Effect of Exercise Programs on Physical Performance in Community-Dwelling Older Adults with and without Frailty: Systematic Review and Meta-Analysis

BACKGROUND

The measurement of physical performance constitutes an indicator of the physical functional capacity of older adults with and without frailty.

AIM

To present a synthesis of knowledge on the effect of exercise programs on physical performance in older adults with and without frailty in the community.

METHOD

A systematic review was carried out in accordance with the PRISMA-2020 criteria. The search for articles was made until 4 May 2023 in PubMed, Scopus, Web of Science, Cochrane Library, SciELO and LILACS. The outcome variable was physical performance, measured through the SPPB (Short Physical Performance Battery). The mean difference (MD) was estimated to evaluate the effect.

RESULT

We found 2483 studies, of which 12 met the eligibility criteria for the systematic review and 9 for the meta-analysis. The effect of exercise on SPPB scores was significantly higher in the exercise group compared to control in non-frail older adults with MD = 0.51 [95% CI, 0.05 to 0.96, p < 0.05]. Likewise, in older adults with frailty, the effect of exercise on the global SPPB score was significantly higher in the exercise group compared to the control with MD = 0.66 [95% CI, 0.09 to 1.24, p < 0.05].

CONCLUSION

Our findings suggest that exercise programs are effective in increasing and/or maintaining physical performance in older adults with and without frailty, whose effect is more evident in older adults with frailty, probably due to the greater margin of recovery of intrinsic capacity. This systematic review shows the differentiated effect of exercise training on physical performance in older adults with and without frailty. Scientific evidence reinforces the importance of implementing physical exercise programs in all older adults, including those who are frail. However, it is necessary to specify the types and doses (duration, frequency and intensity), for individualized groups, previously grouped according to the SPPB score.

Advanced Activities of Daily Living in Community-Dwelling Older Adults: A Cross-Sectional Study of the Mexican Health and Aging Study (MHAS 2018)

BACKGROUND

The advanced activities of daily living (AADLs) in old age is a key indicator of the mobility domain for the intrinsic capacity of older adults living in the community; for this reason, it is relevant to know the prevalence and risk factors related to performing fewer AADLs in different populations.

AIM

To determine the prevalence and factors associated with the ability to perform AADLs in older adults reported in the Mexican Study of Health and Aging (MSHA 2018).

METHODS

A secondary cross-sectional analysis of the MSHA 2018 data was carried out, including a convenience sample of 6474 subjects ≥ 60 years of age, for both sexes, without cognitive deficits. Nine questions related to AADLs were selected from the database. Multiple logistic regression analysis was performed to determine factors associated with <3 AADLs, including sociodemographic, lifestyle, and health status factors.

RESULTS

The prevalence of the ability to perform <3 AADLs was 63%. Age is the most important risk factor for <3 AADLs, which increases by the decade, followed by sedentary lifestyle (OR = 2.15, 95% CI: 1.91-2.42, p < 0.0001).

CONCLUSIONS

Our findings suggest that age, schooling, urban residence, sedentary lifestyle, and comorbidity are the main risk factors for <3 AADLs in older Mexican adults.

Detection of Insomnia and Its Relationship with Cognitive Impairment, Depression, and Quality of Life in Older Community-Dwelling Mexicans

Sleep disturbances are one of the most frequent health problems in old age, among which insomnia stands out. It is characterized by difficulty falling asleep, staying asleep, frequent awakenings, or waking up too early and not having restful sleep, which may be a risk factor for cognitive impairment and depression, affecting functionality and quality of life. Insomnia is a very complex multifactorial problem that requires a multi- and interdisciplinary approach. However, it is frequently not diagnosed in older community-dwelling people, increasing the risk of psychological, cognitive, and quality of life alterations. The aim was to detect insomnia and its relationship with cognitive impairment, depression, and quality of life in older community-dwelling Mexicans. An analytical cross-sectional study was carried out in 107 older adults from Mexico City. The following screening instruments were applied: Athens Insomnia Scale, Mini-Mental State Examination, Geriatric Depression Scale, WHO Quality of Life Questionnaire WHOQoL-Bref, Pittsburgh Sleep Quality Inventory. The frequency of insomnia detected was 57% and its relationship with cognitive impairment, depression, and low quality of life was 31% (OR = 2.5, 95% CI, 1.1-6.6. p < 0.05), 41% (OR = 7.3, 95% CI, 2.3-22.9, p < 0.001), and 59% (OR = 2.5, 95% CI, 1.1-5.4, p < 0.05), respectively. Our findings suggest that insomnia is a frequent clinical disorder that is not diagnosed and a significant risk factor for cognitive decline, depression, and poor quality of life.

Relationship between Self-Perception of Aging and Quality of Life in the Different Stages of Reproductive Aging in Mexican Women

Biological aging has an abrupt beginning in women, changing their body and perceptions, which are not accepted easily because the actual stereotypes are focused on youth and anti-aging. Our interest was to explore what the self-perception of aging (SPA) is in middle-aged women throughout the reproductive aging stages and their association with the quality of life. A cross-sectional study was conducted with 240 women (40−69 years) living in Mexico City, who were separated according to their reproductive aging stage. An electronic version of the Spanish version of the Self-rated Attitudes Towards Old Age (SATO) and the WHO Quality of Life-Bref (WHOQoL) was applied to these women and was sent by WhatsApp or email. Seventeen women of the total sample (7%) had a negative self-perception of aging. There is an association between SATO and WHOQoL (r = −0.273, p < 0.0001), but in the menopausal transition stage, the association is strong in the psychological subscale, and after menopause, early and late postmenopausal women show a better association in the social subscale. Negative SPA impacts the WHOQoL psychological dimension and not the total WHOQoL score. Our findings suggest an association between SPA and quality of life in different reproductive aging stages.

Relationship between oxidative stress and muscle mass loss in early postmenopause: an exploratory study

BACKGROUND

Endocrine changes due to menopause have been associated to oxidative stress and muscle mass loss. The study objective was to determine the relationship between both variables in early postmenopause.

MATERIAL AND METHODS

An exploratory, cross-sectional study was conducted in 107 pre- and postmenopausal women (aged 40-57 years). Levels of serum lipid peroxides and uric acid and enzymes superoxide dismutase and glutathione peroxidase, as well as total plasma antioxidant capacity were measured as oxidative stress markers. Muscle mass using bioelectrical impedance and muscle strength using dynamometry were also measured. Muscle mass, skeletal muscle index, fat-free mass, and body mass index were calculated.

RESULTS

More than 90% of participants were diagnosed with overweight or obesity. Postmenopausal women had lower values of muscle mass and strength markers, with a negative correlation between lipid peroxide level and skeletal muscle index (r= -0.326, p<.05), and a positive correlation between uric acid and skeletal muscle index (r=0.295, p<.05). A multivariate model including oxidative stress markers, age, and waist circumference showed lipid peroxide level to be the main contributor to explain the decrease in skeletal muscle mass in postmenopause, since for every 0.1μmol/l increase in lipid peroxide level, skeletal muscle index decreases by 3.03 units.

CONCLUSION

Our findings suggest an association between increased oxidative stress and muscle mass loss in early postmenopause.

[Postmenopausal symptoms severity enhancement oxidative stress in women with metabolic syndrome]

BACKGROUND

Oxidative stress is a serious imbalance between the reactive oxygen species (ROS) produced and the antioxidant systems, and has been identified to cause metabolic syndrome. Postmenopausal women (POS) with severe symptoms have higher oxidative stress; therefore it is possible to observe higher oxidative stress in postmenopausal women with metabolic syndrome and severe menopause related symptoms.

OBJECTIVE

To determinate if the severe postmenopausal symptoms increased oxidative stress in women with metabolic syndrome.

METHODS

We carry out a cross-sectional study with POS, 48 with metabolic syndrome and 52 healthy. Control group was defined as women heealthy and without severe symptoms (H-SS). Metabolic syndrome was defined according to criteria established by NCEP-ATPIII. We measured lipoperoxides by the TBARS assay as oxidative stress marker. All women answered the Menopause Rating Scale (MRS) that evaluates the severity of global symptoms in three dimensions: psychological, somatic and urogenital; and the Athens Insomnia Scale (AIS). In each questionnaire was used a cutoff value to determine the severity of symptoms and alternative cut-off value for lipoperoxides > or =0.320 mol/L.

RESULTS

The prevalence of high plasma lipoperoxides levels was higher in women with metabolic syndrome (WMS), 39 [81%] vs. 33 [64%], p < 0.05. The WMS, independent of severe symptoms (SS), had high lipoperoxides levels, similar to H+SS, except in urogenital MRS dimen- sion and AIS. The risk of higher lipoperoxides increased with MS and severe symptoms RM=6.32, 95% CI: 1.32-30.20, p < 0.05, adjusted by others pro-oxidants factors.

CONCLUSION

Our findings suggest that the severity of menopausal related symptoms increased oxidative stress in women with metabolic syndrome.

Implementation of an active aging model in Mexico for prevention and control of chronic diseases in the elderly

Background

World Health Organization cites among the main challenges of populational aging the dual disease burden: the greater risk of disability, and the need for care. In this sense, the most frequent chronic diseases during old age worldwide are high blood pressure, type 2 diabetes mellitus, cancer, arthritis, osteoporosis, depression, and dementia. Chronic disease-associated dependency represents an onerous sanitary and financial burden for the older adult, the family, and the health care system. Thus, it is necessary to propose community-level models for chronic disease prevention and control in old age. The aim of the present work is to show our experience in the development and implementation of a model for chronic disease prevention and control in old age at the community level under the active aging paradigm.

Methods/Design

A longitudinal study will be carried out in a sample of 400 elderly urban and rural-dwelling individuals residing in Hidalgo State, Mexico during five years. All participants will be enrolled in the model active aging. This establishes the formation of 40 gerontological promoters (GPs) from among the older adults themselves. The GPs function as mutual-help group coordinators (gerontological nuclei) and establish self-care and self-promotion actions for elderly well-being and social development. It will be conformed a big-net of social network of 40 mutual-help groups of ten elderly adults each one, in which self-care is a daily practice for chronic disease prevention and control, as well as for achieving maximal well-being and life quality in old age. Indicators of the model's impact will be (i) therapeutic adherence; (ii) the incidence of the main chronic diseases in old age; (iii) life expectancy without chronic diseases at 60 years of age; (iv) disability adjusted life years lost; (v) years of life lost due to premature mortality, and (vi) years lived with disability.

Discussion

We propose that the implementation of the model active aging framework will permits the empowerment of older adults, which constitutes basic social capital for chronic disease prevention and control in old age.

Undernutrition and oxidative stress as risk factors for high blood pressure in older Mexican adults

OBJECTIVE

To determine the relationship between undernutrition and oxidative stress as risk factors for high blood pressure (HBP) in older Mexican adults. We carried out a case-control study in a convenience sample of 62 older adults, 60-80 years of age; 32 without HBP (mean age 75.8 +/- 5.1 years) and 30 with HBP (mean age 65.2 +/- 6.8 years).

METHODS

We measured serum lipoperoxide (LPO) levels, antioxidant enzymes, total antioxidant activity and lipid profile; in addition, we evaluated the nutritional status with anthropometric measurements, the Mini Nutritional Assessment and food intake frequency. Data were analyzed with Student t and odds ratio (OR) statistical tests.

RESULTS

We observed significantly higher LPO levels in subjects with HBP than in normotensive subjects (0.303 +/- 0.10 vs. 0.256 +/- 0.06 micromol/l; p < 0.05). With respect to risk factors for HBP, we found an OR of 12.2 (95% CI 1.9-76.4, p < 0.01) in subjects with high LPO levels (> or = 0.320 micromol/l) and an OR of 5.0 (95% CI 1.1-23.0, p < 0.05) in those with undernutrition.

CONCLUSION

Our findings suggest that high LPO levels and undernutrition are significant risk factors for HBP.

Program of active aging in a rural Mexican community: a qualitative approach

Background

Education is one of the key elements in the promotion of a thorough paradigm for active aging. The aim of this study is to analyze factors that contribute the empowerment of older adults in a rural Mexican community and, thus, promote active aging.

Methods

The study was conducted in a rural Mexican community (Valle del Mezquital), based on an action-research paradigm. One hundred and fifty-five elderly subjects with elementary school education participated in a formal training program promoting gerontological development and health education. Participants in turn became coordinators of mutual-help groups (gerontological nucleus) in Mexico. In-depth interviews were carried out to assess the empowerment after training for active aging.

Results

It was found that there was an increasing feeling of empowerment, creativity and self-fulfillment among participants. Among the main factors that positively influenced training of the elderly toward active aging were the teaching of gerontology topics themselves; besides, their motivation, the self-esteem, the increased undertaking of responsibility, the feeling of belonging to the group, and the sharing of information based on personal experience and on gerontological knowledge.

Conclusion

The main factors that contribute to empowerment of older adults in a rural Mexican community for participate in active aging programs are the training and teaching of gerontology topics themselves; besides, their interest, experience and involvement.

Perceptions on the importance of gerontological education by teachers and students of undergraduate health sciences

BACKGROUND

The main challenge of higher education institutions throughout the world is to develop professionals capable of understanding and responding to the current social priorities of our countries. Given the utmost importance of addressing the complex needs of an increasingly elderly population in Mexico, the National Autonomous University of Mexico has systematically incorporated modules dealing with primary gerontological health care into several of its undergraduate programs in health sciences. The objective of this study was to analyze teacher's and student's perceptions about the current educational practices on gerontology.

METHODS

A cross-sectional study was carried out with a sample of 26 teachers and 122 undergraduate students. Subjects were administered interviews and responded survey instrument.

RESULTS

A vast proportion of the teachers (42%) reported students' attitudes towards their academic training as the most important factor affecting learning in the field of gerontology, whereas students reported that the main problems of education in gerontology were theoretical (32%) and methodological (28%). In addition, 41% of students considered education on ageing matters as an essential element for their professional development, as compared to 19% of teachers (p < 0.05).

CONCLUSION

Our findings suggest that the teachers' perceptions about the low importance of education on ageing matters for the professional practice of health sciences could be a negative factor for gerontology teaching.

Hyperleptinemia as a risk factor for high blood pressure in the elderly

CONTEXT

Studies have demonstrated that high serum leptin levels are associated with aging. However, we do not know whether hyperleptinemia is a relevant risk factor for high blood pressure (HBP) in the elderly.

OBJECTIVE

To determine the relationship between hyperleptinemia and HBP in the elderly.

DESIGN

A comparative cross-sectional study was carried out in a convenience sample of 70 healthy elderly persons comprising 46 women (mean age, 67 +/- 5.8 years) and 24 men (mean age, 73 +/- 7.5 years), and a group of 91 elderly persons with HBP, comprising 62 women (mean age, 67 +/- 8.2 years) and 29 men (mean age, 70 +/- 0.3 years). We measured serum leptin levels through the radioimmunoassay method.

RESULTS

The elderly subjects with HBP had significantly higher leptin levels than the healthy elderly subjects (P = .02). Furthermore, in female elderly subjects we observed a statistically significant correlation between systolic blood pressure and leptin (r = 0.37, P = .003), as well as systolic blood pressure and age (r = 0.29, P = .02), but not with diastolic blood pressure. In male elderly subjects, there was no correlation between leptin and systolic blood pressure or leptin and diastolic blood pressure. However, hyperleptinemia as risk factor for HBP was nearly 5 times higher in men than in women (men, odds ratio = 18.0, 95% confidence interval 3.2-100.9, P < .001 vs women, odds ratio = 3.33, 95% confidence interval 1.4-7.4, P = .003).

CONCLUSIONS

Our data suggest that hyperleptinemia was a significant risk factor for HBP elderly individuals, mainly in men.

Equations for predicting height for elderly Mexican Americans are not applicable for elderly Mexicans

Common indices for the assessment of nutritional status take height into account. Elderly individuals are frequently unable to assume the position needed for this measurement. Therefore, equations have been developed for predicting height in elderly American Whites, American Blacks, and Mexican Americans using knee height as a predictor. These equations may not be applicable for the elderly in other populations. A sample of 736 individuals was studied (186 males, 550 females) with a mean age of 74.7 +/- 8 years. Height and knee height (without shoes) were measured in millimeters. Multiple regression and cross-validation was performed. The correlation between knee height and standing height was similar in women (r = 0.86; P < 0.0001) and men (r = 0.83; P < 0.0001). The equations obtained were as follows: men (height in cm) = 52.6 + (2.17 x knee height in cm) and women (height in cm) = 73.7 + (1.99 x knee height in cm) - (0.23 x age in years). Cross-validation showed that the pure error was less than the root mean square error (RMSE) in both sexes. Mean heights, based on the equations of Chumlea et al. (1998) for Mexican Americans significantly differ from the reference values for females and males. Therefore, the equations developed by Chumlea et al. (1998) for elderly Mexican Americans do not appear to be applicable for elderly Mexicans.