Rosângela Corrêa Dias

Cross-cultural adaptation and evaluation of the psychometric properties of the Falls Efficacy Scale-International Among Elderly Brazilians (FES-I-BRAZIL).

OBJECTIVES To culturally adapt the Falls Efficacy Scale-International (FES-I) and assess its psychometric properties in a sample of community-dwelling elderly Brazilians. METHODS The instrument was translated into Brazilian Portuguese and culturally adapted to the Brazilian population (FES-I-Brazil) as recommended by the Prevention of Falls Network Europe. FES-I-Brazil was applied to 163 elderly people (73.44+/-5.51 years), and the demographic data and history of falls were also collected. From this group, 58 participants were randomly distributed to evaluate reliability. The reliability was analyzed using the intraclass correlation coefficient (ICC) and the internal consistency, using Cronbachs alpha coefficient (alpha). The internal structure of FES-I-Brazil was evaluated by means of exploratory factor analysis. The logistic regression model was used to determine which tasks on the scale were more relevant for discriminating falls. To analyze the sensitivity and specificity of FES-I-Brazil, the receiver operating characteristic (ROC) curve was used. RESULTS The internal consistency of FES-I-Brazil was alpha=0.93, and the intra- and inter-examiner reliability were ICC=0.84 and 0.91, respectively. Factor analysis suggested two factors: concern about falling during social activities and activities of daily living (basic and instrumental), and postural control tasks. FES-I-Brazil scores > or = 23 suggested an association with a previous history of sporadic falls, whereas scores > or = 31 suggested an association with recurrent falls. CONCLUSIONS FES-I-Brazil was shown to be semantically, linguistically and psychometrically appropriate to evaluate the fear of falling in the community-dwelling Brazilian elderly population.

Physical therapy intervention (PTI) increases plasma brain-derived neurotrophic factor (BDNF) levels in non-frail and pre-frail elderly women

Biomarkers are important factors in the identification of the frail elderly (higher risk of developing disease) and in assessing the impact of PTI. On the other hand, BDNF has been related to neuroprotection in a series of central nervous system diseases in older age. The levels of BDNF in groups of elderly women classified according to Fried phenotype (non-frail and pre-frail) were compared. We assessed the impact of a PTI on BDNF levels. A convenience sample of 48 elderly women was randomly selected. The PTI group was composed by 20 elderly women selected from this group. Plasma neurotrophic factors, such as BDNF, glial-derived neutrophic factor (GDNF), and nerve growth factor (NGF) were measured by enzyme-linked immunosorbent assay (ELISA). Timed-up-and-go (TUG) test, hand-grip and work/body weight were evaluated before and after the intervention. Plasma concentrations of BDNF were significantly higher in non-frail in comparison to pre-frail elderly women. After the PTI, higher levels of BDNF were found in elderly women (before 351±68 pg/ml and after 593±79 pg/ml; p<0.001). Both groups had an increase in BDNF levels after the PTI. The low levels of BDNF in pre-frail elderly women suggest that this neurotrophic factor may be a key pathophysiological mediator in the syndrome of frailty. The fact that PTI increased BDNF levels in both groups suggests that it may be possible to modify this phenotype.

Estudo da relação entre função muscular, mobilidade funcional e nível de atividade física em idosos comunitários

OBJECTIVES to evaluate the relationship between lower extremity muscle function, calf circumference (CC), handgrip strength (HG), functional mobility and level of physical activity among age groups (65-69, 70-79, 80+) of older adults (men and women) and to identify the best parameter for screening muscle function loss in the elderly. METHODS 81 community-dwelling elderly (42 women and 39 men) participated. Walking speed (Multisprint Kit), HG (Jamar dynamometer), hip, knee and ankle muscle function (Biodex isokinetic dynamometer), level of physical activity (Human Activity Profile) and CC (tape measure) were evaluated. ANOVA, Pearson correlation and ROC curves were used for statistical analysis. RESULTS Dominant CC (34.9±3 vs 37.7±3.6), habitual (1.1±0.2 vs 1.2±0.2) and fast (1.4±0.3 vs 1.7±0.3) walking speed, HG (23.8±7.5 vs 31.8±10.3), average peak torque and average hip, knee and ankle power (p<0.05) were lower for the 80+ group than for the 65-69 year-olds. There were no differences in physical activity level among age groups. Moderate significant correlations were found between muscle function parameters, walking speed and HG; a fair degree of relationship was found between muscle function parameters, CC and level of physical activity (p<0.05). The ROC curve analysis suggested a cutoff point of 14.51 Kgf for screening muscle function loss in elderly women (p=0.03). CONCLUSIONS This study demonstrated an association between muscle function, HG and fast walking speed, a decrease in these parameters with age and the possibility of using HG to screen for muscle function of the lower extremities.

Characteristics associated with activity restriction induced by fear of falling in community-dwelling elderly

OBJECTIVES The aim of this study was to determine the social-demographic, clinical, functional and psychological factors associated to activity restriction due to fear of falling in community-dwelling elderly and identify which variables best discriminate groups of elderly with different levels of activity restriction and fear of falling. METHODS One hundred and thirteen community-dwelling elderly (74.5±7 years old) participated in the study. Activity restriction induced by fear of falling, previous falls, fall related self-efficacy, frailty phenotype, functional capacity, depressive symptoms, health self-perception, socio-demographic and clinical factors were assessed. Descriptive statistics, chi-square, ANOVA and Kruskal Wallis tests were used to analyze the associations between activity restriction due to fear of falling and all other variables. Path analysis (CHAID) method was used to verify which variables better discriminated groups in relation to activity restriction (α=0.05). RESULTS The participants who reported fear of falling and activity restriction demonstrated higher depression (p=0.038), lower fall related self-efficacy (p<0.001), lower gait velocity (p=0.043) and independence level for instrumental daily living activities (p=0.017), higher number of diseases (p=0.048), worse health self-perception (p=0.040) and more depressive symptom (p=0.023). The best variables to discriminate groups were depression (p=0.004), exhaustion (frailty phenotype) (p=0.010) and social participation activities (p=0.016). CONCLUSION Activity restriction due to fear of falling may have negative effects on functional capacity and psychological aspects in community-dwelling elderly. Psychosocial factors seem to better discriminate the elderly who avoid activities due to fear of falling.

Frailty syndrome and associated factors in community-dwelling elderly in Northeast Brazil

INTRODUCTION Frailty syndrome in the elderly, characterized by decreased physiological reserves, is associated with increased risk of disability and high vulnerability to morbidity and mortality. This study is part of a multicenter project on Frailty in Elderly Brazilians (REDE FIBRA). AIMS To investigate characteristics, prevalence and associated factors related to frailty. METHODOLOGY A total of 391 randomly selected elderly patients aged 65 years were interviewed. Data collection was performed using a multidimensional questionnaire containing information about sociodemographic and clinical variables. Frieds phenotype was used to characterize the frail elderly. Data were analyzed using descriptive statistics, bivariate analysis (χ(2)) and binary logistic regression. RESULTS The prevalence of frailty was 17.1%. In the final multivariate analysis model, the following factors associated with frailty were obtained: advanced chronological age (p<0.001), presence of comorbidity (p<0.035), dependence in basic (p<0.010) and instrumental (p<0.003) activities of daily living and negative perception of health status (p<0030). CONCLUSION The factors associated with frailty suggest a predictive model that helps in understanding the syndrome, guiding actions that minimize adverse effects in the aging process.

Step length appears to be a strong discriminant gait parameter for elderly females highly concerned about falls: a cross-sectional observational study

OBJECTIVE To determine if gait parameters and the Timed Up and Go test can discriminate between elderly females with high and low concern about falls. Knowledge of these parameters could help in the development of rehabilitation programmes focused on the prevention of falls, fear of falling and functional decline. DESIGN Cross-sectional, observational study. SETTING Human motion laboratory. PARTICIPANTS One hundred and fifty-four elderly females (aged 64 to 83 years), divided into two groups based on their Falls Efficacy Scale International score: high concern (n=81) and low concern (n=73) about falls. MAIN OUTCOME MEASURES Eight gait parameters recorded with the GAITRite system and the Timed Up and Go test score. RESULTS Factor 2 (composed of step length, gait velocity and Timed Up and Go mobility test) explained 20% of the variability of the data and was the only factor to discriminate between the groups, with 63% correct classifications. Step length proved to be the variable with the greatest discriminant ability, with a much higher discriminant coefficient (0.889) than the Timed Up and Go test (-0.369) and gait velocity (-0.268). CONCLUSIONS High concern about falls is primarily associated with decreased step length. Step length could be used as a screening tool to identify elderly women with low and high concern about falls in order to target these groups in a rehabilitation programme aimed to slow reduction in gait velocity and mobility.

Relação entre intensidade de dor e capacidade funcional em indivíduos obesos com osteoartrite de joelho

BACKGROUND: Knee osteoarthritis is a chronic disease that affects joint cartilage, causing bone structure alterations, pain and stiffness during movement. Obesity is one of its principal risk factors. Complaints about functional disability are frequent, especially for locomotion activities, which people with knee osteoarthritis perform slower. With the increasing levels of obesity in Brazil, it is important to understand how knee osteoarthritis affects human functional capacity, in order to devise treatment and prevention measures. OBJECTIVE: To examine the influence of pain intensity, radiographic severity, obesity level and symptom duration on the functional capacity of obese individuals with knee osteoarthritis. METHOD: Pain intensity was measured using the Western Ontario and McMaster Universities Index (WOMAC) questionnaire and during functional capacity tests. Radiographic severity was analyzed using the Kellgren-Lawrence classification and the obesity level was assessed using body mass index (BMI). Four functional velocity tests were performed: usual gait, fast gait, ascending stairs and descending stairs. RESULTS: The sample consisted of 31 women and 4 men, with mean age of 51.65 ± 10.72 years and BMI of 41.16 ± 8.37 kg/m2. The greatest intensity of pain was reported during stair activities. Only pain intensity presented significant correlations with the results from the velocity tests. CONCLUSION: Pain intensity is a factor that influences functional activity performance among obese individuals with knee osteoarthritis. Further studies are necessary for identifying the determining factors for functional capacity in such populations.

Prevalência de fragilidade e fatores associados em idosos comunitários de Belo Horizonte, Minas Gerais, Brasil: dados do estudo FIBRA

The prevalence of frailty varies greatly and has received insufficient attention in developing countries. This study aimed to identify the prevalence of frailty and associated factors among the elderly in Belo Horizonte, Minas Gerais State, Brazil. Clinical, functional, and socio-demographic factors were analyzed. An ordinal regression model was used to verify conditions associated with frailty and to determine odds ratios ( α= 0.05). Prevalence rates were 46.3% for pre-frailty was 8.7% for weakness. Pre-frail and frail elderly, respectively, showed higher and increasing odds ratios for dependency in instrumental activities of daily living; restrictions in advanced activities of daily living; use of walking aids; comorbidities; falls; depressive symptoms; lower self-efficacy in preventing falls; hospitalization; and advanced age. The study identified a high percentage of frail states associated with higher odds of adverse health conditions, especially related to disability.The prevalence of frailty varies greatly and has received insufficient attention in developing countries. This study aimed to identify the prevalence of frailty and associated factors among the elderly in Belo Horizonte, Minas Gerais State, Brazil. Clinical, functional, and socio-demographic factors were analyzed. An ordinal regression model was used to verify conditions associated with frailty and to determine odds ratios ( α= 0.05). Prevalence rates were 46.3% for pre-frailty was 8.7% for weakness. Pre-frail and frail elderly, respectively, showed higher and increasing odds ratios for dependency in instrumental activities of daily living; restrictions in advanced activities of daily living; use of walking aids; comorbidities; falls; depressive symptoms; lower self-efficacy in preventing falls; hospitalization; and advanced age. The study identified a high percentage of frail states associated with higher odds of adverse health conditions, especially related to disability.

Correlation between manual muscle strength and interleukin-6 (IL-6) plasma levels in elderly community-dwelling women

Sarcopenia is a loss of muscle mass related to aging and leads to muscle performance decline. An increase in inflammatory mediator levels, especially of IL-6, has been associated to reduced muscle strength in the elderly. The aim of the present cross-sectional study was to correlate IL-6 plasma levels with manual muscle strength (MMS) in 63 community-dwelling elderly women. (71.2+/-7.4years). IL-6 was measured using enzyme-linked immunosorbent assay (ELISA) and MMS was measured using the JAMAR dynamometer. Pearsons test was used to explore the relationship between the outcomes at the significance level of alpha=0.05. IL-6 levels (2.56+/-3.44pg/ml) and MMS (22.86+/-4.62kgf) exhibited an inverse correlation (r=-0.2673 and p=0.0373). The increase in IL-6 plasma levels possibly contributed toward the reduction in manual muscle strength among the elderly women studied.

QUALIDADE DE VIDA NA PERSPECTIVA DE IDOSAS COM INCONTINÊNCIA URINÁRIA

Quality of life from the perspective of elderly women with urinary incontinence Background: Urinary incontinence (UI) is a common clinical condition among elderly people and may interfere with quality of life (QOL). For this reason, assessing its repercussions becomes important. Objective: To ascertain how elderly women undergoing physical therapy for UI perceived their current QOL. Method: This was a qualitative study that investigated QOL from the perspective of twelve elderly women aged 60 years and over, by means of individual semistructured interviews. The sample size was determined by saturation. The interviews were recorded, transcribed and then analyzed using the content analysis technique. Results: QOL was correlated with health, autonomy, personal relationships, financial stability and active life. Psychological impairment was associated with concern and disgust regarding urine loss and fear that this might occur in inappropriate places. Embarrassment because other people had noticed the smell of urine, and previous experience of similar embarrassing situations, was associated with social impairment. Conclusion: Content analysis on the interviews allowed the conclusion that, even though UI was present in these elderly women’s lives and caused psychological and social harm, they had a positive perception of their QOL.