Mariana Asmar Alencar

Força de preensão palmar em idosos com demência: estudo da confiabilidade

Background: Measuring instruments should have their scientific and clinical value evaluated in different populations. The handgrip strength test is widely used, however little has been investigated about its reliability when used in elderly with dementia and the right stage wich its use should be avoided. Objectives: To evaluate the test-retest reliability of the handgrip strength test in elderly with different ratings of dementia. Method: The cognitive function of 76 elderly subjects with dementia was measured, and the caregivers were interviewed to allow classification by the Clinical dementia rating (CDR). For these assessments the Mini-Metal State Examination and the Pfeffer, Lawton, and Katz scales were used. Twenty subjects were classified as borderline (83.4± 5.8 years), 19 as mild (82.4±6.8 years), 19 as moderate (85.8±5.6 years) and 18 as severe dementia (84.0±5.1 years). Handgrip strength was assessed with a JAMAR hydraulic dynamometer and after one week it was reevaluated. Reliability was analyzed by Intraclass Correlation Coefficient (ICC). The significance level was set at α=0.05. Results: Test-retest reliability was excellent for groups with borderline (ICC=0.975; p=0.001), mild (ICC=0.968; p=0.002), and moderate (ICC=0.964; p=0.001) dementia. The analysis of the group with a severe CDR showed no statistical significance and a low ICC (ICC=0.415; p=0.376). Conclusion: The handgrip strength test has excellent reliability when used in elderly with borderline, mild, and moderate dementia, which enables its use in research. However, its use is not recommended in elderly classified with severe dementia due to the measures low reliability and subsequent irrelevance in clinical practice.

Consequências das quedas em idosos vivendo na comunidade

The falls in the elderly are a frequent problem with significant physical, psychological and social consequences. The aim of this study was to make a systematic review about the consequences of falls in older people living in the community. The search was conducted between June and October 2008 in electronic databases Medline, Lilacs, PEDro and SciELO. Only articles in English, Portuguese and Spanish were considered for this review. It were found the following consequences: fractures, immobilization, soft-tissue injuries, contusions, sprains, wounds and abrasions, muscle and neurological injuries, occurrence of other diseases, pain, functional and physical activity decline, medical care, hospitalization, rehabilitation, fear of falling, restriction of activities, sadness, behavior change, feelings of powerlessness, decline in social activity, loss of autonomy and independence, change of home/environment, family rearrangement and death. Fractures and fear of falling were among the most cited consequences. The knowledge about physical, psychological and social consequences of falls in elderly people is important, because it will help to delineate preventive and rehabilitation strategies of these repercussions.

Perfil dos idosos residentes em uma instituição de longa permanência

OBJECTIVE: To describe the clinical and functional profile of elderly living in a long-term care institution. METHODS: 47 older adults living in a long-term care institution of Belo Horizonte/MG took part in the study. For a data collection were used a structured socio-demographic questionnaire, Mini Mental State Examination (MMSE), Geriatric Depression Scale(GDS), Katz Index and Timed Up and Go (TUG). A descriptive statistics were employed by using SPSS14.0. RESULTS: The mean age of the elderly was 73.0 years (±8.99). Most of the elderly was female (51.1%), single (46.8%) without children (51.1%) and with low education. The time of institutionalization ranged from one month to 25 years. The most frequent reason for institutionalization was with purpose of treatment (29.8%) and majority reported receiving visits (80.9%). The elderly took an average of 3.45 medications (±1.87). Only 12.8% reported at least one fall in the last six months and 80.9% reported being afraid of falling. About 38.3% do not use assistive walk device; 12.8% use wheelchair; 42.5%, walker; and 6.4%, cane. The MMSE scores were low, 93.3% were below the cutoff score for their schooling. At GDS, 59.6% were suggesting possible depression. TUG range from 0.10 to 1.58 minutes. Most elderly people reported being independent to perform the activities of Katz (bathing: 80.9%; dressing: 83.0%; toileting: 80.9%; transferring 87.2%; urination 59.6%; defecation: 61.7%; feeding 93.6%) and none reported complete dependence. CONCLUSION: The profile of institutionalized elderly is consistent with the literature on clinical and demographic variables. However, most patients reported being independent for basic activities of daily living, which represents a good opportunity for interventions that aim to prevent or minimize possible losses of function.

Atuação da fisioterapia na síndrome de fragilidade: revisão sistemática

Objective: To carry out a systematic review of the literature on physical therapy interventions and their effect on frail community-dwelling elders. Methods: Systematic review of studies published until June 2008 in the databases Medline, Embase, PEDro, SciELO, LILACS and Cochrane Library. We excluded studies with samples composed of institutionalized, hospitalized and non-frail participants, studies not aimed at treating frailty, and studies that were not specifically related to physical therapy. Results: In accordance with the exclusion criteria, out of the 152 Medline articles, only 15 were considered for analysis, out of the 71 PEDro articles only one was considered as the other ten had already been selected in Medline, and out of the 461 Embase articles only two that had not been selected in others databases were included in this study. A total of seven different types of interventions were verified: 1) muscle strengthening; 2) exercises for muscle strengthening, balance, coordination, flexibility, reaction time and aerobic training; 3) functional training; 4) physical therapy; 5) at-home physical therapy; 6) environment adaptation and prescription of assistive device; 7) water exercise. The results of some studies were contradictory even with similar interventions. The analyzed studies had different definitions for fragility, which made it difficult to compare the results. Conclusion: There is little evidence of the effect of physical therapy intervention on frail community-dwelling elders; thus, it is not possible to reach a consensus or conclusion on the effectiveness of the therapeutic regimens proposed for this complex syndrome.

Comparação da qualidade de vida entre idosos que participam e idosos que não participam de grupos de convivência na cidade de itabira-mg

With the increase in the number of elderly people in Brazil and abroad, the quality of life of elderly over 60 years is worrisome. So, a way that can help the elderly try to improve their quality of life is their participation in conviviality groups. Objective: The purpose of this study is to assess the quality of life and the presence of depressive disorder among elderly participants and non participants in conviviality groups. Methodology: The sample consisted of 30 elderly involved conviviality groups (66,73+5,82 years) and 30 elderly people who do not participate in a group of coexistence (66,70+5,70 years). To assess the quality of life questionnaire it was used the generic SF-36, and to trace the presence of depressive disorder, it was used the GDS. To check the normality between the groups, it was used the Shapiro-Wilk test. The test for independent samples t-Student and the Mann-Whitney U test were used to perform the comparison between groups. The level of significance was maintained at 0.05 for all tests. Results: It was found a statistically significant difference in the functional capacity, general health, vitality and social aspects. Conclusions: The results suggest that older people that participate in conviviality groups have a better quality of life and lower incidence of depression when compared to older people who do not participate in a senior conviviality group.

Qualidade de vida em idosos que praticam atividade física - uma revisão sistemática

OBJECTIVE: To conduct a systematic review of the literature regarding the impact of the practice of regular physical activity in the quality of life of elderly people. METHODS: A systematic review of studies published until September 2008, in the databases Medline, LILACS and SciELO. It were excluded studies that had cross design or that were reports of cases that evaluated the quality of life associated with a specific disease and those in which there were concurrent presence of another intervention. RESULTS: According to the inclusion criteria, of 391 articles found only three were part of the analysis. We identified three types of interventions: 1) warming exercises, aerobic training, muscle strengthening, coordination and cooling, 2) muscle strengthening exercises, functional training, 3) exercises in water. The results of these studies suggest that the quality of life seems to increase with physical activity (interventions 1 and 3), especially if it is held twice a week instead of just once. The benefits of strength training for muscle in quality of life was limited and no benefit from functional training in this outcome was found. CONCLUSION: The limited number of articles found, only a single study for each type of intervention, limits the conclusions of this review regarding the effectiveness of these interventions. It is therefore concluded that there is limited evidence about the benefits of the practice of physical activity on the quality of life of elderly people living in the community. It is suggested that more longitudinal studies with different types of interventions be conducted so that the conclusion about the efficacy of these interventions will be more robust.

Transitions in Frailty Status in Community-Dwelling Older Adults

This cohort examines transition rates between states of frailty over a 12-month period and evaluates the risk factors involved in such transitions. Frailty was defined as having 3 or more of the 5 criteria: weight loss, weakness, exhaustion, slow walking speed, and low physical activity. A total of 36.8% of the participants made transitions between states of frailty. History of cancer (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1-10.9), urinary incontinence (OR, 2.9; 95% CI, 1.3-6.1), and lower advanced activities of daily living (OR, 1/0.8; 95% CI, 0.6-0.9) were significant predictors of worsened frailty. Frailty is a dynamic process with transitions in both directions, worsening and improvement, even within such a short period.