Suzele Cristina Coelho Fabrício-Wehbe

Cross-cultural adaptation and validity of the 'Edmonton Frail Scale - EFS' in a Brazilian elderly sample.

This study aimed to assess the cross-cultural adaptation of the Edmonton Frail Scale (EFS) and its validity in a Brazilian elderly sample. Translation and back-translation were performed, as well as discussion with professionals and elderly for conceptual equivalence, semantic validation and pre-test of the scale. The scale was applied to 137 elderly aged 65 years or older who lived in the community. In the know-groups validation of the frailty diagnosis between gender, age and cognitive deficit, elder elderly, female and with a cognitive deficit scored higher on the frailty diagnosis. A negative convergent correlation was found between the EFS and the Functional Independence Measure (FIM) (-0.53, p< 0.01) and the total score of the Mini-Mental State Examination (MMSE) (-0.60, p< 0.01). The watch test presented high sensitivity and low specificity levels. The Portuguese version of the EFS was considered valid in the study sample.El objetivo de este estudio fue evaluar la adaptacion cultural de la Edmonton Frail Scale (EFS) y su validez enuna muestra de ancianos brasilenos. Fueron realizadas las etapas de traduccion y retrotraduccion, discusioncon profesionales y ancianos para equivalencia conceptual, validacion semantica y prueba piloto de la escala.El instrumento fue aplicado en 137 ancianos, con 65 anos o mas de edad, que vivian en la comunidad. En lavalidacion de grupos conocidos, del diagnostico de fragilidad entre sexo, edad y deficit cognitivo, los ancianoscon edad mas avanzada, sexo femenino y con deficit cognitivo tuvieron mayor puntuacion en el diagnostico defragilidad. Hubo una correlacion convergente negativa de la EFS con la Medida de Independencia Funcional(MIF) (-0,53, p<0,01) y el puntaje bruto del Mini-Examen del Estado Mental (MEEM) (-0,60, p<0,01). La pruebadel reloj presento alta sensibilidad y baja especificidad. La version para la lengua portuguesa de la EFS fueconsiderada valida en la muestra estudiada.DESCRIPTORES: anciano fragil; investigacion metodologica en enfermeria; comparacion transcultural; estudiosde validacion

Diferenciais socioeconômicos e de saúde entre duas comunidades de idosos longevos

OBJETIVO: Identificar diferencias demograficas y socioeconomicas relacionadas con el estado de salud de ancianos mas viejos residentes en dos ciudades de diferentes regiones de Brasil. METODOS: Estudio epidemiologico transversal y comparativo de ancianos mas viejos (>80 anos) residentes en Ribeirao Preto (RP - Sureste de Brasil) y Caxias do Sul (Sur), con muestra probabilistica de 117 sujetos en CS y 155 en RP, realizados entre 2007 y 2008. El instrumento de colecta incluyo datos demograficos y socioeconomicos mini-examen del estado mental, Medida de Independencia Funcional, numero de comorbilidades autoreferidas y Escala de Depresion Geriatrica. RESULTADOS: La edad promedio fue similar, con predominancia de mujeres (~70%) y viudos (~60%) en ambos municipios. La escolaridad promedio no difirio estadisticamente, pero la renta promedio del anciano fue mayor en RP que en CS (p=0,05). RP presento mayor concentracion de individuos en los extremos de escolaridad y renta que CS. El escore promedio del mini-examen del estado mental fue similar entre los dos grupos y mayor para individuos del sexo masculino, con edad entre 80 y 84 anos, casados y con mayor escolaridad. Se observo mejor desempeno funcional entre ancianos de 80 a 84 anos en ambos municipios, entre los de mayor escolaridad en RP; y entre los de sexo masculino y los casados en CS. Ancianos de CS presentaron mayor numero de comorbilidades que los de RP (p<0,001). Ancianos del sexo masculino, casados, y con mayor renta presentaron menos sintomas depresivos en ambos grupos; y los de RP presentaron mayor escores en la Escala de Depresion Geriatrica que los de CS (p<0,001). CONCLUSIONES: Aunque los ancianos de CS presenten menor desigualdad socioeconomica y menos sintomas depresivos, poseen tambien mayor numero promedio de comorbilidades y menor nivel de independencia funcional, al compararlos con los de RP.OBJECTIVE To identify demographic and socioeconomic differentials associated with the health status of oldest-old individuals living in two cities of different Brazilian regions. METHODS A comparative and cross-sectional epidemiological study was conducted with the oldest-old (> 80 years), living in the cities of Ribeirão Preto (RP, Southeastern Brazil) and Caxias do Sul (CS, Southern). The probabilistic sample included 117 individuals in CS and 155 in RP, and data were collected between 2007 and 2008. The instrument included demographic and socioeconomic data, Mini-Mental State Examination, Functional Independence Measure, number of self-reported comorbidities and Geriatric Depression Scale. RESULTS Mean age was similar, with predominance of women (~70%) and widowed individuals (~60%) in both cities. Mean level of education did no differ statistically, although mean income was higher in RP than in CS (p = 0.05). RP showed a higher concentration of individuals in the extreme levels of education and income than that of CS. Mean score of the Mini-Mental State Examination was similar in both groups and higher among men, individuals aged between 80 and 84 years, married and with a higher level of education. Better functional performance was observed in elderly individuals aged between 80 and 84 years in both cities, in those with higher level of education in RP; and in males and married individuals in CS. Elderly individuals in CS showed higher number of comorbidities than those in RP (p < 0.001). Male elderly individuals, married and with -higher income level showed fewer depressive symptoms in both groups; and those in RP showed higher Geriatric Depression Scale score than the others in CS (p < 0.001). CONCLUSIONS Although the oldest old in CS showed lower socioeconomic inequality and fewer depressive symptoms, they also had a higher mean number of comorbidities and lower level of functional independence, when compared to those in RP.

Accidental falls in the elderly and their relation with functional capacity

AIM This study aimed to determinate the prevalence of falls in the elderly and its relationship with the functional capacity. METHOD This is an epidemiological and cross-sectional study; a two-stage cluster sample of 240 male and female subjects aged over 60 years was used. Data were collected from November 2010 to February 2011. The following questionnaires were used: socio-demographic profile, assessment of falls, Functional Independence Measure, Lawton and Brody Scale. Significance was set at 0.05. To identify the occurrence of falls and their relation with functional capacity, the prevalence ratio and prevalence odds ratios were used, as well as multiple logistic regression. RESULTS Average age was 73.5 years (±8.4); 25% 80 years or more, with preponderance of female gender; 48.8% attended school between 1-4 years. The average was 1.33 falls (±0.472), with prevalence in women and elderly between 60 and 79 years old; the most frequently sites were the backyard and bathroom. Strong correlation between the level of functional independence and instrumental activities and age was found, but no relation between elderly victims of falls and the gender and age variables. CONCLUSION Women who suffered falls related to functional independence were predominant, which can be prevented through elderly health promotion strategies, a policy that serves to offer living conditions to people in the aging process.OBJETIVO: determinar a prevalencia de quedas em idosos e sua relacao com a capacidade funcional. METODO: trata-se de estudo epidemiologico transversal de base populacional, com uma amostra por conglomerado de duplo estagio de 240 sujeitos, com idade acima de 60 anos, de ambos os sexos, residentes em Ribeirao Preto, SP. Os dados foram coletados entre novembro de 2010 e fevereiro de 2011 e utilizaram-se os questionarios: perfil social, avaliacao de quedas, Medida de Independencia Funcional e Escala de Lawton e Brody. Foi adotado o nivel de significância de 0,05. Para a identificacao da ocorrencia das quedas e sua relacao com a capacidade funcional, foram utilizadas razao de prevalencia e de chances de prevalencia e regressao logistica multipla. RESULTADOS: a media de idade foi de 73,5 anos (±8,4), 25% com 80 anos ou mais, predominio do sexo feminino; 48,8% estudaram de 1 a 4 anos. Media de 1,33 quedas (±0,472); com maior prevalencia em mulheres e idosos mais jovens; o local mais frequente foi o quintal e o banheiro. Houve forte correlacao entre o nivel de independencia funcional e as atividades instrumentais com a idade, e nao houve relacao entre os idosos que sofreram queda e as variaveis sexo e idade. CONCLUSAO: houve predominio de mulheres que sofreram quedas relacionadas a independencia funcional, podendo-se prevenir com estrategias de promocao a saude ao idoso, politica essa para oferecer condicao de vida a pessoa no processo de envelhecer.

Household arrangements of the elder elderly

The aging context of the elder elderly needs to be taken into account, due to the redefinition of family as a social institution. This is an epidemiological, cross-sectional study that characterized the household arrangements of 147 elder elderly living in Ribeirão Preto, SP, through home interviews. The age range between 80 and 84 years predominated. The majority receives a retirement benefit ranging from one to three minimum wages, and owns their house. On the average, they have 4.08 children and live with 2.8 people. Most men live with their partners, while women live by themselves. The elderly head a large part of households. The most frequent arrangements are families with two and three generations. Regarding the household arrangement, there was equivalence in the results between the ones that moved into the house of the elderly and cases when the elderly moved into the familys house, reinforcing the family as a protector and caregiver of the elderly.O contexto do envelhecimento dos idosos mais velhos necessita ser considerado em decorrencia da redefinicao da familia como instituicao social. Este e estudo epidemiologico, transversal, que caracterizou o arranjo domiciliar de 147 idosos mais velhos residentes na comunidade de Ribeirao Preto, SP, atraves de entrevistas domiciliares. Predominou a faixa etaria de 80 a 84 anos. A maioria recebe aposentadoria, possui de um a tres salarios minimos, mora em casa propria. Possui 4,08 filhos e reside com 2,8 pessoas, em media. Os homens vivem, na maioria, com o conjuge, enquanto as mulheres, sozinhas, e os domicilios sao chefiados pelo idoso. Os arranjos mais continentes foram os bi e trigeracionais. Quanto a formacao do arranjo domiciliar, houve equivalencia nos resultados entre aqueles que afirmaram ter ido morar com o idoso e aqueles em que o idoso foi morar no domicilio da familia, o que reforca a familia como protetora e cuidadora dos idosos.

Adaptação cultural e validade da Edmonton Frail Scale - EFS em uma amostra de idosos brasileiros

This study aimed to assess the cross-cultural adaptation of the Edmonton Frail Scale (EFS) and its validity in a Brazilian elderly sample. Translation and back-translation were performed, as well as discussion with professionals and elderly for conceptual equivalence, semantic validation and pre-test of the scale. The scale was applied to 137 elderly aged 65 years or older who lived in the community. In the know-groups validation of the frailty diagnosis between gender, age and cognitive deficit, elder elderly, female and with a cognitive deficit scored higher on the frailty diagnosis. A negative convergent correlation was found between the EFS and the Functional Independence Measure (FIM) (-0.53, p< 0.01) and the total score of the Mini-Mental State Examination (MMSE) (-0.60, p< 0.01). The watch test presented high sensitivity and low specificity levels. The Portuguese version of the EFS was considered valid in the study sample.El objetivo de este estudio fue evaluar la adaptacion cultural de la Edmonton Frail Scale (EFS) y su validez enuna muestra de ancianos brasilenos. Fueron realizadas las etapas de traduccion y retrotraduccion, discusioncon profesionales y ancianos para equivalencia conceptual, validacion semantica y prueba piloto de la escala.El instrumento fue aplicado en 137 ancianos, con 65 anos o mas de edad, que vivian en la comunidad. En lavalidacion de grupos conocidos, del diagnostico de fragilidad entre sexo, edad y deficit cognitivo, los ancianoscon edad mas avanzada, sexo femenino y con deficit cognitivo tuvieron mayor puntuacion en el diagnostico defragilidad. Hubo una correlacion convergente negativa de la EFS con la Medida de Independencia Funcional(MIF) (-0,53, p<0,01) y el puntaje bruto del Mini-Examen del Estado Mental (MEEM) (-0,60, p<0,01). La pruebadel reloj presento alta sensibilidad y baja especificidad. La version para la lengua portuguesa de la EFS fueconsiderada valida en la muestra estudiada.DESCRIPTORES: anciano fragil; investigacion metodologica en enfermeria; comparacion transcultural; estudiosde validacion

Arranjo domiciliar dos idosos mais velhos

The aging context of the elder elderly needs to be taken into account, due to the redefinition of family as a social institution. This is an epidemiological, cross-sectional study that characterized the household arrangements of 147 elder elderly living in Ribeirão Preto, SP, through home interviews. The age range between 80 and 84 years predominated. The majority receives a retirement benefit ranging from one to three minimum wages, and owns their house. On the average, they have 4.08 children and live with 2.8 people. Most men live with their partners, while women live by themselves. The elderly head a large part of households. The most frequent arrangements are families with two and three generations. Regarding the household arrangement, there was equivalence in the results between the ones that moved into the house of the elderly and cases when the elderly moved into the familys house, reinforcing the family as a protector and caregiver of the elderly.O contexto do envelhecimento dos idosos mais velhos necessita ser considerado em decorrencia da redefinicao da familia como instituicao social. Este e estudo epidemiologico, transversal, que caracterizou o arranjo domiciliar de 147 idosos mais velhos residentes na comunidade de Ribeirao Preto, SP, atraves de entrevistas domiciliares. Predominou a faixa etaria de 80 a 84 anos. A maioria recebe aposentadoria, possui de um a tres salarios minimos, mora em casa propria. Possui 4,08 filhos e reside com 2,8 pessoas, em media. Os homens vivem, na maioria, com o conjuge, enquanto as mulheres, sozinhas, e os domicilios sao chefiados pelo idoso. Os arranjos mais continentes foram os bi e trigeracionais. Quanto a formacao do arranjo domiciliar, houve equivalencia nos resultados entre aqueles que afirmaram ter ido morar com o idoso e aqueles em que o idoso foi morar no domicilio da familia, o que reforca a familia como protetora e cuidadora dos idosos.

Reproducibility of the Brazilian version of the Edmonton Frail Scale for elderly living in the community

OBJECTIVE to verify the inter and intra-rater reproducibility of the Brazilian adapted version of the Edmonton Frail Scale (EFS) in an elderly group of residents. METHOD in order to test the inter-rater reproducibility, two assessments were independently conducted by two researchers on the same day but at different times, in a sample of 103 elderly. Concerning the intra-rater reproducibility, the instrument was administered to 83 elderly (80.6% of the initial sample) by the same researcher in a time gap of 15 days between the two assessments. RESULTS AND DISCUSSION in relation to the inter-rater test, the Kappa was 0.81 (CI 0.61-1.00) and the Intraclass Correlation Coefficient (ICC) corresponded to 0.87 (CI 0.82-0.91, p<0.001). In relation to the intra-rater test, the Kappa was 0.83 (CI 0.72-0.94) and the ICC 0.87 (CI 0.81-1.00, p<0.001). CONCLUSION the results show that the EFS is reliable and can be used as a tool to improve geriatric nursing care in Brazil.OBJETIVO: verificar a reprodutibilidade inter e intraobservadores da versao adaptada para o Brasil da Edmonton Frail Scale, em um grupo de idosos domiciliados. METODOLOGIA: para testar a reprodutibilidade interobservador, duas avaliacoes foram realizadas de forma independente por dois pesquisadores, no mesmo dia, porem, em horarios diferentes, em uma amostra de 103 idosos. Para a reprodutibilidade intraobservador, o instrumento foi aplicado pelo mesmo pesquisador em um intervalo de tempo de 15 dias, entre as duas medidas, em 83 idosos (80,6% da amostra inicial). RESULTADOS E DISCUSSAO: no teste interobservador, o Kappa foi de 0,81 (IC 0,61-1,00) e o coeficiente de correlacao intraclasse de 0,87 (IC 0,82-0,91, p<0,001). No intraobservador, o Kappa foi de 0,83 (IC 0,72-0,94) e o coeficiente de correlacao de 0,87 (IC 0,81-1,00, p<0,001). CONCLUSAO: os resultados demonstram que a Edmonton Frail Scale e confiavel e podera ser utilizada como ferramenta para melhora da assistencia de enfermagem gerontogeriatrica no Brasil.

Transition of care for the elderly after cerebrovascular accidents - from hospital to the home

OBJECTIVE to examine the transition of care in families caring for elderly persons who suffered the first episode of a cerebrovascular accident. METHODOLOGY an instrumental ethnographic case study was used. The sample comprised 20 subjects: 10 caregivers and 10 elderly persons aged 65 or over, of both sexes, with diagnoses of first episode of cerebrovascular accident, capable of communicating, and requiring care from a main carer in their family. The data was collected through interviews, observation, existing documentation and field notes. Qualitative analysis techniques were used to codify and classify the data and to formulate significant categories, which generated typologies of care. RESULTS AND DISCUSSION The central idea was the Transition of Care and showed the context in three typologies: The care process for the dependent elderly person, Strategies for the care process and Impact and acceptance of the limitations. CONCLUSION The data indicates that caring for an elderly person after a cerebrovascular accident is a challenge for the family. The data permitted it possible to elaborate a proposal for a model for the organization of the work, with a view to holistic care delivery in the health services, forming a care network, which constitutes an advance for the area of nursing.OBJETIVO: examinar a transicao do cuidado em familias que cuidam de idosos que sofreram o primeiro episodio de acidente vascular cerebral. METODOLOGIA: foi utilizado o estudo de caso etnografico instrumental. A amostra foi constituida por 20 sujeitos, sendo 10 cuidadores e 10 idosos, com 65 anos ou mais, de ambos os sexos, com diagnostico de primeiro episodio de acidente vascular cerebral, capazes de se comunicarem, demandando cuidado de um cuidador principal na familia. Os dados foram coletados por meio de entrevistas, observacoes, documentos existentes e notas de campo. Foram utilizadas tecnicas de analises qualitativa para codificar, classificar os dados e formular categorias significativas, o que gerou tipologias de cuidado. RESULTADOS E DISCUSSAO: a ideia central foi a transicao do cuidado e mostrou o contexto em tres tipologias: o processo de cuidar do idoso dependente, estrategias para o processo de cuidar e impacto e aceitacao das limitacoes. CONCLUSAO: os dados indicaram que o cuidado com o idoso, apos o acidente vascular cerebral, e um desafio para a familia. Os dados possibilitaram elaborar uma proposta de modelo para a organizacao do trabalho, visando a integralidade do cuidado nos servicos de saude, formando uma rede de cuidado, o que constitui avanco para a area da enfermagem.

Socioeconomic and health differentials between two community-dwelling oldest-old groups

OBJETIVO: Identificar diferencias demograficas y socioeconomicas relacionadas con el estado de salud de ancianos mas viejos residentes en dos ciudades de diferentes regiones de Brasil. METODOS: Estudio epidemiologico transversal y comparativo de ancianos mas viejos (>80 anos) residentes en Ribeirao Preto (RP - Sureste de Brasil) y Caxias do Sul (Sur), con muestra probabilistica de 117 sujetos en CS y 155 en RP, realizados entre 2007 y 2008. El instrumento de colecta incluyo datos demograficos y socioeconomicos mini-examen del estado mental, Medida de Independencia Funcional, numero de comorbilidades autoreferidas y Escala de Depresion Geriatrica. RESULTADOS: La edad promedio fue similar, con predominancia de mujeres (~70%) y viudos (~60%) en ambos municipios. La escolaridad promedio no difirio estadisticamente, pero la renta promedio del anciano fue mayor en RP que en CS (p=0,05). RP presento mayor concentracion de individuos en los extremos de escolaridad y renta que CS. El escore promedio del mini-examen del estado mental fue similar entre los dos grupos y mayor para individuos del sexo masculino, con edad entre 80 y 84 anos, casados y con mayor escolaridad. Se observo mejor desempeno funcional entre ancianos de 80 a 84 anos en ambos municipios, entre los de mayor escolaridad en RP; y entre los de sexo masculino y los casados en CS. Ancianos de CS presentaron mayor numero de comorbilidades que los de RP (p<0,001). Ancianos del sexo masculino, casados, y con mayor renta presentaron menos sintomas depresivos en ambos grupos; y los de RP presentaron mayor escores en la Escala de Depresion Geriatrica que los de CS (p<0,001). CONCLUSIONES: Aunque los ancianos de CS presenten menor desigualdad socioeconomica y menos sintomas depresivos, poseen tambien mayor numero promedio de comorbilidades y menor nivel de independencia funcional, al compararlos con los de RP.OBJECTIVE To identify demographic and socioeconomic differentials associated with the health status of oldest-old individuals living in two cities of different Brazilian regions. METHODS A comparative and cross-sectional epidemiological study was conducted with the oldest-old (> 80 years), living in the cities of Ribeirão Preto (RP, Southeastern Brazil) and Caxias do Sul (CS, Southern). The probabilistic sample included 117 individuals in CS and 155 in RP, and data were collected between 2007 and 2008. The instrument included demographic and socioeconomic data, Mini-Mental State Examination, Functional Independence Measure, number of self-reported comorbidities and Geriatric Depression Scale. RESULTS Mean age was similar, with predominance of women (~70%) and widowed individuals (~60%) in both cities. Mean level of education did no differ statistically, although mean income was higher in RP than in CS (p = 0.05). RP showed a higher concentration of individuals in the extreme levels of education and income than that of CS. Mean score of the Mini-Mental State Examination was similar in both groups and higher among men, individuals aged between 80 and 84 years, married and with a higher level of education. Better functional performance was observed in elderly individuals aged between 80 and 84 years in both cities, in those with higher level of education in RP; and in males and married individuals in CS. Elderly individuals in CS showed higher number of comorbidities than those in RP (p < 0.001). Male elderly individuals, married and with -higher income level showed fewer depressive symptoms in both groups; and those in RP showed higher Geriatric Depression Scale score than the others in CS (p < 0.001). CONCLUSIONS Although the oldest old in CS showed lower socioeconomic inequality and fewer depressive symptoms, they also had a higher mean number of comorbidities and lower level of functional independence, when compared to those in RP.

Quedas em idosos e sua relação com a capacidade funcional

AIM This study aimed to determinate the prevalence of falls in the elderly and its relationship with the functional capacity. METHOD This is an epidemiological and cross-sectional study; a two-stage cluster sample of 240 male and female subjects aged over 60 years was used. Data were collected from November 2010 to February 2011. The following questionnaires were used: socio-demographic profile, assessment of falls, Functional Independence Measure, Lawton and Brody Scale. Significance was set at 0.05. To identify the occurrence of falls and their relation with functional capacity, the prevalence ratio and prevalence odds ratios were used, as well as multiple logistic regression. RESULTS Average age was 73.5 years (±8.4); 25% 80 years or more, with preponderance of female gender; 48.8% attended school between 1-4 years. The average was 1.33 falls (±0.472), with prevalence in women and elderly between 60 and 79 years old; the most frequently sites were the backyard and bathroom. Strong correlation between the level of functional independence and instrumental activities and age was found, but no relation between elderly victims of falls and the gender and age variables. CONCLUSION Women who suffered falls related to functional independence were predominant, which can be prevented through elderly health promotion strategies, a policy that serves to offer living conditions to people in the aging process.OBJETIVO: determinar a prevalencia de quedas em idosos e sua relacao com a capacidade funcional. METODO: trata-se de estudo epidemiologico transversal de base populacional, com uma amostra por conglomerado de duplo estagio de 240 sujeitos, com idade acima de 60 anos, de ambos os sexos, residentes em Ribeirao Preto, SP. Os dados foram coletados entre novembro de 2010 e fevereiro de 2011 e utilizaram-se os questionarios: perfil social, avaliacao de quedas, Medida de Independencia Funcional e Escala de Lawton e Brody. Foi adotado o nivel de significância de 0,05. Para a identificacao da ocorrencia das quedas e sua relacao com a capacidade funcional, foram utilizadas razao de prevalencia e de chances de prevalencia e regressao logistica multipla. RESULTADOS: a media de idade foi de 73,5 anos (±8,4), 25% com 80 anos ou mais, predominio do sexo feminino; 48,8% estudaram de 1 a 4 anos. Media de 1,33 quedas (±0,472); com maior prevalencia em mulheres e idosos mais jovens; o local mais frequente foi o quintal e o banheiro. Houve forte correlacao entre o nivel de independencia funcional e as atividades instrumentais com a idade, e nao houve relacao entre os idosos que sofreram queda e as variaveis sexo e idade. CONCLUSAO: houve predominio de mulheres que sofreram quedas relacionadas a independencia funcional, podendo-se prevenir com estrategias de promocao a saude ao idoso, politica essa para oferecer condicao de vida a pessoa no processo de envelhecer.