Silvia Lanziotti Azevedo da Silva

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.

Prospective monitoring and self-report of previous falls among older women at high risk of falls and fractures: a study of comparison and agreement

Background: The identification of the occurrence of falls is an important step for screening and for rehabilitation processes for the elderly. The methods of monitoring these events are susceptible to recording biases, and the choice of the most accurate method remains challenging. Objectives: (i) To investigate the agreement between retrospective self-reporting and prospective monitoring of methods of recording falls, and (ii) to compare the retrospective self-reporting of falls and the prospective monitoring of falls and recurrent falls over a 12-month period among older women at high risk of falls and fractures. Method: A total of 118 community-dwelling older women with low bone density were recruited. The incidence of falls was monitored prospectively in 116 older women (2 losses) via monthly phone calls over the course of a year. At the end of this monitoring period, the older women were asked about their recall of falls in the same 12-month period. The agreement between the two methods was analyzed, and the sensitivity and specificity of self-reported previous falls in relation to the prospective monitoring were calculated. Results: There was moderate agreement between the prospective monitoring and the retrospective self-reporting of falls in classifying fallers (Kappa=0.595) and recurrent fallers (Kappa=0.589). The limits of agreement were 0.35±1.66 falls. The self-reporting of prior falls had a 67.2% sensitivity and a 94.2% specificity in classifying fallers among older women and a 50% sensitivity and a 98.9% specificity in classifying recurrent fallers. Conclusion: Self-reporting of falls over a 12-month period underestimated 32.8% of falls and 50% of recurrent falls. The findings recommend caution if one is considering replacing monthly monitoring with annual retrospective questioning.

Factors associated with attitudes and beliefs of elders with acute low back pain: data from the study Back Complaints in the Elders (BACE)

ABSTRACT Background The attitudes and beliefs that older people have about acute low back pain (LBP) may influence the coping mechanisms and the adoption of treatment strategies in this population. Objective The aim of this study was to identify the factors associated with the attitudes and beliefs of elderly patients with acute low back pain using the Back Beliefs Questionnaire. Method This is a cross-sectional study with a subsample of the study “Back Complaints in the Elders” (BACE), composed of 532 older Brazilians of both genders with acute LBP. We investigated sociodemographic and clinical aspects, self-perceived health, psychosocial and emotional state, falls, and functional capacity. Multiple regression models were constructed to measure possible associations. Results The percentage of female participants was 85.7% and the mean age was 69.04 (SD=6.2). Disability, symptoms of depression, and expectation of return to activities were independently associated with attitudes and beliefs concerning LBP. Conclusion Screening of psychosocial factors is essential to the prevention of persistent and recurrent LBP. Early signs of these factors can help identify symptoms and behaviors for effective interventions.

Pontos de corte alternativos para massa muscular apendicular para verificação da sarcopenia em idosos brasileiros: dados da Rede Fibra - Belo Horizonte/Brasil

Se establecieron puntos de corte alternativos para el calculo de la masa muscular apendicular (MMA) en ancianos brasilenos para clasificar la sarcopenia. Fueron analizados datos de 562 ancianos participantes del estudio Fibra (Debilidad en Ancianos Brasilenos), en el polo Belo Horizonte. Por medio de la ecuacion de Lee, se determinaron puntos de corte para MMA basado en la percentil 20 de su distribucion en la poblacion estudiada. Luego, los sujetos fueron clasificados para sarcopenia de acuerdo con los criterios del Consenso Europeo sobre Definicion y Diagnostico de la Sarcopenia en Ancianos, ademas de evaluadas las posibles asociaciones de esta con la capacidad funcional y comorbidades. La gran parte de la muestra fue compuesta por mujeres (el 65,5%) con edad media de 74,1 (±6,4) y promedio de 1,5 (±1,4) comorbidades. Los puntos de corte para MMA fueronCorresponding address: Joana Ude Viana – Avenida Presidente Antônio Carlos, 6.627, Pampulha – Belo Horizonte (MG), Brasil – Zip Code: 31270-901 – Phone: (31) 3409-4781 – E-mail: joana_ude@yahoo.com.br – Finance source: Fundação de Amparo à Pesquisa de Minas Gerais (Fapemig), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) – Conflict of interests: Nothing to declare – Presentation: Feb. 3th, 2017 – Accepted for publication: Mar. 5th, 2018 – Approved by the Research Ethics Committee of Universidade Federal de Minas Gerais under Protocol no. 187/07. Alternative appendicular muscle mass cut-off points for verification of sarcopenia in older Brazilians: data from Rede Fibra – Belo Horizonte/Brazil Pontos de corte alternativos para massa muscular apendicular para verificação da sarcopenia em idosos brasileiros: dados da Rede Fibra – Belo Horizonte/Brasil Puntos de corte alternativos para la masa muscular apendicular para la certificación de la sarcopenia en ancianos brasileños: datos de Red Fibra – Belo Horizonte/Brasil Joana Ude Viana1, João Marcos Domingues Dias2, Leani Souza Máximo Pereira2, Silvia Lanziotti Azevedo da Silva3, Lucas Freitas Hoelzle4, Rosângela Corrêa Dias2

Puntos de corte alternativos para la masa muscular apendicular para la certificación de la sarcopenia en ancianos brasileños: datos de Red Fibra - Belo Horizonte/Brasil

Se establecieron puntos de corte alternativos para el calculo de la masa muscular apendicular (MMA) en ancianos brasilenos para clasificar la sarcopenia. Fueron analizados datos de 562 ancianos participantes del estudio Fibra (Debilidad en Ancianos Brasilenos), en el polo Belo Horizonte. Por medio de la ecuacion de Lee, se determinaron puntos de corte para MMA basado en la percentil 20 de su distribucion en la poblacion estudiada. Luego, los sujetos fueron clasificados para sarcopenia de acuerdo con los criterios del Consenso Europeo sobre Definicion y Diagnostico de la Sarcopenia en Ancianos, ademas de evaluadas las posibles asociaciones de esta con la capacidad funcional y comorbidades. La gran parte de la muestra fue compuesta por mujeres (el 65,5%) con edad media de 74,1 (±6,4) y promedio de 1,5 (±1,4) comorbidades. Los puntos de corte para MMA fueronCorresponding address: Joana Ude Viana – Avenida Presidente Antônio Carlos, 6.627, Pampulha – Belo Horizonte (MG), Brasil – Zip Code: 31270-901 – Phone: (31) 3409-4781 – E-mail: joana_ude@yahoo.com.br – Finance source: Fundação de Amparo à Pesquisa de Minas Gerais (Fapemig), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) – Conflict of interests: Nothing to declare – Presentation: Feb. 3th, 2017 – Accepted for publication: Mar. 5th, 2018 – Approved by the Research Ethics Committee of Universidade Federal de Minas Gerais under Protocol no. 187/07. Alternative appendicular muscle mass cut-off points for verification of sarcopenia in older Brazilians: data from Rede Fibra – Belo Horizonte/Brazil Pontos de corte alternativos para massa muscular apendicular para verificação da sarcopenia em idosos brasileiros: dados da Rede Fibra – Belo Horizonte/Brasil Puntos de corte alternativos para la masa muscular apendicular para la certificación de la sarcopenia en ancianos brasileños: datos de Red Fibra – Belo Horizonte/Brasil Joana Ude Viana1, João Marcos Domingues Dias2, Leani Souza Máximo Pereira2, Silvia Lanziotti Azevedo da Silva3, Lucas Freitas Hoelzle4, Rosângela Corrêa Dias2

Alternative appendicular muscle mass cut-off points for verification of sarcopenia in older Brazilians: data from Rede Fibra - Belo Horizonte/Brazil

Se establecieron puntos de corte alternativos para el calculo de la masa muscular apendicular (MMA) en ancianos brasilenos para clasificar la sarcopenia. Fueron analizados datos de 562 ancianos participantes del estudio Fibra (Debilidad en Ancianos Brasilenos), en el polo Belo Horizonte. Por medio de la ecuacion de Lee, se determinaron puntos de corte para MMA basado en la percentil 20 de su distribucion en la poblacion estudiada. Luego, los sujetos fueron clasificados para sarcopenia de acuerdo con los criterios del Consenso Europeo sobre Definicion y Diagnostico de la Sarcopenia en Ancianos, ademas de evaluadas las posibles asociaciones de esta con la capacidad funcional y comorbidades. La gran parte de la muestra fue compuesta por mujeres (el 65,5%) con edad media de 74,1 (±6,4) y promedio de 1,5 (±1,4) comorbidades. Los puntos de corte para MMA fueronCorresponding address: Joana Ude Viana – Avenida Presidente Antônio Carlos, 6.627, Pampulha – Belo Horizonte (MG), Brasil – Zip Code: 31270-901 – Phone: (31) 3409-4781 – E-mail: joana_ude@yahoo.com.br – Finance source: Fundação de Amparo à Pesquisa de Minas Gerais (Fapemig), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) – Conflict of interests: Nothing to declare – Presentation: Feb. 3th, 2017 – Accepted for publication: Mar. 5th, 2018 – Approved by the Research Ethics Committee of Universidade Federal de Minas Gerais under Protocol no. 187/07. Alternative appendicular muscle mass cut-off points for verification of sarcopenia in older Brazilians: data from Rede Fibra – Belo Horizonte/Brazil Pontos de corte alternativos para massa muscular apendicular para verificação da sarcopenia em idosos brasileiros: dados da Rede Fibra – Belo Horizonte/Brasil Puntos de corte alternativos para la masa muscular apendicular para la certificación de la sarcopenia en ancianos brasileños: datos de Red Fibra – Belo Horizonte/Brasil Joana Ude Viana1, João Marcos Domingues Dias2, Leani Souza Máximo Pereira2, Silvia Lanziotti Azevedo da Silva3, Lucas Freitas Hoelzle4, Rosângela Corrêa Dias2

Transição entre níveis de fragilidade em idosos no município de Belo Horizonte, Minas Gerais

Objective: To observe possible changes in frailty phenotype classification over time. Method: 40 individuals of both genders aged over 65 years, living in the metropolitan region of Belo Horizonte, Minas Gerais and identified in a base line Rede FIBRA assessment as frail, who could walk independently or with the aid of devices and who had no illnesses that would prevent tests being carried out, , were considered. A standardized survey previously established by Rede FIBRA was administered. Results: The initial sample was composed of 40 individuals with a mean age of 78.03 (±6.46) years. After 24 months, a follow up of the 22 individuals from the initial sample that could be found was performed. The frailty phenotype classification scores of the same 22 subjects from the two samples were compared. After comparing the groups, it was found that 16 individuals had a lower number of frailty phenotype positive items in the follow up, three had higher positive scores and there was no change in the score of three individuals between assessments (p=0.004). Conclusion: This study found that a large majority of individuals showed improvement in their frailty phenotype classification.

Fenótipo de fragilidade: influência de cada item na determinação da fragilidade em idosos comunitários – Rede Fibra

The phenotype of frailty is used to assess frailty among the elderly by examining the following items: weight loss; exhaustion; low level of physical activity; weakness; and slow gait speed. The aim of the study was to evaluate the contribution of each item to determine the frailty syndrome among elderly Brazilians. The analysis was done using Multinomial Logistic Regression. The total sample of 5532 randomly selected elderly people in many cities in Brazil between December 2008 and September 2009 was assessed using the phenotype of frailty. The most frequent items were level of physical activity, followed by muscular weakness and slow gait speed. Items that were more likely to develop frailty, when positive, were slow gait speed (OR = 10.50, 95%CI 8.55 - 12.90, p <0.001) and muscular weakness (OR = 7.31, 95%CI 6,02 - 8,86, p <0.001). The final model with five items explained 99.6% of frailty in the sample. These results suggested that the level of physical activity, weakness and slow gait speed were the items that most influence the determination of frailty, however the application of all items of the phenotype of frailty is the best way to assess frailty.The phenotype of frailty is used to assess frailty among the elderly by examining the following items: weight loss; exhaustion; low level of physical activity; weakness; and slow gait speed. The aim of the study was to evaluate the contribution of each item to determine the frailty syndrome among elderly Brazilians. The analysis was done using Multinomial Logistic Regression. The total sample of 5532 randomly selected elderly people in many cities in Brazil between December 2008 and September 2009 was assessed using the phenotype of frailty. The most frequent items were level of physical activity, followed by muscular weakness and slow gait speed. Items that were more likely to develop frailty, when positive, were slow gait speed (OR = 10.50, 95%CI 8.55 - 12.90, p <0.001) and muscular weakness (OR = 7.31, 95%CI 6,02 - 8,86, p <0.001). The final model with five items explained 99.6% of frailty in the sample. These results suggested that the level of physical activity, weakness and slow gait speed were the items that most influence the determination of frailty, however the application of all items of the phenotype of frailty is the best way to assess frailty.