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Levasseur M, Lussier-Therrien M, Biron ML, Dubois MF, Boissy P, Naud D, Dubuc N, Coallier JC, Calvé J, Audet M. Scoping study of definitions and instruments measuring vulnerability in older adults. J Am Geriatr Soc 2021; 70:269-280. [PMID: 34669967 DOI: 10.1111/jgs.17451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/02/2021] [Accepted: 08/08/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND It is important to foster social participation and health equity, especially for older adults in situations of vulnerability. Despite growing interest in vulnerability, there is no consensus regarding how to define or measure this concept. This paper provides an inventory and synthesis of definitions of and instruments measuring vulnerability in older adults. METHODS Using a scoping study framework, eight databases (Abstracts in Social Gerontology, Academic Search Complete, AgeLine, CINAHL, MEDLINE, SocINDEX, PsycInfo, Scopus) were searched with relevant keywords [Vulnerab* AND (Concept*, Defin*, Meaning, Terminology, Measurement, Assessment*, Indicator*, Instrument*, Scale*, Questionnaire* OR Test*) AND (Aging, Aging, Elder*, Gerontolog*, Older OR Senior*)]. RESULTS Thirty-one original definitions and five measuring instruments were identified, content-analyzed, and compared. Vulnerability definitions mostly focused on people under conditions that increased their risk of harm because of individual physical factors, the environment, and their interaction. Considering these definitions, experts in the field of aging, including two representing older adults, participated in a workshop, and a consensus was reached to define a situation of vulnerability as "a set of circumstances in which one or more individuals experience, at a specific moment in time, one or multiple physiological, psychological, socioeconomic or social difficulties that may interact to increase their risk of being harmed or having coping challenges that have a negative impact on their life." Although none of the measures fully targeted this definition, the Perceived Vulnerability Scale (PVS) is one of the most complete measures, with 22 items considering feelings of vulnerability toward personal and environmental factors, and good psychometric properties. CONCLUSIONS The proposed definition and the PVS help to provide a common language and measure in health and social sciences research, policy and practice identifying and reaching older adults in situations of vulnerability and intervening to foster social participation and health equity.
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Affiliation(s)
- Mélanie Levasseur
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Marika Lussier-Therrien
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada
| | - Marie Lee Biron
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada
| | - Marie-France Dubois
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Patrick Boissy
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,Department of Surgery, Orthopedic Division, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Daniel Naud
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada
| | - Nicole Dubuc
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jean-Claude Coallier
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada.,Department of Career Counseling, Faculty of Education, Université de Sherbrooke, Québec, Canada
| | | | - Mélisa Audet
- Research Centre on Aging, Eastern Townships Integrated University Health and Social Services Centre - Sherbrooke University Hospital Centre, Québec, Canada
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de Assis FC, da Silva MCO, Geber-Júnior JC, Roschel H, Peçanha T, Drager LF, Santana ANC. Association of health vulnerability with adverse outcomes in older people with COVID-19: a prospective cohort study. Clinics (Sao Paulo) 2021; 76:e3369. [PMID: 34878031 PMCID: PMC8610221 DOI: 10.6061/clinics/2021/e3369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/03/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Health vulnerability is associated with a higher risk of mortality and functional decline in older people in the community. However, few studies have evaluated the role of the Vulnerable Elders Survey (VES-13) in predicting clinical outcomes of hospitalized patients. In the present study, we tested the ability of the VES-13 to predict mortality and the need for invasive mechanical ventilation in older people hospitalized with coronavirus disease 2019 (COVID-19). METHODS This prospective cohort included 91 participants aged ≥60 years who were confirmed to have COVID-19. VES-13 was applied, and the demographic, clinical, and laboratory variables were collected within 72h of hospitalization. A Poisson generalized linear regression model with robust variance was used to estimate the relative risk of death and invasive mechanical ventilation. RESULTS Of the total number of patients, 19 (21%) died and 15 (16%) required invasive mechanical ventilation. Regarding health vulnerability, 54 (59.4%) participants were classified as non-vulnerable, 30 (33%) as vulnerable, and 7 (7.6%) as extremely vulnerable. Patients classified as extremely vulnerable and male sex were strongly and independently associated with a higher relative risk of in-hospital mortality (p<0.05) and need for invasive mechanical ventilation (p<0.05). CONCLUSION Elderly patients classified as extremely vulnerable had more unfavorable outcomes after hospitalization for COVID-19. These data highlight the importance of identifying health vulnerabilities in this population.
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Affiliation(s)
- Fábio Cavalcante de Assis
- Departamento de Clinica Medica, Disciplina de Medicina de Emergencia, Faculdade de Medicina, Universidade de Brasília (UnB), Brasilia, DF, BR
- Time de Resposta Rapida, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Unidade de Terapia Intensiva Cardiologica, Departamento de Cardiopneumologia, Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Escola de Ciencias da Saude (ESCS), Brasilia, DF, BR
- Corresponding author. E-mail:
| | - Michelle Cristina-Oliveira da Silva
- Departamento de Clinica Medica, Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Grupo de Pesquisa em Fisiologia Aplicada e Nutricao, Escola de Educacao Fisica e Esporte, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - João Carlos Geber-Júnior
- Departamento de Clinica Medica, Disciplina de Clinica Geral e Propedeutica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Hamilton Roschel
- Departamento de Clinica Medica, Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Grupo de Pesquisa em Fisiologia Aplicada e Nutricao, Escola de Educacao Fisica e Esporte, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tiago Peçanha
- Departamento de Clinica Medica, Disciplina de Reumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Grupo de Pesquisa em Fisiologia Aplicada e Nutricao, Escola de Educacao Fisica e Esporte, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciano Ferreira Drager
- Unidade de Hipertensao, Disciplina de Nefrologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Unidade de Hipertensao, Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Cabral JF, Silva AMCD, Andrade ACDS, Lopes EG, Mattos IE. Vulnerabilidade e Declínio Funcional em pessoas idosas da Atenção Primária à Saúde: estudo longitudinal. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2021. [DOI: 10.1590/1981-22562021024.200302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Avaliar a associação da vulnerabilidade e o declínio funcional para Atividades Instrumentais de Vida Diária (AIVD) em pessoas idosas atendidas em unidades da Atenção Primária à Saúde (APS) no município de Várzea Grande (MT), Brasil. Método Estudo longitudinal realizado com 304 pessoas idosas, com acompanhamento de 24 meses. A variável de exposição principal, vulnerabilidade, foi mensurada na linha de base utilizando-se o Vulnerable Elders Survey (VES-13). A variável dependente foi “declínio funcional em AIVD”, definido como a diminuição de pelo menos um ponto no score de capacidade funcional, avaliada pela Escala de Lawton e Brody, entre a coleta da linha de base e o follow-up. As associações entre declínio funcional em AIVD e vulnerabilidade, condições de saúde, fatores sociodemográficos, autoavaliação de saúde, estilo de vida e eventos adversos em saúde foram estimadas por meio do Odds Ratio (OR), utilizando regressão logística binária. Resultados 35,20% das pessoas idosas apresentaram declínio da capacidade funcional em AIVD. O declínio funcional se associou no modelo final com a interação entre vulnerabilidade e inatividade física (OR=3,12, IC95%, 1,42-6,86), insatisfação com a vida (OR=2,23, IC95%, 1,09-4,56) e hospitalização (OR=2,01, IC95%, 1,18-3,41). Conclusão O declínio funcional em AIVD foi maior nas pessoas idosas vulneráveis que estavam inativas fisicamente, naquelas insatisfeitas com a vida e que foram hospitalizadas durante o período de seguimento, sendo importante que essas condições sejam identificadas precocemente, para que ações de prevenção de declínio funcional sejam implementadas, além dos programas de incentivo à prática de atividade física pelas pessoas idosas.
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Cabral JF, Silva AMCD, Mattos IE, Neves ÁDQ, Luz LL, Ferreira DB, Santiago LM, Carmo CND. Vulnerability and associated factors among older people using the Family Health Strategy. CIENCIA & SAUDE COLETIVA 2019; 24:3227-3236. [PMID: 31508743 DOI: 10.1590/1413-81232018249.22962017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 01/29/2018] [Indexed: 02/06/2023] Open
Abstract
The objective of this study was to analyze the prevalence of vulnerability and associated factors among older people using family health strategies in Várzea Grande, Brazil. A cross-sectional study was performed with 377 community-dwelling older people. The dependent variable, vulnerability, was assessed using the Vulnerable Elders Survey. The independent variables included sociodemographic characteristics and the health status of the study population assessed using the following validated instruments: the Mini-Mental State Examination; Katz ADL scale and Lawton and Brody IADL scale; Geriatric Depression Scale; and Mini Nutritional Assessment Short-Form. Bivariate analysis was conducted using the Mantel-Haenszel chi-squared test with prevalence ratios and multivariate analysis was performed using Poisson regression. The data showed that 49% of the study population were vulnerable. The variables that showed the strongest association with vulnerability were dependence in IADLs (PR = 4.43), presence of depressive symptoms (PR = 1.34), and being aged 80 and over (PR = 1.34). The prevalence of vulnerability found by the present study was high when compared to other studies with community-dwelling older people. The VES-13 was shown to be easy to use in primary healthcare settings and particularly practical for screening vulnerability among older people.
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Affiliation(s)
- Juliana Fernandes Cabral
- Departamento de Enfermagem, Universidade do Estado de Mato Grosso (Unemat). R. 05, 367w, Centro. 78.300-000 Tangará da Serra MT Brasil.
| | | | - Inês Echenique Mattos
- Departamento de Epidemiologia, Escola Nacional de Saúde Pública. Rio de Janeiro RJ Brasil
| | - Ádila de Queiroz Neves
- Coordenação de Assistência e Saúde do Trabalhador, Universidade Federal de Mato Grosso (UFMT). Cuiabá MT Brasil
| | - Laércio Lima Luz
- Hospital de Base, Instituto de Gestão Estratégica de Saúde. Brasília DF Brasil
| | | | - Lívia Maria Santiago
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Albach CA, Wagland R, Hunt KJ. Cross-cultural adaptation and measurement properties of generic and cancer-related patient-reported outcome measures (PROMs) for use with cancer patients in Brazil: a systematic review. Qual Life Res 2017; 27:857-870. [PMID: 28887596 PMCID: PMC5874274 DOI: 10.1007/s11136-017-1703-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2017] [Indexed: 12/14/2022]
Abstract
Purpose This systematic review (1) identifies the current generic and cancer-related patient-reported outcome measures (PROMs) that have been cross-culturally adapted to Brazilian Portuguese and applied to cancer patients and (2) critically evaluates their cross-cultural adaptation (CCA) and measurement properties. Methods Seven databases were searched for articles regarding the translation and evaluation of measurement properties of generic and cancer-related PROMs cross-culturally adapted to Brazilian Portuguese that are applied in adult (≥18 years old) cancer patients. The methodological quality of included studies was assessed using the COSMIN checklist. Results The bibliographic search retrieved 1674 hits, of which seven studies analysing eight instruments were included in this review. Data on the interpretability of scores were poorly reported. Overall, the quality of the CCA process was inconsistent throughout the studies. None of the included studies performed a cross-cultural validation. The evidence concerning the quality of measurement properties is limited by poor or fair methodological quality. Moreover, limited information regarding measurement properties was provided within the included papers. Conclusions This review aids the selection process of Brazilian Portuguese PROMs for use in cancer patients. After acknowledging the methodological caveats and strengths of each tool, our opinion is that for quality of life and symptoms assessment the adapted FACT-G version and the ESAS could be recommended, respectively. Future research should rely on the already accepted standards of CCA and validation studies. Electronic supplementary material The online version of this article (doi:10.1007/s11136-017-1703-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos Augusto Albach
- Faculty of Health Sciences, University of Southampton, University Road, Southampton, Hampshire SO17 1BJ UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, Hampshire SO17 1BU UK
| | - Katherine J. Hunt
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, Hampshire SO17 1BU UK
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SARAIVA DDCA, AFONSO WV, PINHO NBD, PERES WAF, PADILHA PDC. Cross-cultural adaptation and content validation into Portuguese of the Subjective Global Nutritional Assessment for pediatric patients hospitalized with cancer. REV NUTR 2017. [DOI: 10.1590/1678-98652017000300004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
ABSTRACT Objective Cross-cultural adaptation and content validation of the Brazilian Portuguese version of the Subjective Global Nutritional Assessment questionnaire (originally in English) for use in hospitalized children and adolescents being treated in a reference institute of oncology. Methods The cross-cultural adaptation process consisted of the following stages: conceptual, item, semantic, and operational equivalence. The conceptual equivalence and item was carried out through discussion with members of an expert committee. Semantic equivalence was evaluated through initial translation, synthesis of translations, back translation, discussions with experts, and pretest with 32 patients. During operational equivalence, the experts discussed about the format of questions and instructions, setting, target populations, and mode of administration to later propose a final version. Content validation was performed by the expert committee. Results Minor modifications were made in the instrument to facilitate its use in the Brazilian socio-cultural context. Pretest results showed that the instrument is easily understood by health care professionals and the target population. Conclusion The cross-cultural adaptation and validation of the Subjective Global Nutritional Assessment allowed obtaining a Brazilian version equivalent to the original. The adapted instrument will be an important tool for the subjective assessment of the nutritional status of pediatric patients hospitalized with cancer.
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SARAIVA DDCA, AFONSO WV, PINHO NBD, PERES WAF, PADILHA PDC. Equivalência semântica do Questionário Pediatric Subjective Global Nutritional Assessment para triagem nutricional em pacientes pediátricos com câncer. REV NUTR 2016. [DOI: 10.1590/1678-98652016000200006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objetivo: Realizar a equivalência semântica da Avaliação Nutricional Subjetiva Global Pediátrica e sua adaptação para a língua portuguesa para aplicação em pacientes pediátricos hospitalizados com câncer. Métodos: O processo de equivalência semântica envolveu as seguintes etapas: tradução, síntese das traduções, retrotradução, discussão com comitê de especialistas e pré-teste, etapas que aconteceram na Universidade Federal do Rio de Janeiro e no Instituto Nacional de Câncer José Alencar Gomes da Silva. O questionário foi pré-testado em 32 pacientes pediátricos com câncer, de 2 a 18 anos, para verificar sua adequação nessa população. Resultados: Todas as etapas fundamentaram a equivalência semântica do instrumento. Foram necessárias discretas alterações no instrumento Avaliação Nutricional Subjetiva Global Pediátrica para o contexto brasileiro. Na avaliação das 56 assertivas traduzidas para o português, 81% das respostas dos especialistas classificaram como "inalterado" o significado geral. Evidenciou-se uma boa equivalência semântica entre a tradução e a retrotradução e a versão original. Conclusão: A versão brasileira da Avaliação Nutricional Subjetiva Global Pediátrica foi bem compreendida pela população do estudo e mostrou-se adequada para seguir com as demais etapas de adaptação transcultural e validação da ferramenta para posterior aplicação na população pediátrica hospitalizada com câncer.
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Luz LL, Santiago LM, Silva JFSD, Mattos IE. Psychometric properties of the Brazilian version of the Vulnerable Elders Survey-13 (VES-13). CAD SAUDE PUBLICA 2015; 31:507-15. [DOI: 10.1590/0102-311x00011714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 11/06/2014] [Indexed: 11/22/2022] Open
Abstract
This study aims to assess the psychometric properties of the Brazilian version of the Vulnerable Elders Survey-13 (VES-13). Interviews were carried out with individuals aged 60 years and over receiving care at an ambulatory cancer centre. Test-retest reliability was assessed using the Spearman correlation coefficient, intraclass correlation coefficients and Cohen's kappa coefficient. Construct validity was assessed by testing convergent and discriminant validity using principal component analysis and Varimax rotation. The Spearman correlation coefficient value of the comparison between test and retest scores was 0.98 (p < 0.001). All intraclass correlation coefficient values were higher than 0.60 and kappa coefficients varied between 0.33 and 0.94. Three identified factors explained 72.6% of overall sample variance. VES-13 presented good convergent validity and reasonable discriminant validity. The psychometric properties of the adapted version of the VES-13 are consistent and adequate for use with the Brazilian population.
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Luz L, Santiago L, da Silva J, Mattos I. Psychometric properties of the Brazilian version of the vulnerable elders survey 13 (VES-13). J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mattos I, Luz L, Ferreira D, Rodrigues G, Santiago L. Consistency and stability of vulnerable elders survey 13 (VES-13) scores in a sample of older patients treated for non-Hodgkin lymphoma. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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