Lygia Paccini Lustosa

Influence of dual task and frailty on gait parameters of older community-dwelling individuals

Background: Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology. Objective: To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS. Method: The presence of frailty was verified by Frieds Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite(r) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearsons Correlation tests were administered. Results: The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p<0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001). Conclusions: Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population.

Fragilidade e funcionalidade entre idosos frequentadores de grupos de convivência em Belo Horizonte, MG

The aim was to evaluate the correlation between the frailty phenotype and capacity and functional performance in elders attending conviviality groups. The frailty phenotype was identified with the weight loss; decrease of gait speed; decrease of physical activity; decrease of manual force and exhaustion. The functional capacity was measured by Timed Up and Go (TUG) and functional performance by the Lawton index. The frailty profile was presented in frequencies and the association was assessed by Spearman correlation test (α = 5%). A hundred and seventeen elders participated of this study (70±7.3 yrs). Most participants were classified as pre-frail (51.3%). The mean of the TUG of not frail (NF) was 11.3 s (± 1.9), pre-frail (PF) was 12.7 s (± 3.4) and frail (FF) was 16.7 s (± 3.3). The mean score of Lawton index of NF was 29.8 (± 0.6), PF 28.4 (± 3.3) and FF 27.4 (± 2.8). The frailty phenotype was correlated with functional capacity and performance (TUG, p=0.001). Most participants of the activity groups were pre-frail, and the frail and pre-frail elders had the worst functional performance. This result confirms that the frailty syndrome compromises the functional capacity in the elderly.

Fraturas proximais do fêmur em idosos: qual o melhor tratamento?

The proximal fractures of the femur on the elderly represent a serious problem inside the public health context, because of the high economic costs needed for the treatment and its consequence, as the high taxes of morbidity and mortality. The goal of this study was to discuss, through a literature revision, which is the most indicated treatment for the proximal fractures of the femur, on the elderly. The researched data bases were MEDLINE, COCHRANE and PEDro. The inclusion criterions were published studies on the last seven years, only on the Portuguese, English and Spanish languages, accomplished on human beings, with no genre distinction and with ages above 60 years old, with methodology draw of clinic research, random clinical research and systematic revisions with and without meta-analyses. Seven articles were found and after the analysis, it can be affirmed that there is no specific treatment for the proximal fractures of the femur on the elderly. The normal treatment indicated in most of these fractures is chirurgic and it requires physiotherapy involvement for an adjusted rehabilitation. Despite of the difficulty to compare the studies, was observed that a team of health professionals seems to promote a more effective rehabilitation, beyond prevent complications.

ADAPTAÇÃO TRANSCULTURAL E CONFIABILIDADE DO ACTIVE AUSTRALIA QUESTIONNAIRE PARA IDOSOS

Introducao: A atividade fisica e um importante parâmetro a ser quantificado em idosos. Sao necessarios instrumentos de medida confiaveis para avaliar e elaborar metas de intervencoes terapeuticas efetivas e verificar a evolucao do paciente. Objetivo: Adaptar transculturalmente e determinar a confiabilidade teste-reteste e interexaminadores do Active Australia Questionnaire em idosos da comunidade. Metodos: A adaptacao transcultural foi realizada de acordo com os criterios propostos por Guillemin e Beaton, a saber, traducao, retrotraducao, sintese das traducoes, apresentacao ao comite de especialistas e aplicacao da versao pre-final para testar o questionario. Para a confiabilidade teste-reteste foi dado um intervalo de quatro horas para as coletas e um intervalo de seis horas para a analise interexaminador, apos o reteste. Foram consideradas as informacoes de atividade fisica nos ultimos sete dias. A caracterizacao da amostra foi feita pela analise descritiva. Para a analise da confiabilidade utilizou-se o coeficiente de correlacao intraclasse (CCI). Participaram do estudo 22 idosos (72,5 ± 5,3 anos) e com 7,6 ± 3,9 anos de escolaridade. Resultados: A confiabilidade teste-reteste foi CCI = 0,97 e interexaminadores CCI = 0,82. Conclusao: O instrumento mostrou-se semântica e linguisticamente adequado e confiavel, para avaliar o nivel de atividade fisica em idosos na comunidade.

Vulnerabilidade física de idosos na alta hospitalar

Vulnerability is the individual’s capacity to suffer damage in response to a stimulus. We identified physical vulnerability in older people in hospital discharge; the association of this condition with sociodemographic factors was verified, and we compared vulnerable with not-vulnerable individuals, as well as those referred or not to physical therapy during hospitalization. This was an exploratory study, and the sample consisted of 122 hospitalized older adults. Data were collected using a socio-clinical demographic questionnaire, the Mini-mental State Examination, the Geriatric Depression Scale and the Vulnerable Elders Survey-13. Spearman’s correlation test was used to identify the correlation between vulnerability and socio-clinical demographic data, and the Mann-Whitney test was used to compare vulnerable and not-vulnerable older adults, and those accompanied or not by physical therapy. The significance level was 5%. Vulnerability has been identified in 75.4% of older people. A significant correlation was found between vulnerability and age (r=0.52 p=0.01), length of hospital stay (r=0.25 p=0.01) and number of comorbidities (r=0.25 p=0.01), and a negative association between vulnerability and educational level (r=-0.20 p=0.02). Statistical differences were found between vulnerable and not-vulnerable elders, for age (p=0.01), comorbidities (p=0.01), length of stay (p=0.01), MMSE (p=0.01) and GDS (p=0.01); and among older adults accompanied or not by physical therapy, for vulnerability (p=0.04) and length of hospital stay (p=0.01). Most older adults were physically vulnerable in hospital discharge, being them older, presenting more comorbidities, longer hospitalization, cognitive decline and depressive symptoms. Those treated by physical therapy showed greater vulnerability and longer hospital stay.

Comparison of respiratory muscle strength between fragility subgroups in community elderly

A fragilidade e composta por um tripe constituido por: sarcopenia, disfuncao imunologica e desregulacao neuroendocrina. A sarcopenia e definida como uma diminuicao na forca e na potencia muscular, sendo que os musculos respiratorios tambem sao afetados. O objetivo foi comparar a forca muscular respiratoria (FMR) em idosas residentes na comunidade, classificadas como nao frageis (NF), pre-frageis (PF) e frageis (F) e correlacionar a FMR com a forca de preensao manual (FPM). O estudo foi do tipo transversal, com uma amostra de conveniencia composta por 106 idosas. As participantes foram classificadas quanto ao fenotipo de fragilidade. A FMR foi avaliada por meio da pressao inspiratoria maxima (PImax) e da pressao expiratoria maxima (PEmax). Foram encontradas diferencas significativas da FMR entre os grupos NF e F (PImax: p=0,001 e PEmax: p<0,001) e entre os grupos PF e F (PImax: p<0,001 e PEmax: p<0,001). Em relacao a FPM, foram observadas diferencas significativas entre todos os grupos (p<0,001). Houve correlacao entre FMR e FPM apenas no grupo fragil. Desta forma, a FPM pode ser importante na pratica clinica para diferenciar os subgrupos de fragilidade e identificar a perda de forca muscular, incluindo a perda da FMR.Correspondence to: Vanessa Amaral Mendonça – Rodovia MGT 367, km 583, 5000 – CEP: 39100-000 – Campus JK – Diamantina (MG), Brazil – E-mail: vaafisio@gmail.com Presentation: Apr. 2013 – Accepted for publication: Nov. 2013 – Financing source: none – Conflict of interests: nothing to declare – Presentation at a scientific event: SINTEGRA – 2012/ UFVJM, Diamantina (MG), Brazil – Approval at the Ethics Committee n. 056/11. ABSTRACT | The fragility consist in a tripod comprising: sarcopenia, immune dysregulation, and neuroendocrine dysfunction. Sarcopenia is defined as a decrease in strength and muscle power, so that the respiratory muscles are also affected. The aim was to compare respiratory muscle strength (RMS) in elderly community residents, classified as nonfrail (NF), pre frail (PF) and frail (F), and correlate RMS with the handgrip strength (HS). The study was cross-sectional, with a convenience sample of 106 elderly women. Participants were classified according to the phenotype of frailty. The RMS was assessed by maximal inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Significant differences were found in RMS between groups NF and F (MIP: p=0.001 and MEP: p<0.001) and between groups PF and F (MIP: p<0.001 and MEP: p<0.001). In relation to HS, significant differences were observed between all groups (p<0.001). There was correlation between HS and RMS only in the frail group. Thus, the HS may be important in the clinical evaluation to differentiate subgroups of fragility and identify the loss of muscle strength, including the loss of RMS.

Comparación de la fuerza muscular respiratoria entre los subgrupos de fragilidad en añosas de la comunidad

A fragilidade e composta por um tripe constituido por: sarcopenia, disfuncao imunologica e desregulacao neuroendocrina. A sarcopenia e definida como uma diminuicao na forca e na potencia muscular, sendo que os musculos respiratorios tambem sao afetados. O objetivo foi comparar a forca muscular respiratoria (FMR) em idosas residentes na comunidade, classificadas como nao frageis (NF), pre-frageis (PF) e frageis (F) e correlacionar a FMR com a forca de preensao manual (FPM). O estudo foi do tipo transversal, com uma amostra de conveniencia composta por 106 idosas. As participantes foram classificadas quanto ao fenotipo de fragilidade. A FMR foi avaliada por meio da pressao inspiratoria maxima (PImax) e da pressao expiratoria maxima (PEmax). Foram encontradas diferencas significativas da FMR entre os grupos NF e F (PImax: p=0,001 e PEmax: p<0,001) e entre os grupos PF e F (PImax: p<0,001 e PEmax: p<0,001). Em relacao a FPM, foram observadas diferencas significativas entre todos os grupos (p<0,001). Houve correlacao entre FMR e FPM apenas no grupo fragil. Desta forma, a FPM pode ser importante na pratica clinica para diferenciar os subgrupos de fragilidade e identificar a perda de forca muscular, incluindo a perda da FMR.Correspondence to: Vanessa Amaral Mendonça – Rodovia MGT 367, km 583, 5000 – CEP: 39100-000 – Campus JK – Diamantina (MG), Brazil – E-mail: vaafisio@gmail.com Presentation: Apr. 2013 – Accepted for publication: Nov. 2013 – Financing source: none – Conflict of interests: nothing to declare – Presentation at a scientific event: SINTEGRA – 2012/ UFVJM, Diamantina (MG), Brazil – Approval at the Ethics Committee n. 056/11. ABSTRACT | The fragility consist in a tripod comprising: sarcopenia, immune dysregulation, and neuroendocrine dysfunction. Sarcopenia is defined as a decrease in strength and muscle power, so that the respiratory muscles are also affected. The aim was to compare respiratory muscle strength (RMS) in elderly community residents, classified as nonfrail (NF), pre frail (PF) and frail (F), and correlate RMS with the handgrip strength (HS). The study was cross-sectional, with a convenience sample of 106 elderly women. Participants were classified according to the phenotype of frailty. The RMS was assessed by maximal inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Significant differences were found in RMS between groups NF and F (MIP: p=0.001 and MEP: p<0.001) and between groups PF and F (MIP: p<0.001 and MEP: p<0.001). In relation to HS, significant differences were observed between all groups (p<0.001). There was correlation between HS and RMS only in the frail group. Thus, the HS may be important in the clinical evaluation to differentiate subgroups of fragility and identify the loss of muscle strength, including the loss of RMS.

Comparação da força muscular respiratória entre os subgrupos de fragilidade em idosas da comunidade

A fragilidade e composta por um tripe constituido por: sarcopenia, disfuncao imunologica e desregulacao neuroendocrina. A sarcopenia e definida como uma diminuicao na forca e na potencia muscular, sendo que os musculos respiratorios tambem sao afetados. O objetivo foi comparar a forca muscular respiratoria (FMR) em idosas residentes na comunidade, classificadas como nao frageis (NF), pre-frageis (PF) e frageis (F) e correlacionar a FMR com a forca de preensao manual (FPM). O estudo foi do tipo transversal, com uma amostra de conveniencia composta por 106 idosas. As participantes foram classificadas quanto ao fenotipo de fragilidade. A FMR foi avaliada por meio da pressao inspiratoria maxima (PImax) e da pressao expiratoria maxima (PEmax). Foram encontradas diferencas significativas da FMR entre os grupos NF e F (PImax: p=0,001 e PEmax: p<0,001) e entre os grupos PF e F (PImax: p<0,001 e PEmax: p<0,001). Em relacao a FPM, foram observadas diferencas significativas entre todos os grupos (p<0,001). Houve correlacao entre FMR e FPM apenas no grupo fragil. Desta forma, a FPM pode ser importante na pratica clinica para diferenciar os subgrupos de fragilidade e identificar a perda de forca muscular, incluindo a perda da FMR.Correspondence to: Vanessa Amaral Mendonça – Rodovia MGT 367, km 583, 5000 – CEP: 39100-000 – Campus JK – Diamantina (MG), Brazil – E-mail: vaafisio@gmail.com Presentation: Apr. 2013 – Accepted for publication: Nov. 2013 – Financing source: none – Conflict of interests: nothing to declare – Presentation at a scientific event: SINTEGRA – 2012/ UFVJM, Diamantina (MG), Brazil – Approval at the Ethics Committee n. 056/11. ABSTRACT | The fragility consist in a tripod comprising: sarcopenia, immune dysregulation, and neuroendocrine dysfunction. Sarcopenia is defined as a decrease in strength and muscle power, so that the respiratory muscles are also affected. The aim was to compare respiratory muscle strength (RMS) in elderly community residents, classified as nonfrail (NF), pre frail (PF) and frail (F), and correlate RMS with the handgrip strength (HS). The study was cross-sectional, with a convenience sample of 106 elderly women. Participants were classified according to the phenotype of frailty. The RMS was assessed by maximal inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Significant differences were found in RMS between groups NF and F (MIP: p=0.001 and MEP: p<0.001) and between groups PF and F (MIP: p<0.001 and MEP: p<0.001). In relation to HS, significant differences were observed between all groups (p<0.001). There was correlation between HS and RMS only in the frail group. Thus, the HS may be important in the clinical evaluation to differentiate subgroups of fragility and identify the loss of muscle strength, including the loss of RMS.