Effectiveness of an exercise program on postural control in frail older adults

Background: Exercise programs have proved to be helpful for frail older adults. This study aimed to investigate the effects of an exercise program with a focus on postural control exercises in frail older adults. Method: Twenty-six older adults (76.7 +/- 4.9 years) deemed clinically stable, chosen from the Falls Unit, University Hospital Mutua Terrassa, Barcelona, Spain, participated in this single-group study. Volunteers' postural control was evaluated using the Timed Up and Go test (TUG) and the Guralnik test battery, and their static and dynamic posturography were evaluated using the Synapsys Posturography System (R). These evaluations were performed before and after the intervention program, which included an educational session and two weekly 1-hour sessions over an 8-week period of stretching exercises, proprioception, balance, and motor coordination. Data were analyzed using the Student's t-test or the Wilcoxon test, with a significance level of 5%. Results: The TUG and Guralnik tests did not show significant differences. Concerning static posturography, there was improvement in the base of support (P = 0.006), anteroposterior displacement with eyes open (P = 0.02) and closed (P = 0.03), and the total amplitude of the center of pressure with eyes closed (P = 0.02). Regarding dynamic posturography, a decrease of the oscillation speed in the anteroposterior direction (P = 0.01) was observed in individuals with their eyes open. Conclusion: The program used in this study was safe and was able to promote some improvement in postural control, especially in the anteroposterior direction and in the base of support. However, it is noteworthy that further improvements could be obtained from a program of longer duration and greater frequency.

Mini-Mental State Examination performance in frail, pre-frail, and non-frail community dwelling older adults in Ermelino Matarazzo, Sao Paulo, Brazil

Background: Frailty in older adults is a multifactorial syndrome defined by low metabolic reserve, less resistance to stressors, and difficulty in maintaining organic homeostasis due to cumulative decline of multiple physiological systems. The relationship between frailty and cognition remains unclear and studies about Mini-Mental State Examination (MMSE) performance and frailty are scarce. The objective was to examine the association between frailty and cognitive functioning as assessed by the MMSE and its subdomains. Methods: A cross-sectional population-based study (FIBRA) was carried out in Ermelino Matarazzo, a poor subdistrict of the city of Sao Paulo, Brazil. Participants were 384 community dwelling older adults, 65 years and older who completed the MMSE and a protocol to assess frailty criteria as described in the Cardiovascular Health Study (CHS). Results: Frail older adults had significantly worse performance on the MMSE (p < 0.001 for total score). Linear regression analyses showed that the MMSE total score was influenced by age (p < 0.001), education (p < 0.001), family income (p < 0.001), and frailty status (p < 0.036). Being frail was associated more significantly with worse scores in Time Orientation (p < 0.004) and Immediate Memory (p < 0.001). Conclusions: Our data suggest that being frail is associated with worse cognitive performance, as assessed by the MMSE. It is recommended that the assessment of frail older adults should include the investigation of their cognitive status.

Medication adherence in frail elderly outpatients with dementia

Since drug therapy in the elderly is complex and longterm and aged people commonly present some level of impairment and disability, medication adherence tend to decrease with age. Cognitive function is a key factor associated with medication adherence and professional or caregiver assistance may be necessary to maintain correct drug use. This study aims to analyze frail elderly outpatients aged 80 years or over diagnosed with dementia. The study is cross-sectional and is being conducted at the Ambulatory of Frailty of the University Hospital of the University of São Paulo (AF-UH). It is being based on information collected through an interview conducted with the patient or its caregiver. Medication adherence is assessed by the proportion of the prescribed drugs used in concordance with the prescription. Here it is presented the results of a pilot study. Thirty patients were included in the pilot study of which 23 (76.7%) were female and 7 (23.3%) males. The mean(SD) age, number of dwelling relatives, living children and prescribed drugs was, respectively, 86(5) years, 3(2), 3(2) and 6(3). The AF-UH consultation is the only regular physician encounter for 60.7% of the patients. Out of 30 patients, 5 (16.7%) live alone. Medication is a caregiver responsibility in 22 (73.4%) patients; the others (26.6%) self-administer their medicines. 13 (43.3%) of patients regularly use at least one drug not prescribed. Dementia was present in 8 patients all of which have a caregiver responsible for the management and,or the administration of the medicines; on the other hand, only 4 of the 22 nondemented patients (18.2%) have assistance of a caregiver (p<.001). The mean(SD) number of prescribed drugs was higher in nondemented patients [6.5(2.4)] than in those with dementia[3.5(2.3)] (p=.004). Educational level was similar between caregivers and patients (p=.503) as well as between caregivers of demented and non demented patients (p=.582). Among patients without dementia, those with caregiver assistance pre-presented the same mean(SD) medication adherence [0.93(0.14)] than those without it [0.78(0.28)] (p=.305). When compared to nondemented patients without caregivers, demented patients showed higher medication adherence [1.00(0.00)] (p=.013) since all of them used their drugs as recommended. The lower number of prescribed drugs and caregiver assistance seem to play an important role in the adherence of pharmacotherapy of demented patients in the studied population.

Frailty criteria and cognitive performance are related: data from the fibra study in Ermelino Matarazzo, São Paulo, Brazil

Objectives: To assess the relationship between the CHS frailty criteria (Fried et al., 2001) and cognitive performance. Design: Cross sectional and population-based. Setting: Ermelino Matarazzo, a poor sub district of the city of Sao Paulo, Brazil. Participants: 384 community dwelling older adults, 65 and older. Measurements: Assessment of the CHS frailty criteria, the Brief Cognitive Screening Battery (memorization of 10 black and white pictures, verbal fluency animal category, and the Clock Drawing Test) and the Mini-Mental State Examination (MMSE). Results: Frail older adults performed significantly lower than non-frail and pre frail elderly in most cognitive variables. Grip strength and age were associated to MMSE performance, age was associated to delayed memory recall, gait speed was associated to verbal fluency and CDT performance, and education was associated to CDT performance. Conclusion: Being frail may be associated with cognitive decline, thus, gerontological assessments and interventions should consider that these forms of vulnerability may occur simultaneously.

Síndrome de fragilidade relacionada à incapacidade funcional no idoso

OBJETIVOS: Caracterizar o perfil sociodemográfico de idosos, verificar os níveis de fragilidade segundo sexo, independência funcional e atividades instrumentais da vida diária e correlacionar as dimensões da Medida da Independência Funcional e Atividades Instrumentais da Vida Diária com idade, escolaridade, fragilidade e morbidades. MÉTODOS: Estudo de natureza observacional e transversal utilizando amostra de 240 idosos que residiam em Ribeirão Preto, São Paulo. O período de coleta foi de novembro/2010 e fevereiro/2011. Os questionários: perfil sociodemográfico, Escala de Fragilidade de Edmonton, Medida da Independência Funcional e Escala de Lawton e Brody foram utilizados. Para análise, foram empregados a estatística descritiva e o teste t-student e Pearson. RESULTADOS: A média de idade foi de 73,5 anos (±8,4), 57,5% eram casados, 39,1% apresentaram algum nível de fragilidade. Entre os idosos frágeis, 29,8% tinham dependência mínima/supervisão, e 81,9% dependência parcial para as atividades instrumentais da vida diária. CONCLUSÃO: Evidenciou-se maior dependência para as atividades nos idosos frágeis, sendo o sexo feminino com maior prevalência de fragilidade.

Sobrecarga de trabalho em cuidadores de idosos fragilizados que vivem no domicílio

OBJETIVOS: Avaliar a sobrecarga dos cuidadores de idosos fragilizados que residem no domicílio; caracterizar os idosos que são considerados frágeis e seus cuidadores; avaliar o grau de dependência dos idosos de acordo com o nível de fragilidade e correlacioná-lo com a sobrecarga de trabalho dos seus cuidadores. MÉTODOS: Estudo transversal com amostra de 60 cuidadores e de idosos frágeis, que viviam no domicílio. A coleta de dados realizada no domicílio com idosos frágeis e seus cuidadores. Utilizaram-se os instrumentos de perfil sociodemográfico do idoso e do cuidador, a Escala de Fragilidade de Edmonton, a Medida da Independência Funcional para os idosos e a Escala Zarit Burden Interview, para os cuidadores. Para a análise foram empregados a estatística descritiva e o teste de Pearson. RESULTADOS: A maioria dos cuidadores era do sexo feminino (75%), casados (58,3%) e, 45% eram filhos. Quanto à sobrecarga, 31,7% responderam que raramente se sentiam sobrecarregados. Mas, houve correlação entre a fragilidade e a sobrecarga, ou seja, quanto maior o nível de fragilidade, maior a sobrecarga do cuidador. CONCLUSÃO: Evidenciou-se a maioria dos cuidadores do sexo feminino e quanto maior o grau de dependência funcional, maior o grau de fragilidade o que eleva o nível de sobrecarga do cuidador.

Exercício resistido em idosos frágeis: uma revisão da literatura

INTRODUÇÃO: A síndrome da fragilidade, bastante comum em pessoas de idade avançada, consiste em um conjunto de sinais e sintomas no qual estão presentes critérios como perda de peso corporal não intencional em um ano (aproximadamente 5%), diminuição na velocidade da marcha, níveis baixos de atividade física, exaustão subjetiva e diminuição de força muscular. Os consequentes efeitos dessas mudanças relacionadas à idade, que incluem sarcopenia, disfunção imunológica e desregulação neuroendócrina, aumentam a vulnerabilidade do organismo ao estresse, reduzindo a habilidade de adaptar, compensar ou modular esses estímulos. Diferentes intervenções têm sido propostas para atenuar esse processo, sendo o exercício resistido (ER) uma das opções estudadas. OBJETIVO: Realizar uma revisão bibliográfica averiguando os efeitos dos ER na fisiopatologia da síndrome da fragilidade. MATERIAIS E MÉTODOS: Foi realizada uma revisão bibliográfica do período de 2004 a 2010, por meio das bases de dados LILACS, MEDLINE e PubMed. RESULTADOS: Por meio das análises dos estudos, foram observadas alterações nos sistemas hormonal e imune, atuando de forma sistêmica na reversão ou minimização dos efeitos da sarcopenia exercendo influência positiva na síndrome da fragilidade. CONCLUSÃO: O ER deve ser indicado como opção terapêutica para idosos frágeis ou pré-frágeis que não apresentem contraindicações para realização desta modalidade de exercício.