Tiago da Silva Alexandre

Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly

BackgroundSarcopenia, defined as low muscle mass (LMM), and dynapenia have been associated with adverse outcomes in elderly.ObjectiveContrast the association of sarcopenia versus dynapenia with incidence of disability.DesignA four-year prospective study (2006–2010).SettingSão Paulo, Brazil.Participants478 individuals aged 60 and older from the Saúde, Bem-Estar e Envelhecimento (SABE) study who were non-disabled at baseline.MeasurementsSarcopenia, measured according to the European Working Group on Sarcopenia in Older People (EWGSOP), includes: LMM assessed by skeletal muscle mass index ≤8.90kg/m2 (men) and ≤6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and <20kg (women); and low physical performance (LPP) assessed by gait speed ≤0.8m/s. Diagnosis of sarcopenia required LMM plus LMS or LPP. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, perception of vision, hearing and body mass index.OutcomesDisability in mobility or instrumental activities of daily living (IADL) or disability in activities of daily living (ADL) and IADL.ResultsThe incidence density of mobility or IADL disability was 43.4/1000 person/year and 22.6/1000 person/year for IADL and ADL disability. There was no significant difference in incidence density according sarcopenia or dynapenia status. After controlling for all covariates, sarcopenia was associated with mobility or IADL disability (relative risk ratio = 2.23, 95%Confidence Interval: 1.03–4.85). Dynapenia was not associated with disability.ConclusionsSarcopenia according to the EWGSOP definition can be used in clinical practice as a screening tool for early functional decline (mobility or IADL disability).

Gender differences in incidence and determinants of disability in activities of daily living among elderly individuals: SABE study.

Determining the groups that are most susceptible to developing disability is essential to establishing effective prevention and rehabilitation strategies. The aim of the present study was to determine gender differences in the incidence of disability regarding activities of daily living (ADL) and determinants among elderly residents of Sao Paulo, Brazil. In 2000, 1634 elderly with no difficulties regarding ADL (modified Katz Index) were selected. These activities were reassessed in 2006 and disability was the outcome for the analysis of determinants. The following characteristics were analyzed at baseline: socio-demographic, behavioral, health status, medications, falls, hospitalizations, depressive symptoms, cognition, handgrip, mobility and balance. The incidence density was 42.4/1000 women/year and 17.5/1000 men/year. After adjusting for socioeconomic status and health conditions, women with chronic diseases and social vulnerability continued to have a greater incidence of disability. The following were determinants of the incidence of disability: age and depressive symptoms in both genders; stroke and slowness on the sit-and-stand test among men; and osteoarthritis and sedentary lifestyle among women. Better cognitive performance and handgrip strength were protective factors among men and women, respectively. Adverse clinical and social conditions determine differences between genders regarding the incidence of disability. Decreased mobility and balance and health conditions that affect the central nervous system or lead to impaired cognition disable men more, whereas a sedentary lifestyle, reduction in muscle strength and conditions that affect the osteoarticular system disable women more.

Accuracy of Timed Up and Go Test for screening risk of falls among community-dwelling elderly

OBJECTIVE To determine the accuracy of the Timed Up and Go Test (TUGT) for screening the risk of falls among community-dwelling elderly individuals. METHOD This is a prospective cohort study with a randomly by lots without reposition sample stratified by proportional partition in relation to gender involving 63 community-dwelling elderly individuals. Elderly individuals who reported having Parkinsons disease, a history of transitory ischemic attack, stroke and with a Mini Mental State Exam lower than the expected for the education level, were on a wheelchair and that reported a single fall in the previous six months were excluded. The TUGT, a mobility test, was the measure of interested and the occurrence of falls was the outcome. The performance of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) was determined through the Older American Resources and Services, and the socio-demographic and clinical data were determined through the use of additional questionnaires. Receiver Operating Characteristic Curves were used to analyze the sensitivity and specificity of the TUGT. RESULTS Elderly individuals who fell had greater difficulties in ADL and IADL (p<0.01) and a slower performance on the TUGT (p=0.02). No differences were found in socio-demographic and clinical characteristics between fallers and non-fallers. Considering the different sensitivity and specificity, the best predictive value for discriminating elderly individuals who fell was 12.47 seconds [(RR=3.2) 95%CI: 1.3-7.7]. CONCLUSIONS The TUGT proved to be an accurate measure for screening the risk of falls among elderly individuals. Although different from that reported in the international literature, the 12.47 second cutoff point seems to be a better predictive value for Brazilian elderly individuals.

Fatores associados à qualidade de vida de cuidadores de idosos em assistência domiciliária

O objetivo do presente estudo foi investigar se o comportamento da qualidade de vida (QV) de cuidadores de idosos em assistencia domiciliaria pode ser influenciado por caracteristicas sociodemograficas, pela rede de suporte oferecida ao cuidador e por variaveis relacionadas ao ato de cuidar. Foram entrevistados 40 cuidadores de idosos de um Programa de Assistencia Domiciliaria da cidade de Sao Paulo. A QV foi mensurada utilizando-se a versao brasileira do Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36). Caracteristicas sociodemograficas, as variaveis relacionadas a rede de suporte oferecida ao cuidador e ao ato de cuidar foram obtidas por meio de questionario complementar. A analise de regressao linear mostrou relacao independente entre tres dominios do SF-36 e o maior numero de horas dedicadas ao cuidado: dominios capacidade funcional, aspecto fisico e aspecto emocional. Possuir mais de oito anos de escolaridade implicou em melhor pontuacao no dominio estado geral de saude e pior pontuacao no dominio aspecto social. Os cuidadores com mais de 60 anos de idade apresentaram pior pontuacao no dominio aspecto fisico e as mulheres pior pontuacao no dominio dor. Os filhos ou conjuges que prestam cuidado aos seus pais ou parceiros apresentaram pior pontuacao no dominio aspecto emocional. Os cuidadores que modificaram sua rotina para prestar os cuidados apresentaram pior pontuacao no dominio saude mental. Tanto fatores sociodemograficos como a rede de suporte oferecida ao cuidador e os fatores relacionados a dinâmica do cuidado sao capazes de influenciar negativamente a QV de cuidadores principais de idosos em atendimento domiciliario.

Similarities Among Factors Associated With Components of Frailty in Elderly SABE Study

Objective: To analyze similarities among factors associated with the components of frailty in elderly. Method: We studied 1,413 elderly from the second wave of the SABE Study in 2006. Each of the five components of the frailty phenotype was considered a dependent variable in the hierarchical logistic regression models. Results: In both genders, age, schooling, sedentary lifestyle, and screening positive for depression were associated similarly with more than one component of frailty. Other similarities were also observed with stroke and screening positive for cognitive decline in men, and number of diseases and gait speed in women. The most similar associations happened between weakness and slowness; weakness, slowness, and LPAL; or weakness, slowness, and exhaustion. Discussion: Encouraging physical activity, screening for and treating depression and treating both diseases of the central nervous system and chronic diseases must be the focus of strategies to avoid, delay, or even remedy frailty.

Weight Gain Among Elderly Women as Risk Factor for Disability Health, Well-Being and Aging Study (SABE Study)

Objective: To examine the association between weight change and the incidence of disability in activities of daily living (ADL) among elderly women. Method: In 2006, 227 women aged ≥75 years and independent in ADL were selected from SABE Study (Health, Well-being, and Aging) in Sao Paulo, Brazil. The dependent variable was the report of difficulty on ≥1 ADL in 2009. Differences in weight were calculated between baseline and second interview, and converted to percentage change in relation to initial weight. A change (gain or loss) ≥5% was considered significant. A logistic regression analysis was performed including sociodemographic and health-related variables. Results: After adjusting, weight gain remained associated to disability (OR = 2.42; p = .027), whereas weigh loss lost significance (OR = 1.66; p = .384). Discussion: Weight loss is generally considered more worrisome than weight gain in elderly. However, weight loss alone was not a risk factor for disability in our study.

Nutritional status and risk for disability in instrumental activities of daily living in older Brazilians.

OBJECTIVE The aim of the present study was to examine the association between nutritional status and the incidence of disability regarding instrumental activities of daily living (IADL) among older adults. DESIGN The study is part of the longitudinal SABE (Saúde, Bem-Estar e Envelhecimento; Health, Wellbeing and Ageing) Study that began in 2000 (first wave) with a multistage, clustered, probabilistic sample (n 2143) of older adults (≥60 years). The second wave was carried out in 2006, when 1115 elders were re-interviewed. The dependent variable was the occurrence of disability in 2006 (report of difficulty on ≥1 IADL). Nutritional status (measured at baseline) was classified on the basis of BMI: ≤23·0 kg/m2 (underweight); >23·0 and <28·0 kg/m2 (ideal range - reference); ≥28·0 and <30·0 kg/m2 (overweight); and ≥30·0 kg/m2 (obesity). SETTING São Paulo, Brazil. SUBJECTS One thousand and thirty-four individuals without difficulties regarding IADL in 2000 were selected, 611 of whom were re-interviewed in 2006. RESULTS In the multiple logistic regression analysis adjusted for baseline variables (gender, age, number of chronic diseases, stroke, osteoarthritis and cognitive status), underweight (OR = 2·03; P = 0·034) and obesity (OR = 1·79; P = 0·022) remained associated with disability. CONCLUSIONS Both underweight and obesity are associated with an increased risk of developing disability regarding IADL among older adults, in an independent fashion of other risk factors. Thus, adequate nutritional status is a key point to consider in the establishment of preventive measures.

Low supply of social support as risk factor for mortality in the older adults

OBJECTIVES To determine the relationship between social support and mortality in older adults, independent of other health conditions. METHOD This was a longitudinal study using the database of the 2006 SABE Study (Heath, Well-being and Aging), composed of 1413 individuals aged 60 years and over, living in São Paulo/Brazil. The present study used a questionnaire constructed for the SABE Study, which was reviewed by experts of Latin America and the Caribbean. The social network was evaluated using the variables: social support received; social support offered; number of members in the social network. The covariates included were age, gender, living arrangements, marital status, income, education, comorbidity, depressive symptoms, cognition and functional difficulties. Death as an outcome was evaluated after four years of follow-up. RESULTS From a total of 1413 older adults at baseline, 268 died in a mean follow-up period of 3,9 years (SE=0,03). In the model adjusted offering social support and having networks composed of 9 or more members reduced the risk of death in the older adults. CONCLUSIONS This study suggest that older adult who are offered support can benefit from mutual exchanges since reciprocity in relationships improves psychological well-being and is indicative of the quality of relationships. Thus, the older adults are part of a group of people whose role is not only to receive, but also to provide help to others, and the support offered seems to be as important as that received.

Gender Differences in the Incidence and Determinants of Components of the Frailty Phenotype Among Older Adults: Findings From the SABE Study.

Objective: To analyze gender differences in incidence and determinants of the components of the frailty phenotype. Method: A total of 1,413 older adults were selected in 2006. To estimate the incidence of each frailty component, only individuals who did not exhibit a given component at baseline (independently of the presence of other components) were included in the study. The variables of interest were socioeconomic, behavioral, clinical, anthropometric factors and physical performance. The incidence of each component in 2010 was the outcome. Results: Unintentional weight loss and slowness were more incident in men up to 74 years of age. The other frailty components were more incident in women at all age groups, except weakness. Besides age, the determinants of incidence of the components of frailty were different between genders. Discussion: Strategies for preventing or delaying the installation of frailty need to address gender differences, considering the greater complexity in the network determinants among women.

Abdominal obesity as a risk factor for disability in Brazilian older adults.

OBJECTIVE To assess the role of abdominal obesity in the incidence of disability in older adults living in São Paulo, Brazil, in a 5-year period. DESIGN Longitudinal study, part of the SABE Study (Health, Wellbeing and Aging). We assessed the disability incidence in the period (reported difficulty in at least one activity of daily living (ADL) in 2010) in relation to abdominal obesity in 2006 (waist circumference ≥102 cm in men and ≥88 cm in women). We used Poisson regression to evaluate the association between obesity and disability incidence, adjusting for sociodemographic and clinical factors including BMI. SETTING São Paulo, Brazil. SUBJECTS Older adults (n 1109) who were independent in ADL in 2006. In 2010, 789 of these were located and re-interviewed. RESULTS The crude disability incidence (at least one ADL) was 27·1/1000 person-years in the period. The incidence rate was two times higher in participants with abdominal obesity compared with those without (39·1/1000 and 19·4/1000 person-years, respectively; P<0·001). This pattern was observed in all BMI levels. In regression models, abdominal obesity remained associated with disability incidence (incidence rate ratio=1·90; P<0·03), even after controlling for BMI, gender, age, low grip strength, cognitive impairment, physical inactivity and chronic diseases. CONCLUSIONS Abdominal obesity was strong risk factor for disability, showing a more significant effect than BMI, and thus should be an intervention target for older adults. Waist measure is simple, cost-effective and easily interpreted, and therefore can be used in several settings to identify individuals at higher risk of disability.