74 years, n=400 at each site. Outcome measures Likert scale question on self-rated health, Center for Epidemiological Studies Depression Scale and 10-point analogical quality-of-life (QoL) scale. Results Relationships between social support and study outcomes differed between Canadian and Latin American older adults. Among Canadians, those without a partner had a lower prevalence of good health (PR=0.90; 95% CI 0.82 to 0.98), and those with high support from friends had a higher prevalence of good health (PR=1.09; 95% CI 1.01 to 1.18). Among Latin Americans, depression was lower among those with high levels of support from family (PR=0.63; 95% CI 0.48 to 0.83), children (PR=0.60; 95% CI 0.45 to 0.80) and partner (PR=0.57; 95% CI 0.31 to 0.77); good QoL was associated with high levels of support from children (PR=1.54; 95% CI 1.20 to 1.99) and partner (PR=1.31; 95% CI 1.03 to 1.67). Conclusions Among older adults, different sources of support were relevant to health across societies. Support from friends and having a partner were related to good health in Canada, whereas in Latin America, support from family, children and partner were associated with less depression and better QoL.

Socioeconomic status, social relations and domestic violence (DV) against elderly people in Canada, Albania, Colombia and Brazil

PURPOSE To determine whether gender, socioeconomic conditions, and/or social relations are related to recent experiences of DV in older adult populations. MATERIALS AND METHODS Data on socioeconomic status and social relations were collected in 2012 from 1995 community-dwelling older adults in Canada, Colombia, Brazil, and Albania. Violence experienced in the last 6 months was measured using the Hurt, Insulted, Threatened with harm, or Screamed at (HITS) scale and classified according to type (physical or psychological) and perpetrator (partner or family member). Binary logistic regression analyses were used to assess associations between experiences of violence and gender, socioeconomic conditions, and social relations. RESULTS Physical violence (by partner or family member) was reported by 0.63-0.85% of participants; the prevalence of psychological violence (by partner or family member) ranged from 3.2% to 23.5% in men and 9% to 26% in women. After adjustment for socioeconomic status, social relations, age and site, women experienced more psychological violence perpetrated by family members than did men (odds ratio (OR): 1.8; 95% CI: 1.2-2.6). Social relations, such as multifamily living arrangements and low levels of support from partners, children, and family, were associated with psychological DV. Current working status was associated with greater odds of victimization by partners among men (OR: 2.35 95% CI: 1.34-1.41), but not among women. CONCLUSIONS Gender and social relations are important determinants of experiencing violence in older adults. The findings of this study demonstrate the importance of a gender-based approach to the study of DV in older adults.

Validez y fiabilidad de la escala de Braden para predecir riesgo de úlceras por presión en ancianos1

Objetivo Determinar la validez predictiva y la fiabilidad de la escala de Braden para predecir el riesgo de ulceras por presion (UP) en ancianos en una institucion de referencia de tercer nivel de atencion. DiseNo Estudio de cohorte. Material y mEtodos Se tomaron los 831 pacientes sin UP al ingreso, mayores de 60 anos, hospitalizados al menos durante 72 horas en el Hospital de Caldas durante un ano, septiembre 1988-1999. Las variables demograficas y el diagnostico primario al ingreso a las salas de hospitalizacion se tomaron de la historia clinica. Se clasifico el tipo de piel, se valoro el estado funcional mediante la escala de Barthel. La version original en ingles de la escala de Braden se tradujo al espanol y se aplico a las 72 horas del ingreso y cada semana hasta tres semanas, evaluando de forma simultanea el desarrollo de UP, las cuales se estadificaron de I a IV. La sensibilidad, la especificidad, el Valor Predictivo Positivo (VPP) y el Valor Predictivo Negativo (VPN) fueron calculados para los diferentes puntajes de la Escala de Braden en las cuatro aplicaciones o hasta la evaluacion anterior a la deteccion de la primera UP. Resultados El promedio de edad fue 71,9 (DE 8), 57% eran hombres y 96,9% procedian del hogar. El puntaje en la escala de Barthel oscilo entre 0 y 100 con una media de 46,9. En cuanto a los diagnosticos al ingreso las enfermedades cardiovasculares, osteomusculares, gastrointestinales y neurologicas fueron en su orden las patologias mas frecuentes. El 8,04% de los sujetos estudiados desarrollaron UP durante el estudio, 71,6% la desarrollaron durante la primera semana, 20,8% en la segunda y 7,5% en la tercera semana. Se presentaron principalmente en sacro y en estados I y II. El rango de los puntajes en la Escala de Braden oscilo entre 6 y 23. El percentil 25 en todas las evaluaciones estuvo entre 15 y 16 puntos, y el percentil 75 en 21. Las variaciones de los puntajes entre las tres evaluaciones fueron minimas. Las Curvas Operantes de Receptor (COR) derivadas de los datos muestran que un puntaje de 16 produce un punto de corte optimo donde simultaneamente se maximiza la sensibilidad a 85,4% y la especificidad a 63,2% con un VPP de 12,5 en ese punto y un VPN de 98,6. Conclusiones Este estudio permite concluir que en ancianos hospitalizados la escala de Braden para predecir riesgo de UP es confiable y valida, con un punto de corte de 16. Ademas sugiere que se deben tener en cuenta otros factores que afectan su validez como la edad y el estado funcional.

Fear of falling and its association with life-space mobility of older adults: a cross-sectional analysis using data from five international sites

Background fear of falling (FOF) is a major health concern among community-dwelling older adults that could restrict mobility. Objective to examine the association of FOF with life-space mobility (i.e. the spatial area a person moves through in daily life) of community-dwelling older adults from five diverse sites. Methods in total, 1,841 older adults (65-74 years) were recruited from Kingston, Canada; Saint-Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia and Natal, Brazil. FOF was assessed using the Fall Efficacy Scale-International (FES-I total score), and the life space was quantified using the Life-Space Assessment (LSA), a scale that runs from 0 (minimum life space) to 120 (maximum life space). Results the overall average LSA total score was 68.7 (SD: 21.2). Multiple-linear regression analysis demonstrated a significant relationship of FOF with life-space mobility, even after adjusting for functional, clinical and sociodemographic confounders (B = -0.15, 95% confidence interval (CI) -0.26 to -0.04). The FOF × site interaction term was significant with a stronger linear relationship found in the Canadian sites and Tirana compared with the South American sites. After adjusting for all confounders, the association between FOF with LSA remained significant at Kingston (B = -0.32, 95% CI -0.62 to -0.01), Saint-Hyacinthe (B = -0.81, 95% CI -1.31 to -0.32) and Tirana (B = -0.57, 95% CI -0.89 to -0.24). Conclusion FOF is an important psychological factor that is associated with reduction in life space of older adults in different social and cultural contexts, and the strength of this association is site specific. Addressing FOF among older adults would help improve their mobility in local communities, which in turn would improve social participation and health-related quality of life.

Phenotype of sarcopenic obesity in older individuals with a history of falling

BACKGROUND Although sarcopenic obesity is associated with disability in middle-aged community-dwelling individuals, the phenotype of sarcopenic obesity in people 65 and older, especially those with a history of falls, remain unknown. To fill this knowledge gap, the goal of this study was to obtain a comprehensive phenotype of sarcopenic obesity in this high-risk population. METHODS Cross-sectional study of 680 subjects (mean age=79±9, 65% female) assessed between 2009 and 2013 at the Falls and Fractures Clinic, Nepean Hospital (Penrith, Australia). The assessment included a comprehensive examination, posturography, gait velocity, grip strength, bone densitometry and body composition by DXA, and blood tests for biochemical status. Patients were divided into four groups based on DXA and clinical criteria: 1) sarcopenic obese; 2) non-sarcopenic obese; 3) sarcopenic and; 4) non-sarcopenic/non-obese. The difference between groups was assessed by one-way ANOVA, chi-square analysis, and multivariable linear regression. RESULTS Sarcopenic obese subjects were older (81.1±7.3), mostly female and more likely to have lower bone mineral density, lower grip strength, slower gait velocity, and poor balance. Sarcopenic obese individuals also showed significantly higher parathyroid hormone and lower vitamin D. CONCLUSIONS We identified a particular set of clinical and biochemical characteristics in our subgroup of sarcopenic obese older fallers. Identification of these particular characteristics in the clinical setting is essential in order to prevent poor outcomes in this high-risk population.

Validity and applicability of a video-based animated tool to assess mobility in elderly Latin American populations

To assess the reliability and the validity of Portuguese‐ and Spanish‐translated versions of the video‐based short‐form Mobility Assessment Tool in assessing self‐reported mobility, and to provide evidence for the applicability of these videos in elderly Latin American populations as a complement to physical performance measures.

Experiences of violence across life course and its effects on mobility among participants in the International Mobility in Aging Study

Background Life course exposure to violence may lead to disability in old age. We examine associations and pathways between life course violence and mobility disability in older participants of the International Mobility in Aging Study (IMIAS). Methods A cross-sectional study using IMIAS 2012 baseline. Men and women aged 65–74 years were recruited at 5 cities (n=1995): Kingston and Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Mobility was assessed by the Short Physical Performance Battery (SPPB) and by 2 questions on difficulty in walking and climbing stairs. Childhood physical abuse history and the HITS instrument were used to gather information on childhood exposure to violence and violence by intimate partners or family members. Multivariate logistic regression and mediation analysis models were constructed to explore the significance of direct and indirect effects of violence on mobility. Interaction effects of gender on violence and on each of the mediators were tested. Results Experiences of physical violence at any point of life were associated with mobility disability (defined as SPPB<8 or limitation in walking/climbing stairs) while psychological violence was not. Chronic conditions, C reactive protein, physical activity and depression mediated the effect of childhood exposure to violence on both mobility outcomes. Chronic conditions and depression were pathways between family and partner violence and both mobility outcomes. Physical activity was a significant pathway linking family violence to mobility. Gender interactions were not significant. Conclusions Our results provide evidence for the detrimental effects of life course exposure to violence on mobility in later life.