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Batista PP, Perracini MR, do Carmo Correia de Lima M, de Amorim JSC, Pereira DS, Pereira LSM. Risk of sarcopenia and mobility of older adults during the COVID-19 pandemic: the longitudinal data from the REMOBILIZE study. Aging Clin Exp Res 2024; 36:80. [PMID: 38546804 PMCID: PMC10978643 DOI: 10.1007/s40520-024-02720-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/01/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND We assessed whether clinical, functional and behavioral factors were associated with the decrease in mobility trajectories reported in older people at risk of sarcopenia (RS) and without risk of sarcopenia (NRS) during COVID-19 pandemic. METHODS We prospectively analyzed mobility trajectories reported in older adults with RS and NRS over 16-month follow-up (Remobilize study). The self-perceived risk of sarcopenia and mobility were assessed using the SARC-F and the Life-Space Assessment (LSA) tools, respectively. Gender, age, comorbidities, pain, functional limitation, physical activity (time spent in walking; min/week), and sitting time (ST; hours/day) were assessed. We used a multilevel model to determine changes in mobility between groups and over time. RESULTS Mobility was lower in RS than in NRS. Older people at RS, who were women, aged 70-79 years and 80 years or older, inactive, and with moderate to severe functional limitation experienced reduced mobility trajectories reported over the pandemic. For older people at NRS, trajectories with reduce mobility reported were experienced by women with comorbidities, for those with insufficient walking time and aged 70-79 years; aged 70-79 years and with ST between 5 and 7 hours/day; for those with insufficient walking time and increased ST; and for those with pain and increased ST. CONCLUSION Mobility trajectories reported in older people at risk of sarcopenia were negatively influenced by insufficient level of physical inactivity and pre-existing moderate to severe functional limitation. Health and social interventions should be target to avoid mobility limitation during and after the COVID-19 pandemic.
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Affiliation(s)
- Patricia Parreira Batista
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil.
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maria do Carmo Correia de Lima
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Daniele Sirineu Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil
| | - Leani Souza Máximo Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6.627. Pampulha, Belo Horizonte, MG, Brazil
- Postgraduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, MG, Brazil
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Hernandes ECR, Aliberti MJR, Guerra RO, Ferriolli E, Perracini MR. Intrinsic capacity and hospitalization among older adults: a nationally representative cross-sectional study. Eur Geriatr Med 2024:10.1007/s41999-024-00933-y. [PMID: 38491314 DOI: 10.1007/s41999-024-00933-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/04/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Monitoring intrinsic capacity (IC) in community-dwelling older people can be potentially used to alert for adverse health outcomes. However, whether there is an association between IC and hospitalization has yet to be fully explored. This study aimed to investigate the association of the IC composite measure and its 5 domains with hospitalization in the previous year and length of hospital stay. METHODS We conducted cross-sectional analyses using data from a representative sample of community-dwelling adults (≥ 65 years). We assessed the IC domains (vitality, locomotor, cognitive, sensory, and psychological) using validated self-reported information and performance tests. We calculated standardized estimated scores (z scores) for IC composite measure and domains and conducted multivariate logistic and ordinal regressions. The primary outcomes were hospitalizations in the previous year and length of hospital stay. RESULTS In a sample of 5354 participants (mean age = 73 ± 6 years), we found that participants with high IC composite z scores were less likely to have experienced hospitalization in the previous year (OR = 0.51; 95% CI = 0.44-0.58). Among those who were hospitalized, high IC scores were associated with short stays (OR = 0.87; 95% CI = 0.80-0.95). Cognitive and psychological domains were associated with hospitalizations, and the locomotor domain was related to length of hospital stay. The vitality domain was associated with both outcomes. CONCLUSION IC as a composite measure was associated with previous hospitalizations and length of stay. IC can help clinicians identify older people prone to adverse outcomes, prompting preventive integrated care interventions.
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Affiliation(s)
- Elisângela Cristina Ramos Hernandes
- Masters' and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesáreo Galeno, 448, Tatuapé, São Paulo, 03071-000, Brazil
| | - Márlon Juliano Romero Aliberti
- Laboratorio de Investigaçao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas, Disciplina de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Research Institute, Hospital Sirio-Libanes, São Paulo, Brazil
| | - Ricardo Oliveira Guerra
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Eduardo Ferriolli
- Laboratorio de Investigaçao Medica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clinicas, Disciplina de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Masters' and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesáreo Galeno, 448, Tatuapé, São Paulo, 03071-000, Brazil.
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil.
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Coelho de Amorim JS, Perracini MR, Alexandre TDS, Máximo RDO, Nascimento-Souza MA. Dynapenic Abdominal Obesity, Single and Recurrent Falls in Older Brazilian Adults: Elsi-Brazil Results. J Aging Health 2024; 36:35-45. [PMID: 37083131 DOI: 10.1177/08982643231169315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Objective: Cross-sectional study to verify the association between dynapenic abdominal obesity and the occurrence of single and recurrent falls among Brazilian adults aged 50 years and over. Methods: Baseline data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), comprising 8374 individuals aged 50 years and over, were analyzed. Participants were categorized according to the report of falls, dynapenic abdominal obesity was determined by combining the presence of abdominal obesity (waist circumference) and dynapenia (handgrip strength). A multinomial regression adjusted for multiple variables was conducted. Results: The prevalence of a fall was 10.4% (95% CI: 9.7-11.2) and 10.8% for single and recurrent (95% CI: 9.9-11.9). Dynapenic abdominal obesity was associated with a single fall (OR: 1.3; 95% CI 1.1-1.7) and showed greater strength of association with recurrent falls (OR: 2.8; 95% CI 2.1-3.8). Conclusions: Our data showed that the coexistence of abdominal obesity and dynapenia in older adults creates additional challenges for aging.
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Affiliation(s)
| | - Monica Rodrigues Perracini
- Programa de Pós-Graduação em Fisioterapia, Universidade Cidade São Paulo, São Paulo, Brasil
- Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil
| | - Tiago da Silva Alexandre
- Programa de Pós-Graduação em Fisioterapia, Universidade Federal de São Carlos, São Paulo, Brasil
- Programa de Pós-Graduação em Gerontologia, Universidade Federal de São Carlos, São Paulo, Brasil
| | | | - Mary Anne Nascimento-Souza
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz Minas, Belo Horizonte, Brasil
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Karpusenko T, Alfonsi M, Cirino NTDO, Ishigaki EY, Sanudo A, Paschoal SMP, Leme LEG, Perracini MR. Factors associated with unrecovered falls among older adults. Geriatr Nurs 2023; 51:323-329. [PMID: 37084686 DOI: 10.1016/j.gerinurse.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 04/23/2023]
Abstract
This cross-sectional exploratory study investigated factors associated with unrecovered falls among older patients with a history of falls in the previous year participating in a clinical trial on fall prevention by asking them about their inability to get up independently after the fall. Participants' sociodemographic, clinical, functional (ADL/IADL, TUG, chair-stand test, hand grip, risk of falling) and fall location were investigated. We conducted a multivariate regression analysis adjusted for covariates to identify the main factors associated with unrecovered falls. Out of 715 participants (mean age: 73.4 years; 86% women), 51.6% (95% IC; 47.9 - 55.3%) experienced unrecovered falls. Depressive symptoms, ADL/IADL limitation, mobility limitation, undernutrition, and outdoor falls were associated with unrecovered falls. While assessing the risk of falling, professionals should consider preventive strategies and preparedness procedures for those who are more likely to experience unrecovered falls, such as training to get up from the floor, alarms, and support services.
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Affiliation(s)
- Tatiana Karpusenko
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil
| | - Maynara Alfonsi
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil.
| | - Nayara Tasse de Oliveira Cirino
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Department of Physical Therapy, Universidade de Cuiabá, Avenida Virgílio Favetti, 1200, Zip code: 78.306-211, Tangará da Serra, Mato Grosso, Brazil
| | - Erika Yukie Ishigaki
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Centro Universitário Faculdade de Medicina do ABC, Avenida Lauro Gomes, 2000, Zip code: 09060-870, Santo André, Brazil.
| | - Adriana Sanudo
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Department of Preventive Medicine, Universidade Federal de São Paulo, Rua Botucatu, 740, Zip code: 04023-062, São Paulo, Brazil
| | - Sergio Marcio Pacheco Paschoal
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil
| | - Luiz Eugênio Garcez Leme
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Institute of Orthopedics and Traumatology, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil.
| | - Monica Rodrigues Perracini
- PrevQuedas Brazil Research Group, Faculty of Medicine, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, Zip code: 05403-010, São Paulo, Brazil; Master's and Doctoral Programs in Physical Therapy, Rua Cesáreo Galeno, 448, Zip code: 03071-000, São Paulo, Brazil; Master's and Doctoral Programs in Gerontology, Rua Tessália Vieira de Camargo, 126, Zip code: 13083-887, Campinas, Brazil.
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Trombini-Souza F, de Moura VTG, da Silva LWN, Leal IDS, Nascimento CA, Silva PST, Perracini MR, Sacco ICN, de Araújo RC, Nascimento MDM. Effects of two different dual-task training protocols on gait, balance, and cognitive function in community-dwelling older adults: a 24-week randomized controlled trial. PeerJ 2023; 11:e15030. [PMID: 37101796 PMCID: PMC10124542 DOI: 10.7717/peerj.15030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/19/2023] [Indexed: 04/28/2023] Open
Abstract
Background Although alternating dual-task (ADT) training is functionally easier for older adults, a large part of the motor and cognitive tasks is simultaneously performed, especially during activities of daily living that require maintaining body balance. Objective To evaluate the effects of mixed dual-task training on mobility, cognitive function, and balance in community-dwelling older adults. Methods Sixty participants were randomly allocated at a 1:1 ratio into the experimental group-single motor task (SMT) and simultaneous dual task (SDT) interchangeably in stage 1 (for 12 weeks) and after strictly with SDT in stage 2 (the last 12 weeks)-or into the control group-only SMT and SDT interchangeably in stages 1 and 2. Gait parameters were acquired by two inertial sensors. Physical and cognitive performance were acquired by specific questionnaires. Generalized linear mixed models were used for analyzing interaction and main effects. Results No between-group difference was observed for gait performance. Both protocols improved mobility (mean change ((MC) = 0.74)), dual-task effect (MC = -13.50), lower limb function (MC = 4.44), static (MC = -0.61), and dynamic balance (MC = -0.23), body sway (MC = 4.80), and cognitive function (MC = 41.69). Conclusion Both dual-task training protocols improved these outcomes.
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Affiliation(s)
- Francis Trombini-Souza
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil
- Master’s and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | | | | | - Iara dos Santos Leal
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil
- Master’s and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | | | | | - Monica Rodrigues Perracini
- Master’s and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Isabel CN Sacco
- School of Medicine, Department of Physical Therapy, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Cappato de Araújo
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil
- Master’s and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Marcelo de Maio Nascimento
- Department of Physical Education, Federal University of São Francisco Valley, Petrolina, Pernambuco, Brazil
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Fares MOA, Perracini MR, Rosa MABMV, Cunha AIL, de Souza MA, Ricci NA. Research utilisation in older people care: Translation, cross-cultural adaptation and validation of instruments into Brazilian Portuguese. Int J Older People Nurs 2023; 18:e12494. [PMID: 35842923 DOI: 10.1111/opn.12494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 01/13/2023]
Abstract
AIMS To translate and culturally validate the Estabrooks' Kinds of Research Utilization (RU) and the Conceptual Research Utilization Scale (CRU) into Brazilian Portuguese; and to describe the research use by health professionals working on Long Term Care Institutions (LTCI) for older people. BACKGROUND Research utilisation ensures greater quality and effectiveness in the care provided by health professionals. However, there are no instruments to evaluate research utilisation in Latin America countries, like Brazil. MATERIALS & METHODS A methodological cross-sectional questionnaire validity and descriptive study. The translation and adaptation of the instruments was performed in seven steps following psychometric guidelines. The instruments evaluate research utilisation by health professionals in clinical practice. The RU is composed of single-items of instrumental, persuasive, conceptual and overall forms; and the CRU the conceptual form through a 5-item scale. Professionals of technical level and graduated working in nine LTCI were evaluated from August to December 2018. Descriptive and inferential (reliability, correlation, internal consistency and structure of CRU) analyses were conducted. RESULTS Sample composed of 117 professionals, 67.5% of healthcare aides and 32.5% of graduated health professionals. All forms of research utilisation showed high implementation in practice (about 75% of the time, or frequently). CRU internal consistency (α = 0.885) and structure were adequate. There were significant correlations between RU and CRU (from very low r = 0.187 to high r = 0.712). Intra-rater, inter-rater and alternate forms reliability ranged from moderate to substantial. CONCLUSIONS The Brazilian versions of the RU and the CRU are valid, reliable and acceptable for evaluating research utilisation by professionals working on LTCI. It is of great relevance to introduce these instruments in low- and middle-income countries to have future data on how much older people care is influenced by the best evidence available. These instruments can be adapted to different healthcare settings and populations.
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Affiliation(s)
- Mainá Osório Akel Fares
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | | | - Ana Izabel Lopes Cunha
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Mariana Abacherly de Souza
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Natalia Aquaroni Ricci
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
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Beach B, Bélanger-Hardy L, Harding S, Rodrigues Perracini M, Garcia L, Tripathi I, Gillis M, Dow B. Caring for the caregiver: Why policy must shift from addressing needs to enabling caregivers to flourish. Front Public Health 2022; 10:997981. [PMID: 36339159 PMCID: PMC9626797 DOI: 10.3389/fpubh.2022.997981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/28/2022] [Indexed: 01/26/2023] Open
Abstract
Policies supporting caregivers ("caregiver policies") are limited in the extent to which they meet the needs of those who care for others. Where policies do exist, they focus on relieving the burdens associated with caring or the needs of the person they care for, rather than consider the holistic needs of the caregiver that would enable them to flourish. We argue that the established approach to caregiver policies reflects a policy failure, requiring a reassessment of current practice related to caregiver support. Often, caregiver policies target the care recipient rather than the caregiver's needs. Through a consultative exercise, we identified five areas of need that existing caregiver policies touch upon. Yet current approaches remain piecemeal and inadequate in a global context. Caregiver policies should not just relieve burden to the extent that caregivers can continue in the role, but they should support caregivers to flourish, and future work may benefit from drawing on related frameworks from positive psychology, such as the PERMA™ model; this is important for both policymakers and researchers.
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Affiliation(s)
- Brian Beach
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom,*Correspondence: Brian Beach
| | | | - Susana Harding
- International Longevity Centre – Singapore, Singapore, Singapore
| | | | - Linda Garcia
- LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Ishika Tripathi
- LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Briony Dow
- National Ageing Research Institute, Parkville, VIC, Australia
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Felipe SGB, Parreira Batista P, da Silva CCR, de Melo RC, de Assumpção D, Perracini MR. Impact of COVID-19 pandemic on mobility of older adults: A scoping review. Int J Older People Nurs 2022; 18:e12496. [PMID: 35941278 PMCID: PMC9538411 DOI: 10.1111/opn.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/12/2022] [Accepted: 07/03/2022] [Indexed: 01/13/2023]
Abstract
AIMS AND OBJECTIVES To identify the most frequent determinants of contact limitation on older adults' mobility addressed by the recommendations to mitigate mobility limitation during the COVID-19 pandemic and identify the recommendations characteristics and means of dissemination that might guide coping actions. BACKGROUND Measures for physical contact restriction were implemented to prevent COVID-19 spread. These measures directly impacted older people, reducing their mobility, especially outside home environment. Health systems worldwide need to be prepared to implement strategies to mitigate negative effects of reduced mobility in this population. DESIGN Scoping review using Arksey and O'Malley's methodological framework. METHOD Therefore, a scoping review was conducted in LILACS, CINAHL, MEDLINE, WEB OF SCIENCE and SCOPUS databases. Documents and reports with recommendations from government agencies were also consulted. Results were presented in a narrative synthesis based on a conceptual model of mobility proposed by Webber (The Gerontologist, 2010, 50, 443) regarding the most frequently addressed determinants, characteristics of the proposed interventions, and means of dissemination for the older person population. FINDINGS Twenty-eight studies were selected for the final sample. According to Webber's model, most articles (n = 14) presented the impacts on mobility from the perspective of physical determinants, relating this aspect to biological losses in the musculoskeletal system, and a minority assessed mobility in vital spaces, encompassing environmental (n = 3) and financial (n = 1) determinants. Also, the most frequent recommendation was that physical activity promotes maintenance of mobility and prevents the occurrence of adverse results, such as falls, fractures and functional decline. As to dissemination, digital technologies were recognised as a strategy to motivate, instruct and monitor exercise practice to increase mobility in older adults. CONCLUSION The main conditions related to the decline in mobility of older adults during COVID-19 pandemic were physical inactivity and sedentary lifestyle. The practice of physical activity is widespread and needs to be adapted according to individual needs. Finally, digital technologies are essential tools in this period, but other alternatives should also be considered for low-income seniors. IMPLICATIONS FOR PRACTICE It is hoped that the gaps identified through this scoping review can help enhance the discussion on the broader assessment of mobility in older adults and the design of interventions when contact restriction is a reality.
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Affiliation(s)
| | | | | | | | | | - Monica Rodrigues Perracini
- Universidade Estadual de Campinas (UNICAMP)CampinasSão PauloBrazil,Universidade Cidade de São Paulo (UNICID)São PauloSão PauloBrazil
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Coelho de Amorim JS, Ornellas G, Lloyd-Sherlock P, Pereira DS, da Silva A, Duim E, Lima CA, Perracini MR. Discontinuation of Health Interventions Among Brazilian Older Adults During the Covid-19 Pandemic: REMOBILIZE Study. Int J Health Serv 2022; 52:330-340. [PMID: 35404167 PMCID: PMC9006088 DOI: 10.1177/00207314221092354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/22/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022]
Abstract
The objective of this study was to analyze changes in access to health interventions during the pandemic among Brazilian older adults and to investigate the factors associated with social and health inequalities. We conducted an online survey with Brazilian adults aged 60 + years between May and June 2020. A multidimensional questionnaire was used to investigate access to health interventions during the pandemic and associated factors. Of 1482 participants, 56.5% reported health care before the pandemic, and 36.4% discontinued it during the pandemic. The discontinuation rate was 64.4% (95% CI 61.1-67.6). Participants with higher educational level (nine or more years of education: OR 0.34; 95% CI 0.17-0.70) and higher income (eight or more times the minimum wage: OR 0.54; 95% CI 0.36-0.81) were associated with less probability of discontinuation. Presenting multimorbidity (OR: 1.42; 95% CI 1.06-1.90) and polypharmacy (OR: 0.61; 95% CI 0.46-0.81) were associated with discontinuity in health interventions. Our study showed that structural health inequities in access to health care shaped the rates of discontinuation in health care interventions during the COVID-19 pandemic. Strategic actions should be set up to actively monitor socially vulnerable older adults and strengthen community-based services to mitigate the discontinuation of health care interventions.
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Affiliation(s)
| | - Giulianna Ornellas
- Instituto Federal de Educação, Ciência e Tecnologia, Rio de Janeiro (RJ), Brazil
| | | | | | - Alexandre da Silva
- Department of Collective Health, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil
| | - Etienne Duim
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Camila Astolphi Lima
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil
- Master's and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
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Aliberti MJ, Bertola L, Szlejf C, Oliveira D, Piovezan RD, Cesari M, de Andrade FB, Lima-Costa MF, Perracini MR, Ferri CP, Suemoto CK. Validating intrinsic capacity to measure healthy aging in an upper middle-income country: Findings from the ELSI-Brazil. Lancet Reg Health Am 2022; 12:100284. [PMID: 36776430 PMCID: PMC9903598 DOI: 10.1016/j.lana.2022.100284] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background While efforts have been made to validate intrinsic capacity (IC) as a multidimensional indicator of healthy aging in high-income countries, we still need evidence from lower-income countries. We examined associations of IC with wide ranges of activities of daily living in a nationally representative sample of Brazilians aged≥50 years. Methods This cross-sectional analysis included 7175 participants from the Brazilian Longitudinal Study of Aging. IC domains (cognitive, psychological, sensory, locomotor, and vitality) were determined using self-reported and physical performance measures. IC was operationalized through factorial analysis. We investigated associations of IC and its domains with functional ability in basic, instrumental, and advanced activities of daily living (ADL, IADL, and AADL) using logistic regressions adjusted for sociodemographic, clinical, and modifiable risk factors. Findings The IC bi-factorial model revealed satisfactory goodness-of-fit. Preserved ability in ADL and IADL, respectively, ranged from 69% and 29% to 89% and 74% across IC quartiles. In adjusted analyses, every standard deviation increment in IC composite score was associated with almost twice the odds of preserved ADL (OR=1·72; 95%CI=1·54-1·93), preserved IADL (OR=1·95; 95%CI=1·77-2·16), and high performance in AADL (OR=1·79; 95%CI=1·59-2·00). Similar results were reported using the IC domains as predictors. Although age, race/ethnicity, and education did not modify associations of IC with functional ability, we found sex differences with stronger relationships of IC with preserved ADL or IADL in females. Interpretation Our results support IC validity and reliability to measure healthy aging in diverse socioeconomic and cultural settings. Incorporating IC in routine practices can promote holistic and person-centered care approaches in aging societies. Funding The Brazilian Ministry of Health and Ministry of Science, Technology, Innovation, and Communication.
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Affiliation(s)
- Márlon J.R. Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil,Research Institute, Hospital Sirio-Libanes, São Paulo, Brazil,Corresponding author at: Laboratorio de Investigacao Medica em Envelhecimento (LIM-66). Av. Dr. Eneas de Carvalho Aguiar 155, 8º andar, Clinica Medica, São Paulo 05403-000, SP, Brazil.
| | - Laiss Bertola
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Claudia Szlejf
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil,Department of Big Data, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Déborah Oliveira
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ronaldo D. Piovezan
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Maria Fernanda Lima-Costa
- Rene Rachou Institute, Fundação Oswaldo Cruz, Minas Gerais, Brazil,Post Graduation in Public Health, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | | | - Cleusa P. Ferri
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Claudia K. Suemoto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Ramadi A, Ezeugwu VE, Weber S, Funabashi M, Lima CA, Perracini MR, Beaupre LA. Progressive Resistance Training Program Characteristics in Rehabilitation Programs Following Hip Fracture: A Meta-Analysis and Meta-Regression. Geriatr Orthop Surg Rehabil 2022; 13:21514593221090799. [PMID: 35514534 PMCID: PMC9067046 DOI: 10.1177/21514593221090799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Older adults often experience incomplete recovery after a hip fracture. Rehabilitation programs with progressive resistance training are associated with improved functional recovery. This systematic review and meta-analysis with meta-regression a) evaluated resistance training characteristics reported in hip fracture rehabilitation programs, b) performed meta-analysis of resistance training impact on strength (primary outcome), gait and physical activity (secondary outcomes), and c) explored resistance training program characteristics associated with improved outcomes using meta-regression. Materials and Methods: Medline, EMBASE, CINAHLPLUS, and Web of Science Core Collection databases were searched (January2000–February2021). Randomized controlled trials including progressive resistance training rehabilitation programs after hip fracture surgery in adults ≥50 years old were included. Meta-analyses and exploratory meta-regression were performed. Results: Meta-analysis showed significant increases in strength (10 trials-728 participants; Standardized Mean Difference (SMD) [95%CI]; .40 [.02, .78]) immediately following program completion in intervention relative to control participants. Meta-analysis on 5 trials (n = 384) with extended follow up found no significant group differences (SMD = .47 [-.28, 1.23]) in strength. Center-based relative to home-based programs were associated with significantly greater improvements in strength (P < .05) as were programs where resistance training intensity was prescribed using one-repetition maximum relative to other exercise prescription methods (P < .05). In gait meta-analysis (n = 10 trials-704 participants), gait speed in intervention participants immediately after the program was significantly higher than control (SMD = .42 [.08, .76]) but this finding was not maintained in extended follow-up (n = 5 trials-240 participants; SMD = .6 [-.26, .38]). Higher resistance training intensity was associated with significant improvements in gait speed (P < .05). No meta-analysis was performed for the 3 heterogeneous studies reporting physical activity. Discussion: Progressive resistance training improved muscle strength and gait speed after hip fracture surgery in adults ≥50years old immediately after the program ended, but the longer-term impact may be more limited. Conclusions: Higher resistance training intensity and center-based programs may be associated with more improvement, but require further research.
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Affiliation(s)
- Ailar Ramadi
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Victor E Ezeugwu
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sydnie Weber
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | | | | | | | - Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
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12
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Lima CA, Perracini MR, Funabashi M, Weber S, Beaupre L. Domains of Balance Training Delivered in Rehabilitation Programs Following Hip Fracture Surgery in Older Adults: A Systematic Review. J Geriatr Phys Ther 2022; 45:90-106. [PMID: 33534338 DOI: 10.1519/jpt.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this systematic review was to assess the domains and characteristics of balance training (BT) interventions delivered in rehabilitation programs following hip fracture to identify potential treatment gaps. METHODS Manual and electronic searches (Web of Science, Medline, EMBASE, CINAHL, and ProQuest) were conducted. We selected randomized controlled trials with older adults following hip fracture surgery that included either specific BT or gait, mobility, or transfer training. Two independent reviewers extracted data and rated the methodological quality using the Physiotherapy Evidence Database scale. A third reviewer provided consensus. Extracted BT data included balance domain, progression, frequency, duration, intensity, level of supervision, setting, and rehabilitation phase. RESULTS AND DISCUSSION We included 17 trials from 19 studies; 11 studies were rated as moderate to high methodological quality, but only 8 were considered to have high-quality BT components. Half of the interventions included only one balance domain, with stability during movement being the most commonly included domain. The primary balance progression utilized was reducing hand support. Dual task, anticipatory postural adjustment, reactive strategies, and perceptual training domains were rarely included. Balance training duration and intensity were poorly described. Although most programs were home-based with minimal levels of supervision, a few extended beyond postacute phase of rehabilitation. CONCLUSION Further consideration should be given to include more challenging BT domains with planned progressions to maximize patient recovery through hip fracture rehabilitation programs.
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Affiliation(s)
- Camila Astolphi Lima
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Master's and Doctoral Programs in Gerontology, Faculty of Medicine, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Martha Funabashi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Ontario, Toronto, Canada
| | - Sydnie Weber
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Giangiardi VF, Perracini MR, da Silva ML, Setti GBR, Curzio LE, Vegas M, Alouche SR. Functional Outcomes Associated With Independence in Walking Among People With Hereditary Ataxias: An Exploratory Cross-sectional Study. Phys Ther 2022; 102:6506304. [PMID: 35079839 DOI: 10.1093/ptj/pzac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 08/14/2021] [Accepted: 11/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to identify functional outcomes related to independence in walking among people affected by hereditary ataxias. METHODS Sixty participants were selected by convenience in a list provided by an organization of people with ataxia. Sociodemographic and clinical data were collected using a semistructured questionnaire. The Assessment and Rating of Ataxia was used to assess and rate cerebellar ataxia. Changes in body structure and function, limitation in activities, and restriction in participation were evaluated with specific outcome measures. Participants were classified as independent in walking if they were able to walk without walking aids or human assistance and as dependent in walking if they have been using walking aids (sticks, crutches, or walkers) for more than 6 months, using a wheelchair for locomotion most of the day, or both. Multivariate logistic regression analyses were conducted hierarchically and in blocks considering upper limbs function, balance systems, sensory functions, postural control, walking, independence, cognition, and perception as independent variables. The prevalence ratio for walking independence was determined. RESULTS The final regression model pointed out that gait capacity assessed by the 6-Minute Walk Test and dexterity assessed by the Box and Blocks test were the main markers related to walking independence in individuals with hereditary ataxias. CONCLUSION The distance covered in 6 minutes of walking (walking endurance) and upper extremity dexterity can be used to better assess the progression of cerebellar disease related to walking independence in individuals with hereditary ataxias. IMPACT This study supports early detection of individuals who are at risk of loss of walking independence and an optimized rehabilitation plan.
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Affiliation(s)
- Vivian Farahte Giangiardi
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Liliane da Silva
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Milena Vegas
- School of Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Sandra Regina Alouche
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
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Trombini-Souza F, Nogueira RTDSA, Serafim ACB, Lima TMMD, Xavier MKA, Perracini MR, de Araújo RC, Sacco ICN, Nascimento MDM. Concern About Falling, Confidence in Balance, Quality of Life, and Depression Symptoms in Community-Dwelling Older Adults After a 24-week Dual-Task Training With Variable and Fixed Priority: A Randomized Controlled Trial. Res Aging 2022; 44:658-668. [DOI: 10.1177/01640275221073993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the effect of a 24-week dual-task training with progression from variable to fixed priority on the concern about falling, confidence in balance, quality of life, and depression symptoms in community-dwelling older adults. Methods A total of 60 participants (60–80 y.o.) were randomly allocated into a dual-task training group with progression from variable to fixed priority (experimental group) or into a dual-task training group with variable priority (control group). Results No between-group difference was observed after the intervention. A significant time effect showed a reduction in concern about falling [mean difference (MD) = -2.91)] and depression symptoms (MD = −1.66), an increase in the physical function (MD = 7.86), overall mental health (MD = 5.82), perception of vitality, energy, and less fatigue (MD = 10.45), general perception of overall health (MD = 6.81), and their health compared to the last year (MD = 11.89). Conclusion The experimental protocol was not superior to the control one. However, both protocols improved these outcomes.
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Affiliation(s)
- Francis Trombini-Souza
- Department of Physical Therapy, University of Pernambuco, Brazil
- Master’s and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Brazil
| | | | | | | | | | | | - Rodrigo Cappato de Araújo
- Department of Physical Therapy, University of Pernambuco, Brazil
- Master’s and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Brazil
| | - Isabel CN Sacco
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Department, Universidade de Sao Paulo, Brazil
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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de Aquino MPM, de Oliveira Cirino NT, Lima CA, de Miranda Ventura M, Hill K, Perracini MR. The Four Square Step Test is a useful mobility tool for discriminating older persons with frailty syndrome. Exp Gerontol 2022; 161:111699. [DOI: 10.1016/j.exger.2022.111699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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Lima MDCCD, Perracini MR, Guerra RO, Borim FDSA, Yassuda MS, Neri AL. Precisão da medida de mobilidade no espaço de vida para discriminar fragilidade e sarcopenia em idosos. Rev bras geriatr gerontol 2022. [DOI: 10.1590/1981-22562022025.210219.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Identificar o perfil de mobilidade nos espaços de vida em idosos que vivem na comunidade e estabelecer a precisão dos pontos de corte desse instrumento para discriminar entre níveis de fragilidade, fragilidade em marcha e de risco de sarcopenia. Método Estudo observacional e metodológico com 391 participantes com 72 anos e mais (80,4±4,6), que responderam ao Life Space Assessment (LSA) e a medidas de rastreio de fragilidade e risco de sarcopenia usando respectivamente o fenótipo de fragilidade e o SARC-F. Os pontos de corte para fragilidade e risco de sarcopenia foram determinados por meio da Curva ROC (Receiver Operating Characteristic) com intervalos de confiança de 95%. Resultados A média da pontuação no LSA foi 53,6±21,8. Os pontos de corte de melhor acurácia diagnóstica foram ≤54 pontos para fragilidade em marcha (AUC= 0,645 95%; p<0,001) e ≤60 pontos para risco de sarcopenia (AUC= 0,651 95%; p<0,001). Conclusão A capacidade de idosos de se deslocar nos vários níveis de espaços de vida, avaliado pelo LSA demonstrou ser uma ferramenta viável que pode contribuir no rastreio de fragilidade em marcha e de risco de sarcopenia e, com isso, prevenir desfechos negativos.
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Batista PP, Perracini MR, de Amorim JSC, de Lima MDCC, Lima CA, Pereira DS, Dantas RG, Fittipaldi EODS, Santos AD, Campos HLM, Pereira LSM. Prevalence risk of sarcopenia in older Brazilian adults during the pandemic: A cross-sectional analysis of the Remobilize Study. SAO PAULO MED J 2022; 141:e2022159. [PMID: 36541952 PMCID: PMC10065115 DOI: 10.1590/1516-3180.2022.0159.r1.19082022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Social distancing has led to lifestyle changes among older adults during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES This study aimed to estimate the prevalence risk of sarcopenia (RS) and investigate its associated factors during the COVID-19 pandemic in older Brazilian adults. DESIGN AND SETTING Cross-sectional observational analysis of baseline data as part of the Remobilize Study. METHODS Participants in the study were older adults (≥ 60 years), excluding those who were bedridden or institutionalized. The data collected consisted of answers about the RS (SARC-F), functional status, walking, sedentary behavior (SB), pain, comorbidity, and life space mobility. RESULTS A total of 1,482 older adults (70 ± 8.14 years, 74% women) participated in the study, and an RS prevalence of 17.1% was found. (95% confidence interval [CI] 15.25-19.15%). The adjusted multivariate model showed a significant association between RS and functional limitation (odds ratio [OR]: 19.05; CI 13.00-28.32), comorbidity (OR: 5.11; CI 3.44-7.81), pain (OR: 4.56; CI 3.33-6.28), total walking (OR: 0.99; CI 0.99-1.00), SB of 8-10 hours (OR: 1.85; CI 1.15-2.93), and SB of > 10 hours (OR: 3.93; CI 2.48-6.22). RS was associated with mobility during the pandemic (OR: 0.97; CI 0.96-0.98). P < 0.05. CONCLUSIONS During the pandemic, the prevalence of RS in older Brazilians was estimated at 17.1%. Moderate to severe functional limitation, comorbidities, presence of pain, walking, longer SB period, and reduced life space mobility significantly contributed to RS in older adults during the pandemic.
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Affiliation(s)
- Patricia Parreira Batista
- PT, MSc. Doctoral Student Postgraduate Program in Rehabilitation
Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais
(UFMG), Belo Horizonte (MG), Brazil
| | - Monica Rodrigues Perracini
- PT, PhD. Professor, Master’s and Doctoral Programs in Physical
Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo (SP), Brazil;
Master’s and Doctoral Programs in Gerontology, Faculty of Medical Sciences,
Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | | | - Maria do Carmo Correia de Lima
- PT, PhD. Faculty of Medical Sciences, Master’s and Doctoral
Programs in Gerontology, Universidade Estadual de Campinas (UNICAMP), Campinas
(SP), Brazil
| | - Camila Astolphi Lima
- PT, PhD. Postdoctoral Student of Master’s and Doctoral Program
in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo (SP),
Brazil
| | - Daniele Sirineu Pereira
- PT, PhD. Professor, Postgraduate Program in Rehabilitation
Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais
(UFMG), Belo Horizonte (MG), Brazil
| | - Renata Gonçalves Dantas
- PT, MSc. Doctoral Student of Master’s and Doctoral Program in
Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo (SP),
Brazil; and Professor of Physical Therapy, Universidade Estadual do Sudoeste da
Bahia (UESB), Vitória da Conquista (BA), Brazil
| | | | - Aurélio Dias Santos
- PT, MSc. Professor, Department of Physiotherapy, Centro
Universitário Dr. Leão Sampaio (UNILEÃO), Juazeiro do Norte (CE), Brazil
| | - Hércules Lázaro Morais Campos
- PT, MSc. Professor, Department of Physiotherapy, Universidade
Federal do Amazonas/Instituto de Saúde e Biotecnologia (UFAM/ISB), Coari (AM),
Brazil. Doctoral Student, Postgraduate Program in Public Health, Universidade
Federal do Espírito Santo (UFES), Vitória (ES), Brazil
| | - Leani Souza Máximo Pereira
- PT, PhD. Professor, Postgraduate Program in Rehabilitation
Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais
(UFMG), Belo Horizonte (MG), Brazil
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Lima MDCCD, Perracini MR, Guerra RO, Borim FDSA, Yassuda MS, Neri AL. Accuracy of the life-space mobility measure for discriminating frailty and sarcopenia in older people. Rev bras geriatr gerontol 2022. [DOI: 10.1590/1981-22562022025.210219.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective To identify the profile of a sample of older people recruited at home based on a measure of life-space mobility and to establish the accuracy of the cut-off points of this instrument for discriminating between levels of frailty, frailty in walking speed and risk of sarcopenia. Method An observational methodological study of 391 participants aged ≥72 (80.4±4.6) years, who answered the Life-Space Assessment (LSA) and underwent frailty and risk of sarcopenia screening using the frailty phenotype and SARC-F measures, respectively, was performed. The cut-off points for frailty and risk of sarcopenia were determined using ROC (Receiver Operating Characteristic) curves and their respective 95% confidence intervals. Results Mean total LSA score was 53.6±21.8. The cut-off points with the best diagnostic accuracy for total LSA were ≤54 points for frailty in walking speed (AUC=0.645 95%; p<0.001) and ≤60 points for risk of sarcopenia (AUC=0.651 95%; p<0.001). Conclusion The ability of older people to move around life-space levels, as assessed by the LSA, proved a promising tool to screen for frailty in walking speed and risk of sarcopenia, thus contributing to the prevention of adverse outcomes.
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Santos AD, Prado-Rico JM, Cirino NTDO, Perracini MR. Are foot deformity and plantar sensitivity impairment associated with physical function of community-dwelling older adults? Braz J Phys Ther 2021; 25:846-853. [PMID: 34535410 DOI: 10.1016/j.bjpt.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 07/15/2021] [Accepted: 07/30/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Foot deformities are highly prevalent in older adults and negatively impact their mobility and quality of life. However, the association between foot problems and physical function is still unclear. OBJECTIVE To investigate whether structural foot deformities and plantar tactile sensitivity are associated with lower extremity physical function impairment in community-dwelling older adults. METHODS We included 200 men and women aged 60 years and older from a community-based program. The foot assessment included toe deformities and calluses inspection and evaluation of plantar tactile sensitivity using monofilaments. The Short Physical Performance Battery (SPPB) was used to assess lower extremity physical function. We conducted a multivariate logistic regression analysis to investigate the association between foot problems and lower extremity physical function. RESULTS Hallux valgus was the most prevalent deformity among older adults. Those participants with reduced plantar tactile sensitivity (OR= 2.77; 95% CI: 1.38, 5.55) and a hallux valgus (OR= 2.23; 95% CI: 1.10, 4.52) were more likely to present poor lower extremity physical function. CONCLUSION Hallux valgus and impaired plantar sensitivity were associated with reduced lower extremity physical function in older adults. Further studies are necessary to identify this causality and to what extent management of these foot problems can improve general mobility and quality of life of older adults.
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Affiliation(s)
- Aurélio Dias Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Janina Manzieri Prado-Rico
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | | | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil; Master's and Doctoral Programs in Gerontology, Faculty of Medicine, Universidade Estadual de Campinas, São Paulo, SP, Brazil.
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Dos Santos RB, Lago GN, Jencius MC, Barbosa BA, Lima CA, Paschoal SM, Hill KD, Leme LEG, Perracini MR. Older adults' views on barriers and facilitators to participate in a multifactorial falls prevention program: Results from Prevquedas Brasil. Arch Gerontol Geriatr 2020; 92:104287. [PMID: 33147535 DOI: 10.1016/j.archger.2020.104287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/24/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To understand the reasons older people engage in a multifactorial fall prevention program and, to identify the barriers and facilitators for adherence. METHODS Cross-sectional study, with 218 older adults from the intervention group of a 12-week multifactorial fall prevention program (Prevquedas Brazil). We interviewed participants using a semi-structured questionnaire concerning reasons to engage in, barriers, and facilitators to participating in the program. We compared participants with low (0-5 sessions) and moderate/high (6-12 sessions) adherence regarding barriers and facilitators. RESULTS Physical and mental health problems (55 %), and competing demands (45.2 %) were the most frequent barriers reported. Pleasant environment (97.7 %), a sense of receiving proper care (96.7 %), and empathy with the team (96.7 %) were the main facilitators. Seven out of the twelve facilitators distinguished participants with high adherence from those with low adherence. Only the barriers related to the program characteristics and the lack of social support were able to identify participants with low adherence. Open-ended questions revealed that self-determination, commitment, and the desire of being physically active and fit promoted participation. Anticipated health benefits and functional gains, a need to take action due to fall consequences, and encouragement from others were among the reasons to engage in the program. CONCLUSION Although barriers should not be neglected, facilitators are critically important for adherence. Health professionals may develop skills to facilitate uptake and optimize older adults' participation. Implementing sustainable fall prevention programs in low and middle-income countries requires overcoming the fragmentation and inflexibility of healthcare services.
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Affiliation(s)
- Renato Barbosa Dos Santos
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Giulia Neves Lago
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Mariane Chikasawa Jencius
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Bianca Alexandre Barbosa
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Camila Astolphi Lima
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil
| | - Sergio Marcio Paschoal
- Orthopedic and Traumatology Institute, Faculty of Medicine, Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Keith David Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Luiz Eugenio Garcez Leme
- Orthopedic and Traumatology Institute, Faculty of Medicine, Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil.
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22
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Moraes SAD, Furlanetto EC, Ricci NA, Perracini MR. Sedentary behavior: barriers and facilitators among older adults after hip fracture surgery. A qualitative study. Braz J Phys Ther 2020; 24:407-414. [PMID: 31345662 PMCID: PMC7563798 DOI: 10.1016/j.bjpt.2019.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/23/2019] [Accepted: 07/02/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Understand the experience of older adults after hip fracture surgery considering barriers and facilitators related to sedentary behavior. METHODS A qualitative study using a semi-structured interview with three men and eight women aged 60 years or older after hip fracture surgery. RESULTS Five barriers emerged: physical complaints, lack of accessibility, fear of falling, demotivation and negative social representation of old age, and two facilitators: overcoming dependency and having a caregiver. CONCLUSION Our results highlight that physical complaints commonly addressed by physical therapists on their interventions are not the only impediments to reduce sedentary behavior. Important individual and social barriers should not be neglected when physical therapists conduct interventions to reduce sedentary behavior to maximize functional recovery in older adults after hip fracture surgery. Future clinical trials are required to investigate the effectiveness of more comprehensive interventions to reduce sedentary behavior in this population.
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Affiliation(s)
| | | | - Natalia Aquaroni Ricci
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
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23
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Cervato CJ, Buarque GLA, Robinson K, Frost R, Gavind J, Perracini MR, Melo RCD. Defining, reporting, and monitoring near-falls in older adults: a scoping review protocol. Geriatr Gerontol Aging 2020. [DOI: 10.5327/z2447-212320212000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: In addition to traditional risk factors for falls (e.g., reduced muscle strength, polypharmacy, and poor vision), researchers have been investigating whether other factors, such as near-falls, can be identified to allow early intervention and prevention. A near-fall can be defined as a slip, trip, or loss of balance that would result in a fall if adequate recovery mechanisms were not activated. Despite the increasing interest in near-falls, there is no consensus about the definition, reporting methods, and contributing factors. OBJECTIVE: To identify how near-falls among older adults have been defined, reported, and monitored in the scientific literature. METHODS: Indexed literature published in English, Spanish, and Portuguese will be considered and retrieved from 10 databases, until August 31st, 2020. Two authors will independently screen titles, abstracts, and full texts against the eligibility criteria, and disagreements will be resolved by a third reviewer. This review will consider studies with different designs that have included older adults (aged 60 years and over), recruited participants from different settings, and had an explicit definition and/or reporting of near-falls. A customized form will be used to extract data from the included studies. The results will be presented in tabular form, accompanied by a narrative summary. This protocol is registered at https://osf.io/txnv4. EXPECTED RESULTS AND RELEVANCE: Depending on the results, a conceptual framework for near-fall reporting, contributing factors, and a possible prodrome of falls will also be presented. It is expected that the present study will help professionals identify and manage near-falls in different settings.
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24
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Lima WPD, Lima CA, Santos RBD, Soares WJDS, Perracini MR. Utilitarian walking and walking as exercise among community-dwelling older adults: what factors influence it? Rev bras geriatr gerontol 2020. [DOI: 10.1590/1981-22562020023.190255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objective : to investigate the association between utilitarian walking and walking as exercise, and socio-demographic, clinical and functional covariates related to these walking types. Methods : a cross-sectional exploratory study was conducted with 148 older adults (aged 60 and over). Walking frequency and duration was assessed using the IPEQ-W (Incidental and Planned Exercise Questionnaire - Version W). Socio-demographic, clinical conditions, level of disability and mobility were also assessed. Types of walking were compared among the variables using the Mann-Whitney test and non-parametric Spearman rho correlations were used to investigate the association between the types of walking and the variables. Results : the participants performed a mean of 1.1 (±2.1) h/week of walking as exercise and 2.2 (±2.3) h/week of utilitarian walking. Older adults who had diabetes (p=0.015) did fewer h/week of walking as exercise. Participants who were older (p=0.014), reported poor self-rated health (p<0.001), poor disability levels (p<0.001), hypertension (p=0.048), strokes (p<0.001), heart disease (p=0.026), urinary incontinence (p<0.001), dizziness (p=0.008), or sleep disorders (p=0.042) spent fewer hours performing utilitarian walking. Correlations between the covariates and types of walking varied from very weak to weak. Conclusion : chronic diseases and unfavorable health conditions decreased walking time. Utilitarian walking was the most frequent type of walking performed by the older adults. Health care professionals and public policy managers should use utilitarian walking as a way of increasing levels of physical activity and to promote healthy aging.
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Machado AFP, Perracini MR, Rampazo ÉP, Driusso P, Liebano RE. Effects of thermotherapy and transcutaneous electrical nerve stimulation on patients with primary dysmenorrhea: A randomized, placebo-controlled, double-blind clinical trial. Complement Ther Med 2019; 47:102188. [PMID: 31779988 DOI: 10.1016/j.ctim.2019.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the effects of thermotherapy and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pressure pain threshold (PPT) and conditioned pain modulation (CPM) in patients with primary dysmenorrhea (PD). DESIGN A randomized, placebo-controlled, double-blind clinical trial. SETTING Physiotherapy Department of the Universidade Cidade de São Paulo, São Paulo (Brazil). INTERVENTIONS Eighty-eight dysmenorrheic women were randomly allocated into four groups: Thermotherapy + TENS(n = 22), Thermotherapy(n = 22), TENS(n = 22) and Placebo(n = 22). Thermotherapy was applied by microwave diathermy (20 min), and TENS (200 μs, 100 Hz, 30 min), into the lower abdomen both. MAIN OUTCOME MEASURES Pain intensity was measured using the numeric rating scale (NRS) and the McGill Pain Questionnaire (Br-MPQ). PPT and CPM were recorded from women's abdominal and lumbar. The evaluation was done in 5 times: baseline, after 20, 50, 110 min and 24 h from intervention. RESULTS There was a significant decrease in the NRS for Thermotherapy + TENS vs. TENS, for Thermotherapy vs. TENS and for Placebo, after 20 min; for Thermotherapy vs. TENS and for Placebo, after 110 min and 24 h. Abdome PPT increased in the Thermotherapy + TENS vs. TENS and Placebo, after 50 min; for Thermotherapy + TENS vs. Placebo and for Thermotherapy vs. Placebo, after 110 min. No changes in lumbar PPT and CPM were observed. CONCLUSIONS The use of thermotherapy reduced NRS compared to the TENS and Placebo after 20, 110 min and 24 h. Thermotherapy demonstrated an increase in the PPT in the abdomen after 50 and 110 min and decreased the Br-MPQ scores after 110 min in patients with PD.
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Affiliation(s)
- Aline Fernanda Perez Machado
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil.
| | - Monica Rodrigues Perracini
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Érika Patrícia Rampazo
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Patricia Driusso
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Richard Eloin Liebano
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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26
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Camara CTP, de Freitas SMSF, Lima CA, Amorim CF, Prado-Rico JM, Perracini MR. The walking cane length influences the postural sway of community-dwelling older women. Physiother Res Int 2019; 25:e1804. [PMID: 31322813 DOI: 10.1002/pri.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/30/2019] [Accepted: 07/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mobility-related problems in older people may be relieved by the use of walking canes. However, the influence of the cane length on the postural stability of cane users has not been explored. OBJECTIVE The objective of this study is to examine the influence of a single-point cane with different lengths on the postural sway of regular cane users, older women during two stance positions, with feet parallel and semi-tandem stance. METHODS Eighteen older women, who used a single-point walking cane for at least 6 months, stood on a force plate with feet parallel or in semitandem position for 40 s. They always used a cane that was adjusted to one of three different lengths resulting from the distance between the wrist crease and the floor, named WF, or this distance plus 7.5 or 10 cm. Amplitude and speed of the centre of pressure (COP) and its components (rambling and trembling) in the anterior-posterior and medial-lateral directions and mean vertical force applied to the cane were compared across cane lengths. RESULTS The amplitude and velocity of COP, rambling and trembling increased with the cane length. This effect was observed for the anterior-posterior with the feet parallel and in the medial-lateral direction with the semi-tandem position. More force was applied on the shorter cane (WF) in semitandem position. CONCLUSION Longer canes increased the postural sway in the older women and restricted the body weight loaded on the cane. Improper cane length influences the postural sway particularly in a semitandem stance of regular cane users. This may cause a negative impact on postural stability required in daily life activities. The current findings may contribute to the prescription of this assistive device for older adults.
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Affiliation(s)
- Camila Thais Pinto Camara
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Sandra Maria Sbeghen Ferreira de Freitas
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,Department of Kinesiology, The Pennsylvania State University, PA, USA
| | - Camila Astolphi Lima
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - César Ferreira Amorim
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,Master's and Doctoral Programs in Gerontology, Faculty of Medicine, Universidade Estadual de Campinas, São Paulo, Brazil
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27
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Campos HLM, Liebano RE, Lima CA, Perracini MR. Multidimensional investigation of chronic pain experience and physical functioning following hip fracture surgery: clinical implications. Br J Pain 2019; 14:5-13. [PMID: 32110393 DOI: 10.1177/2049463719861994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Older adults experience significant chronic pain after hip fracture, resulting in decreased physical functioning. However, pain investigation in this population is mostly limited to self-reported pain intensity. Detailed pain assessment may identify intervention targets other than pain relief. The aim of this study is to investigate multiple dimensions of pain experience (intensity, sensory, affective, evaluative and miscellaneous dimensions) and to correlate them to lower limb functionality and limitations in daily living activities. Methods We conducted a cross-sectional study of 50 older adults (77.1 ± 8.1 years old) who underwent hip fracture surgery in the past 4 months. We used the Numeric Rating Scale (NRS), the McGill Pain Questionnaire (MPQ) and an algometer to assess pain intensity, pain quality and pressure pain threshold, respectively. Lower limb functionality and limitation in basic (activities of daily living (ADL)) and instrumental activities of daily living (IADL) were assessed using the Short Physical Performance Battery (SPPB) and the Brazilian OARS Multidimensional Functional Assessment Questionnaire. Results Participants described pain as brief, momentary and transient, especially during weight-bearing activities. Although the pain intensity measured by the NRS was reported as moderate to severe (7.5 ± 1.6 points), it was not correlated with physical functioning. However, we observed a moderate negative correlation between pressure pain threshold, ADL and IADL disability (r = -0.41, p < 0.01). Among pain qualities, the sensory category was moderately negatively correlated to SPPB (r = -0.41, p < 0.01), and the evaluative category was moderately correlated to ADL and IADL disability (r = 0.43, p < 0.01). Conclusion Pain can be present 4 months after hip fracture surgery, particularly during weight-bearing activities, and it is associated with poor lower limb functionality, as well as ADL and IADL disability. Older adults may benefit from pain assessments that go beyond pain intensity measurements after hip fracture, as this helps clinicians optimise pain management and overall functional recovery.
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Affiliation(s)
| | - Richard Eloin Liebano
- Universidade Cidade de São Paulo, São Paulo, Brazil.,Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | | | - Monica Rodrigues Perracini
- Universidade Cidade de São Paulo, São Paulo, Brazil.,Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
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Ferrer MLP, Perracini MR, Rebustini F, Buchalla CM. WHODAS 2.0-BO: normative data for the assessment of disability in older adults. Rev Saude Publica 2019; 53:19. [PMID: 30726500 PMCID: PMC6394378 DOI: 10.11606/s1518-8787.2019053000586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/23/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE: To examine the normative data of WHODAS 2.0-BO for older Brazilians (World Health Disability Assessment Schedule – Brazilian version for older people) and its distribution according to sex, age, health, subjective health perception, performance in a mobility test and presence of chronic diseases and depression. METHODS: Cross-sectional study, with 350 participants with 60 years of age or older, men and women, patients of a geriatric specialized center for medical consultations or rehabilitation. The older adults were evaluated using a semi-structured questionnaire containing demographic and clinical data (WHODAS 2.0-BO) and the geriatric depression scale (GDS), having been subsequently subjected to a mobility test (Timed Up and Go). The data were analyzed via their distribution in percentiles of the population and via analysis of variance. RESULTS: Two-hundred and sixty-six (76%) participants were women, and the average age was 71.8 (DP = 6.7) years old. The average score in WHODAS 2.0-BO was 4.3 (DP = 5.2) points, the highest value found having corresponded to 33 points. The average time for the Timed Up and Go test was 10.0 (SD = 3.2) seconds. About 30% of the older adults did not report any difficulties in the tasks evaluated by WHODAS 2.0-BO and half of the sample scored up to two points. CONCLUSIONS: A score corresponding to 12 points in the 90 percentile on a scale from zero to 40 was observed, which suggests severe disability. The score in WHODAS 2.0-BO increased with the advance in age, as well as in the presence of comorbidities, negative health perception, depression, high blood pressure, visual and hearing impairment and mobility impairment.
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Affiliation(s)
- Michele Lacerda Pereira Ferrer
- Universidade São Francisco. Faculdade de Fisioterapia. Bragança Paulista, SP, Brasil.,Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Saúde Pública. São Paulo, SP, Brasil
| | - Monica Rodrigues Perracini
- Universidade Cidade de São Paulo. Programa de Pós-Graduação em Fisioterapia. São Paulo, SP, Brasil.,Universidade Estadual de Campinas. Faculdade de Ciências Médicas. Programa de Pós-Graduação em Gerontologia. Campinas, SP, Brasil
| | - Flávio Rebustini
- Universidade Estadual Paulista "Júlio de Mesquita Filho". Rio Claro, SP, Brasil.,Universidade de São Paulo. Escola de Artes, Ciências e Humanidades. Programa de Pós-Graduação em Gerontologia. São Paulo, SP, Brasil
| | - Cassia Maria Buchalla
- Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil
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Lima CA, Ricci NA, Nogueira EC, Perracini MR. The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review. Physiotherapy 2018; 104:383-394. [PMID: 29945726 DOI: 10.1016/j.physio.2018.02.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 01/29/2018] [Accepted: 02/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Berg Balance Scale (BBS) is often used in clinical practice to predict falls in the older adults. However, there is no consensus in research regarding its ability to predict falls. OBJECTIVE To verify whether the BBS can predict falls risk in older adults. DATA SOURCE Manual and electronic searches (Medline, EMBASE, CINAHL, Ageline, Lilacs, Web of Science, Cochrane Library and PEDro) were conducted using blocks of words (older adults, falls, BBS, study design) and their synonyms, with no language restrictions and published since 1989. STUDY SELECTION CRITERIA Prognostic studies or clinical trials were used to assess the BBS and falls history. DATA EXTRACTION AND DATA SYNTHESIS In this narrative synthesis, two independent assessors extracted data from articles and a third reviewer provided consensus, in case of disagreement. The methodological quality was assessed using the Quality In Prognosis Studies tool. RESULTS 1047 studies were found and 8 studies were included in this review. The mean BBS score was high, regardless of the history of falls. Three studies presented cut-off scores for BBS, ranging from 45 to 51 points. Two studies reported a difference in the BBS score between fallers and non-fallers. Studies presented low to moderate risk of bias. LIMITATIONS Unfeasible to conduct a meta-analysis due the heterogeneity of included studies. CONCLUSION The evidence to support the use of BBS to predict falls is insufficient, and should not be used alone to determine the risk of falling in older adults. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42016032309.
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Affiliation(s)
- C A Lima
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
| | - N A Ricci
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
| | - E C Nogueira
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
| | - M R Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Master's and Doctoral Programs in Gerontology, Faculty of Medicine, Universidade Estadual de Campinas, São Paulo, Brazil.
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30
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Moraes SAD, Soares WJS, Lustosa LP, Bilton TL, Ferrioli E, Perracini MR. Characteristics of falls in elderly persons residing in the community: a population-based study. Rev bras geriatr gerontol 2017. [DOI: 10.1590/1981-22562017020.170080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Object: to examine the characteristics to the last fall of Brazilian elderly persons who experienced falls in 2008 and 2009, and to identify if there is a relationship with sociodemographic characteristics, physical health, comorbidities, clinical conditions and the circumstances of the falls. Methods: a cross-sectional, population based study was carried out with participants aged 65 and older from Barueri in the state of São Paulo and Cuiabá in the state of Mato Grosso, Brazil. Households were enrolled within each census region according to population density and the number of elderly persons living in each region. A multidimensional questionnaire composed of sociodemographic factors and data regarding falls was used. Associations were analyzed using contingency tables, and Fisher's Exact or Pearson's Chi-square test was used. Results: 774 elderly people were included in the study, 299 of whom reported falling in the previous year. Of these, 176 (58.9%) had fallen once and 123 (41.1%) reported having fallen twice or more. Among fallers the mean age was 72.53 (±6.12) years and 214 (71.6%) were female. About 107 (35.8%) of the elderly reported having fallen forwards, 79 (26.4%) fell to the side and 42(14%) fell backwards. Regarding the circumstances of the falls, 107 (35.8%) reported having lost their balance, 79 (26.4%) said they had stumbled and 42 (14%) said they had slipped. There was an association between the mechanism and circumstances of the falls and having fallen once or twice or more. There was an association between the circumstances of falls and the number of medications taken. Conclusion: The characteristics of falls were different among elderly persons who had fallen once or twice or more, which may guide health professionals, the elderly and their families in relation to specific fall prevention strategies.
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Perez Machado AF, Perracini MR, Cruz Saraiva de Morais AD, da Silva BO, Driusso P, Liebano RE. Microwave diathermy and transcutaneous electrical nerve stimulation effects in primary dysmenorrhea: clinical trial protocol. Pain Manag 2017; 7:359-366. [PMID: 28936905 DOI: 10.2217/pmt-2017-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study will be to analyze the effects of microwave diathermy (MWD) and transcutaneous electrical nerve stimulation (TENS) on primary dysmenorrhea. Eighty eight women, age range 18-44 years, with no previous pregnancy, no practice physical activities, a BMI of ≤29.9 kg/m2, a regular menstrual cycle and a diagnosis of primary dysmenorrhea, with menstrual pain ranging from mild to severe, will be selected. The participants will be randomized into four groups: MWD and TENS, MWD and placebo TENS, placebo MWD and TENS, and placebo MWD and placebo TENS. Pain will be measured using the visual numeric scale and the McGill Pain Questionnaire; the pressure pain threshold using a digital algometer and conditioned pain modulation using the cold pressor test. Brazilian Clinical Trials Registry (RBR-5QKCK4. Registered on 16 March 2016).
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Affiliation(s)
- Aline Fernanda Perez Machado
- Master's & Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo/SP, Brazil
| | - Monica Rodrigues Perracini
- Master's & Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo/SP, Brazil
| | | | - Bruna Oliveira da Silva
- Department of Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo/SP, Brazil
| | - Patricia Driusso
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos/SP, Brazil
| | - Richard Eloin Liebano
- Physical Therapy Department, Universidade Federal de São Carlos (UFSCar), São Carlos/SP, Brazil
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32
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Perracini MR, Franco MRC, Ricci NA, Blake C. Physical activity in older people - Case studies of how to make change happen. Best Pract Res Clin Rheumatol 2017; 31:260-274. [PMID: 29224701 DOI: 10.1016/j.berh.2017.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/28/2017] [Indexed: 01/06/2023]
Abstract
Enhancing physical activity (PA) is recognized as a powerful intervention for the prevention and treatment of chronic diseases and disability in older people. Furthermore, there is an agreement that increased PA in daily life is a key determinant of active and healthy ageing and should be recommended for frail and sedentary older people. Unfortunately, relatively few older people engage in regular PA or stay active in the long term. This article summarizes and discusses PA recommendations for older adults without focussing on specific diseases, presents the main barriers and facilitators for increasing PA levels, and considers the implementation of these recommendations on the basis of the existing evidence. Finally, we provide case studies of PA programmes for older people that were successfully implemented and highlight the current lessons learned.
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Affiliation(s)
| | | | - Natalia Aquaroni Ricci
- Department of Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil.
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland.
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Dantas RG, Perracini MR, Guerra RO, Ferriolli E, Dias RC, Padula RS. What are the sociodemographic and health determinants for older adults continue to participate in work? Arch Gerontol Geriatr 2017; 71:136-141. [PMID: 28458105 DOI: 10.1016/j.archger.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 04/12/2017] [Accepted: 04/17/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to determine the sociodemographic and health factors that influence older adults who continue to participate in the workforce. METHODS Data were collected and evaluated for 1762 older adults aged 65 years and older who were living in the community and were enrolled in a population-based study (FIBRA Network Study). Older adults who participated in the workforce were compared with those who did not in terms of sociodemographic characteristics, physical and mental health, and physical functioning and performance in advanced and instrumental activities characteristic of daily living. A multivariate hierarchical logistic regression analysis was performed. RESULTS Factors associated with not participating in the workforce were aged (OR: 1.71, [95% CI: 1.26-2.30], p<0.001), female gender (OR: 1.70, [95% CI: 1.22-2.37], p=0.002), poor visual perception (OR: 1.31, [95% CI: 1.00-1.72], p=0.046), using 4 or more medications regularly (OR: 1.41, [95% CI: 1.489-2.247], p=0.034), having 3 or more comorbidities (OR: 1.44, [95% CI: 1.01-2.04], p=0.040), and a handgrip strength below 24.6kg/f (18.1-24.6kg/f (2nd tertile): OR: 1.52, [95% CI: 1.06-2.18], p=0.022; 0-18kg/f (1st tertile): OR: 1.60, [95% CI: 1.08-2.38], p=0.019). The probability estimates of the final model explained 67.9% of the events related to not participating in the workforce, as observed by the area under the ROC curve. CONCLUSION Our results highlight that work in later life is influenced by sociodemographic characteristics, intrinsic capacity, and multimorbidity. We suggest that strategies for optimizing healthy and active aging may help older people to continue participating in the workforce and contributing toward their communities.
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Affiliation(s)
- Renata Gonçalves Dantas
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Ricardo Oliveira Guerra
- Faculdade de Ciências da Saúde do Trairi, Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Brazil
| | - Eduardo Ferriolli
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Rosangela Correa Dias
- Department of Physical Therapy/Program of Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosimeire Simprini Padula
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
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Lima CA, Soares WJDS, Bilton TL, Dias RC, Ferrioll E, Perracini MR. Correlates of excessive daytime sleepiness in community-dwelling older adults: an exploratory study. Rev bras epidemiol 2015; 18:607-17. [DOI: 10.1590/1980-5497201500030007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/30/2014] [Indexed: 01/14/2023] Open
Abstract
Excessive daytime sleepiness (EDS) imposes a wide range of adverse health-related outcomes in older people, such as disability, which impair everyday activities and may increase the risk of fall. Few studies have explored EDS in Brazilian older people living in the community who are typically cared in primary health services. This study aims to investigate the prevalence of EDS and its sociodemographic, physical and mental health correlates among community-dwelling older adults. This is an exploratory, population-based study derived from Frailty in Brazilian Older Adults (FIBRA) study including adults aged 65 years and older. Participants with a score ≥ 11 points on the Epworth Sleepiness Scale were considered as having excessive daytime sleepiness. A structured, multidimensional questionnaire was used to investigate sociodemographic, physical and mental health, and self-rated health variables. The sample was composed of 776 older adults, of whom 21% (n = 162) presented excessive daytime sleepiness. Multivariate regression analysis revealed that EDS is associated with obesity (OR = 1.50; 95%CI 1.02 - 2.20), urinary incontinence (OR = 1.53; 95%CI 1.01 - 2.31), poor self-rated health (OR = 1.54; 95%CI 1.06 - 2.24), and depression symptoms (OR = 1.49; 95%CI 1.00 - 2.20). Our results suggest that healthcare professionals should identify older adults with EDS and implement intervention strategies to minimize the negative impact of the co-occurrence of this condition with obesity, depression and urinary incontinence over health and quality of life.
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Camara CTP, de Freitas SMSF, de Lima WP, Lima CA, Amorim CF, Perracini MR. Comparison of Two Methods for Estimating Adjustable One-Point Cane Length in Community-Dwelling Older Adults. Physiother Res Int 2015; 22. [PMID: 26317393 DOI: 10.1002/pri.1641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/08/2015] [Accepted: 06/12/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE Our aim is to estimate inter-observer reliability, test-retest reliability, anthropometric and biomechanical adequacy and minimal detectable change when measuring the length of single-point adjustable canes in community-dwelling older adults. METHODS There are 112 participants in the study. They are men and women, aged 60 years and over, who were attending an outpatient community health centre. An exploratory study design was used. Participants underwent two assessments within the same day by two independent observers and by the same observer at an interval of 15-45 days. Two measures were used to establish the length of a single-point adjustable cane: the distance from the distal wrist crease to the floor (WF) and the distance from the top of the greater trochanter of the femur to the floor (TF). Each individual was fitted according to these two measures, and elbow flexion angle was measured. RESULTS AND DISCUSSION Inter-observer reliability and the test-retest reliability were high in both TF (ICC3.1 = 0.918 and ICC2.1 = 0.935) and WF measures (ICC3.1 = 0.967 and ICC2.1 = 0.960). Only 1% of the individuals kept an elbow flexion angle within the standard recommendation of 30° ± 10° when the cane length was determined by the TF measure, and 30% of the participants when the cane was determined by the WF measure. The minimal detectable cane length change was 2.2 cm. CONCLUSION Our results suggest that, even though both measures are reliable, cane length determined by WF distance is more appropriate to keep the elbow flexion angle within the standard recommendation. The minimal detectable change corresponds to approximately a hole in the cane adjustment. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Camila Astolphi Lima
- Department of Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | | | - Monica Rodrigues Perracini
- Department of Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,Faculty of Medicine, Universidade Estadual de Campinas, São Paulo, Brazil
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Molina KI, Ricci NA, de Moraes SA, Perracini MR. Virtual reality using games for improving physical functioning in older adults: a systematic review. J Neuroeng Rehabil 2014; 11:156. [PMID: 25399408 PMCID: PMC4247561 DOI: 10.1186/1743-0003-11-156] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/31/2014] [Indexed: 11/10/2022] Open
Abstract
The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population. This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review. The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.
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Affiliation(s)
- Karina Iglesia Molina
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, Rua Cesáreo Galeno, 448, 03071-000 Tatuapé, SP, Brazil.
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Molina KI, Ricci NA, de Moraes SA, Perracini MR. Virtual reality using games for improving physical functioning in older adults: a systematic review. J Neuroeng Rehabil 2014. [PMID: 25399408 DOI: 10.1186/1743-0003-11-156.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population. This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review. The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.
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Affiliation(s)
- Karina Iglesia Molina
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo - UNICID, Rua Cesáreo Galeno, 448, 03071-000 Tatuapé, SP, Brazil.
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Ricci NA, Pessoa GS, Ferriolli E, Dias RC, Perracini MR. Frailty and cardiovascular risk in community-dwelling elderly: a population-based study. Clin Interv Aging 2014; 9:1677-85. [PMID: 25336932 PMCID: PMC4199970 DOI: 10.2147/cia.s68642] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Evidence suggests a possible bidirectional connection between cardiovascular disease (CVD) and the frailty syndrome in older people. PURPOSE To verify the relationship between CVD risk factors and the frailty syndrome in community-dwelling elderly. METHODS This population-based study used data from the Fragilidade em Idosos Brasileiros (FIBRA) Network Study, a cross-sectional study designed to investigate frailty profiles among Brazilian older adults. Frailty status was defined as the presence of three or more out of five of the following criteria: unintentional weight loss, weakness, self-reported fatigue, slow walking speed, and low physical activity level. The ascertained CVD risk factors were self-reported and/or directly measured hypertension, diabetes mellitus, obesity, waist circumference measurement, and smoking. RESULTS Of the 761 participants, 9.7% were characterized as frail, 48.0% as pre-frail, and 42.3% as non-frail. The most prevalent CVD risk factor was hypertension (84.4%) and the lowest one was smoking (10.4%). It was observed that among those participants with four or five risk factors there was a higher proportion of frail and pre-frail compared with non-frail (Fisher's exact test: P=0.005; P=0.021). Self-reported diabetes mellitus was more prevalent among frail and pre-frail participants when compared with non-frail participants (Fisher's exact test: P≤0.001; P≤0.001). There was little agreement between self-reported hypertension and hypertension identified by blood pressure measurement. CONCLUSION Hypertension was highly prevalent among the total sample. In addition, frail and pre-frail older people corresponded to a substantial proportion of those with more CVD risk factors, especially diabetes mellitus, highlighting the need for preventive strategies in order to avoid the co-occurrence of CVD and frailty.
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Affiliation(s)
- Natalia Aquaroni Ricci
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Germane Silva Pessoa
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Eduardo Ferriolli
- Faculty of Medicine, Universidade de São Paulo (USP), Ribeirão Preto, Brazil
| | - Rosangela Correa Dias
- Department of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
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Tomomitsu MRSV, Perracini MR, Neri AL. Fatores associados à satisfação com a vida em idosos cuidadores e não cuidadores. Ciênc saúde coletiva 2014; 19:3429-40. [DOI: 10.1590/1413-81232014198.13952013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 03/23/2014] [Indexed: 11/22/2022] Open
Abstract
O objetivo do artigo é investigar associações entre a satisfação com a vida e variáveis sociodemográficas, condições de saúde, funcionalidade, envolvimento social e suporte social em idosos cuidadores e não cuidadores, e entre satisfação e intensidade do estresse no grupo de cuidadores. A amostra foi composta por 338 cuidadores selecionados por dois itens do Elders Life Stress Inventory, versão brasileira. A partir de sorteio aleatório, foi composto um grupo-comparação de idosos não cuidadores, com a mesma distribuição por gênero, idade e renda dos cuidadores. Os dados foram derivados de medidas de autorrelato (questionários e escalas). Idosos cuidadores com menor satisfação e maior estresse apresentaram mais sintomas de insônia, de fadiga, de doenças e pior desempenho AIVD. Aqueles com maior satisfação e menor estresse apresentaram bom nível de suporte social. Insônia, depressão e fadiga associaram-se com baixa satisfação entre os cuidadores; fadiga, depressão e menor suporte social entre os não cuidadores. Condições de saúde e psicossociais desfavoráveis e baixo nível de satisfação podem limitar a qualidade de vida e do cuidado oferecido por cuidadores familiares idosos, o que sugere a relevância de oferecer-lhes suporte instrumental, psicológico e informativo.
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Soares WJDS, Moraes SAD, Ferriolli E, Perracini MR. Fatores associados a quedas e quedas recorrentes em idosos: estudo de base populacional. Rev bras geriatr gerontol 2014. [DOI: 10.1590/s1809-98232014000100006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo: Identificar a prevalência e os fatores associados a quedas e quedas recorrentes em uma amostra de idosos que vivem na comunidade no município de Cuiabá-MT. Métodos: Estudo transversal, de base populacional, com idosos de 65 anos ou mais. Os domicílios foram arrolados por meio do sorteio de regiões censitárias, de acordo com a densidade populacional e o número de idosos em cada região. Foi utilizado um inquérito multidimensional contendo dados sociodemográficos, clínicos, psicológicos, de desempenho funcional e uma bateria de testes físicos. Resultados: A amostra foi composta por 391 participantes, com idade média (dp) de 72,4 (6,0) anos. Do total de participantes, 37,5% referiram ter caído no último ano e 16,5% relataram duas ou mais quedas. Cair foi associado a sintomas depressivos (OR=1,96; 95% IC 1,22-3,14, p=0,005); morar só (OR=2,83; 95% IC 1,57-5,12, p<0,001); baixa autoeficácia para quedas (OR=1,77; 95% IC 1,10-2,83, p=0,017); e artrite (OR= 2,10; 95% IC 1,34-3,29, p=0,001). Cair recorrentemente foi associado a: gênero feminino (OR=2,54; 95% IC 1,23-5,21, p=0,011); ter 80 anos e mais (OR=2,30; 95% IC 1,12-4,72, p=0,022); queixa de tontura (OR=1,91; 95% IC 1,04-3,49, p=0,035); morar só (OR=2,57; 95% IC 1,27-5,18, p=0,008); artrite (OR=1,94; 95% IC 1,07-3,51, p=0,027); e sintomas depressivos (OR=2,13 95% IC 1,17-3,88, p=0,013). Conclusão: Os fatores associados a quedas e quedas recorrentes modificáveis foram morar só, ter sintomas depressivos, baixa autoeficácia para quedas, tontura e artrite. Sugere-se que esses fatores sejam considerados em programas de prevenção de quedas nesta população.
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Abstract
OBJETIVOS: Comparar idosos cuidadores e não cuidadores quanto às condições de saúde, psicossociais e de desempenho funcional e conhecer a influência das variáveis socioeconômicas sobre estes grupos. MÉTODO: Estudo envolvendo idosos residentes de três cidades brasileiras - Parnaíba-PI, Campinas-SP e Ivoti-RS - com base nos dados do estudo FIBRA. A amostra foi composta de 676 idosos, 338 cuidadores e 338 não cuidadores. Os cuidadores responderam afirmativamente a duas questões sobre a prestação de cuidado no Elders Life Stress Inventory. Os instrumentos utilizados foram: versões brasileiras da Geriatric Depression Scale, da Interpersonal Support Evaluation List, da escala de atividades instrumentais de vida diária (AIVD), de 13 itens de atividades avançadas de vida diária e escala de satisfação com a vida. Foram aplicadas questões de autorrelato sobre idade, gênero, renda familiar, número de doenças e fadiga. RESULTADOS: Os cuidadores compuseram 29,7% da amostra. A tarefa de cuidar era mais frequente entre as mulheres (65,7%), os idosos de 65 a 74 anos e os de menor renda familiar. Houve frequência maior de queixa de insônia entre os cuidadores comparados com os não cuidadores (p=0,013). Para os grupos, ser mais pobre significou maior frequência de insônia e de dependência em AIVD, além de mais sintomas depressivos entre os cuidadores (p=0,24). As mulheres eram as mais doentes e os homens os mais isolados socialmente. Os cuidadores mais velhos reportaram maior grau de dependência em AIVD (p=0,015). CONCLUSÃO: Circunstâncias socioeconômicas podem contribuir para desfechos negativos sobre as condições de saúde física e bem-estar psicológico, especialmente entre os cuidadores.
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Proença de Oliveira-Maul J, Barbosa de Carvalho H, Goto DM, Maia RM, Fló C, Barnabé V, Franco DR, Benabou S, Perracini MR, Jacob-Filho W, Saldiva PHN, Lorenzi-Filho G, Rubin BK, Nakagawa NK. Aging, diabetes, and hypertension are associated with decreased nasal mucociliary clearance. Chest 2013; 143:1091-1097. [PMID: 23100111 DOI: 10.1378/chest.12-1183] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND We showed previously that nasal mucociliary clearance was decreased in critically ill elderly subjects, most of whom had diabetes mellitus (DM) and/or hypertension (HTN). To determine if these changes were due to the effects of aging, disease, or critical illness, we studied nasal mucociliary clearance and mucus properties in an ambulatory population consisting of young, elderly, and healthy subjects and those with DM, HTN, or both. METHODS Of 440 subjects contacted, 252 entered the study. The subjects were divided into the following groups: (1) healthy (n 5 79, 18-94 years, 50 men) and (2) DM and/or HTN, of which 37 had DM (14-90 years, 12 men), 52 had HTN (23-90 years, 12 men), and 84 had both DM and HTN (25-82 years, 33 men). Subjects were also grouped by age: , 40 years, 40 to 59 years, and 60 years. We assessed demographic and clinical data, quality of life using the 36-Item Short Form Health Survey (SF-36) questionnaire, nasal mucociliary clearance using the saccharine transit test (STT), and in vitro mucus properties by examining the sneeze (high airflow) clearability and contact angle. A logistic regression analysis for prolonged STT . 12 min was used, and we controlled for age, sex, and diseases. RESULTS Subjects aged . 60 years reported a decreased SF-36 physical component relative to other age groups. Sex, BMI, BP, heart rate, pulse oximetry, blood glucose level, and mucus properties were not associated with prolonged STT. Aging and DM and/or HTN independently increased the risk of prolonged STT. CONCLUSIONS Aging and DM, HTN, or both diseases are independently associated with decreased nasal mucociliary clearance. This may predispose toward respiratory infections.
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Affiliation(s)
- Janaína Proença de Oliveira-Maul
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, LIM 34, University of São Paulo City, Brazil; Department of Pathology, LIM 05, University of São Paulo City, Brazil
| | | | - Danielle Miyuki Goto
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, LIM 34, University of São Paulo City, Brazil; Department of Pathology, LIM 05, University of São Paulo City, Brazil
| | | | - Claudia Fló
- Department of Geriatrics, University of São Paulo City, Brazil
| | - Viviane Barnabé
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, LIM 34, University of São Paulo City, Brazil; Department of Pathology, LIM 05, University of São Paulo City, Brazil
| | | | - Simon Benabou
- Department of Pathology, LIM 05, University of São Paulo City, Brazil
| | | | | | | | - Geraldo Lorenzi-Filho
- Division of Pneumology, Heart Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Bruce K Rubin
- Virginia Commonwealth University Department of Pediatrics and Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA
| | - Naomi Kondo Nakagawa
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, LIM 34, University of São Paulo City, Brazil; Department of Pathology, LIM 05, University of São Paulo City, Brazil.
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Ruggero CR, Bilton TL, Teixeira LF, Ramos JDLA, Alouche SR, Dias RC, Perracini MR. Gait speed correlates in a multiracial population of community-dwelling older adults living in Brazil: a cross-sectional population-based study. BMC Public Health 2013; 13:182. [PMID: 23448191 PMCID: PMC3598989 DOI: 10.1186/1471-2458-13-182] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 02/13/2013] [Indexed: 12/25/2022] Open
Abstract
Background Gait speed is a strong predictor of a wide range of adverse health outcomes in older adults. Mean values for gait speed in community-dwelling older adults vary substantially depending on population characteristics, suggesting that social, biological, or health factors might explain why certain groups tend to self-select their gait speed in different patterns. The vast majority of studies reported in the literature present data from North American and European populations. There are few population-based studies from other regions with a different ethnicity and/or social and health conditions. To address this, the present study identified the mean usual and fast gait speeds in a representative multiracial population of community-dwelling older adults living in a developing country, and explored their association with sociodemographic, mental and physical health characteristics. Methods This was a cross-sectional population-based study of a sample of 137 men and 248 women, aged 65 years and over. Usual gait speed and fast gait speed were measured on a 4.6 m path. Participants were classified into slow, intermediate, and faster groups by cluster analysis. Logistic regression analysis was used to estimate the independent effect of each factor on the odds of presenting with a slower usual and slower fast gait speeds. Results Participants had a mean (SD) usual gait speed of 1.11 (0.27) m/s and a mean fast gait speed of 1.39 (0.34) m/s. We did not observe an independent association between gait speed and race/ethnicity, educational level, or income. The main contributors to present a slower usual gait speed were low physical activity level, stroke, diabetes, urinary incontinence, high concern about falling, and old age. A slower fast gait speed was associated with old age, low physical activity, urinary incontinence and high concern about falling. Conclusion A multiracial population of older adults living in a developing country showed a similar mean gait speed to that observed in previously studied populations. The results suggest that low physical activity, urinary incontinence and high concern about falling should not be neglected and may help identify those who might benefit from early intervention.
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Affiliation(s)
- Cintia Regina Ruggero
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
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de Moraes SA, Soares WJDS, Ferriolli E, Perracini MR. Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study. BMC Geriatr 2013; 13:4. [PMID: 23290128 PMCID: PMC3545826 DOI: 10.1186/1471-2318-13-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 12/06/2012] [Indexed: 01/23/2023] Open
Abstract
Background Dizziness is a common complaint among older adults and has been linked to a wide range of health conditions, psychological and social characteristics in this population. However a profile of dizziness is still uncertain which hampers clinical decision-making. We therefore sought to explore the relationship between dizziness and a comprehensive range of demographic data, diseases, health and geriatric conditions, and geriatric syndromes in a representative sample of community-dwelling older people. Methods This is a cross-sectional, population-based study derived from FIBRA (Network for the Study of Frailty in Brazilian Elderly Adults), with 391 elderly adults, both men and women, aged 65 years and older. Elderly participants living at home in an urban area were enrolled through a process of random cluster sampling of census regions. The outcome variable was the self-report of dizziness in the last year. Several feelings of dizziness were investigated including vertigo, spinning, light or heavy headedness, floating, fuzziness, giddiness and instability. A multivariate logistic regression analysis was conducted to estimate the adjusted odds ratios and build the probability model for dizziness. Results The complaint of dizziness was reported by 45% of elderly adults, from which 71.6% were women (p=0.004). The multivariate regression analysis revealed that dizziness is associated with depressive symptoms (OR = 2.08; 95% CI 1.29–3.35), perceived fatigue (OR = 1.93; 95% CI 1.21-3.10), recurring falls (OR = 2.01; 95% CI 1.11-3.62) and excessive drowsiness (OR = 1.91; 95% CI 1.11–3.29). The discrimination of the final model was AUC = 0.673 (95% CI 0.619-0.727) (p< 0.001). Conclusions The prevalence of dizziness in community-dwelling elderly adults is substantial. It is associated with other common geriatric conditions usually neglected in elderly adults, such as fatigue and drowsiness, supporting its possible multifactorial manifestation. Our findings demonstrate the need to expand the design in future studies, aiming to estimate risk and identify possible causal relations.
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Abstract
OBJETIVO: Explorar o relacionamento entre variáveis sociodemográficas, clínicas, funcionais e psico-cognitivas em idosos participantes de grupo de convivência, residentes na comunidade, e identificar a associação entre a interação dessas variáveis e quedas e quedas recorrentes. MÉTODO: Estudo transversal, exploratório com 150 idosos, de ambos os sexos, participantes de um grupo de terceira idade no município de Itu, São Paulo. Utilizou-se uma entrevista semiestruturada contendo características sociodemográficas, de saúde física, físico-funcionais (Brazilian OARS Multidimensional Functional Assessment Questionnaire - BOMFAQ e Timed up and go test - TUG), de saúde mental (Geriatric Depression Scale - GDS-15 e Mini Mental State Examination - MMSE). O nível de atividade física foi determinado por questões sobre frequência e duração das atividades físicas. A variável desfecho utilizada foi o número de quedas no último ano. Foi conduzida uma análise de cluster para se identificar perfis de grupos formados pela distribuição da variabilidade dos dados em cada bloco de variáveis: sociodemográficas, desempenho físico-funcional, saúde física e mental. Procedeu-se a análise de regressão uni e multivariada com quedas únicas e quedas recorrentes. RESULTADOS: A idade média dos participantes foi de 71,9 (±5,6) anos. A prevalência de quedas foi de 38,7%. A análise univariada revelou uma associação independente entre o cluster saúde mental (sem sintomas depressivos e com declínio cognitivo) e quedas recorrentes (OR=2,73 IC 95% 1,04-7,22 p=0,042), porém esta associação não foi significativa na análise multivariada (p=0,082). CONCLUSÃO: Não foi possível identificar um perfil de caidores e caidores recorrentes em idosos ativos. Mas nossos achados sugerem que, em idosos ativos com história de quedas, uma avaliação geriátrica abrangente com ênfase na função cognitiva seja considerada.
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Abstract
Abstract Dizziness is a common complaint among older adults. Aim To identify the prevalence of dizziness and its related factors in a sample of community-dwelling older adults. Methods A prospective population-based study with a representative sample of older adults aged 65 years and over. A multidimensional questionnaire and a battery of measures were used for assessing physical function. Results The prevalence of dizziness was 45%. Vertigo was found in 70.4% of older adults with dizziness and 43.8% of them referred vertigo crises along life. A significant association was found between dizziness and female gender (p=0.004), memory difficulties complaints (p=0.015), bad health perception (p=0.001), depression (p<0.0001), five or more comorbidities (p=0.021), self-reported fatigue (p<0.0001), recurrent falls (p=0.001), excessive sleepiness (p=0.003), fear of falling (p<0.0001), left leg unipedal stance (p=0.002) and Short Performance Physical Battery score (p=0.009). Conclusion Dizziness is a common complaint among older adults and it is associated with limiting clinical conditions, such as depression, fatigue, excessive sleepiness and impaired memory. It is highlighted the association between dizziness and recurrent falls, fear of falling and lower performance in physical function tests, which can restrict independence. These data suggest the importance of a multifactorial approach to dizziness in older adults.
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Abstract
AIM To analyze the hierarchical structure of activities of daily living (ADL) among vestibular older adults, according to its power to discriminate disability. METHODS An exploratory cross-sectional study was conducted comprising 235 elderly, aged 65 years and older, with chronic vestibular dysfunction. Functional capacity was assessed through the Brazilian version of OARS Multidimensional Functional Assessment Questionnaire which consists of 15 activities of daily living (ADL). The sample was classified in each ADL according to the difficulty level in performing the activity. A multiple correlation analysis technique and discriminant analysis was used to analyze the hierarchical structure of ADL. RESULTS The sample consisted of 75.3% women, with an average age of 73.55±5.94 years. The ADL and their respective discrimination measurements were: getting into and out of bed (0.293); eating (0.129); combing hair (0.150); walking on flat surfaces (0.270); having a bath/shower (0.512); getting dressed (0.325); getting to the toilet in time (0.107); climbing stairs (0.338); taking medicines on time (0.035); walking close to home (0.529); shopping (0.503); preparing meals (0.398); cutting toenails (0.242); getting off buses (0.452); and cleaning the house (0.408). CONCLUSION The tasks that reflect a higher demand upon the vestibular system were the most impaired, in the following order: walking close to home, having a bath/shower, shopping, getting off buses, cleaning the house, preparing meals, climbing stairs, getting dressed, getting into and out of bed, walking on flat surfaces, cutting toenails, combing hair, eating, getting to the toilet in time, taking medicines on time.
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Cordeiro RC, Jardim JR, Perracini MR, Ramos LR. Factors associated with functional balance and mobility among elderly diabetic outpatients. ACTA ACUST UNITED AC 2009; 53:834-43. [DOI: 10.1590/s0004-27302009000700007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 06/16/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: To characterize balance and mobility among diabetic elderly outpatients and to estimate the extent to which functional balance and mobility abnormalities can be influenced by sociodemographic, clinical and other functional factors in a cross-sectional study. METHODS: Ninety-one elderly (65+ years) outpatients were assessed. Mobility was evaluated by the Timed Up and Go Test (TUGT) and the balance, by the Berg Balance Scale (BS). RESULTS: TUGT mean score was 15.65 ± 5.9 seconds and BS mean score was 49.31 ± 7.3 points. Using linear regression analysis (α < 0.05), significant and independent positive relationships were obtained between TUGT and age, daily activities (ADL/IADL), step strategy, and proprioceptive sensitivity. Factors negatively associated with BS were: ADL/IADL, step strategy, proprioceptive sensitivity, orthostatic hypotension (OH) and conflictive sensory conditions. CONCLUSION: Elderly diabetic outpatients show abnormal balance and mobility related mainly to advanced age, disability, absence of step strategy, absence of proprioceptive sensitivity and presence of OH.
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Gazzola JM, Ganança FF, Aratani MC, Perracini MR, Ganança MM. Clinical evaluation of elderly people with chronic vestibular disorder. Braz J Otorhinolaryngol 2007; 72:515-22. [PMID: 17143431 PMCID: PMC9448939 DOI: 10.1016/s1808-8694(15)30998-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2005] [Accepted: 06/08/2006] [Indexed: 11/25/2022] Open
Abstract
Dizziness is common among the elderly. Aim To characterize social, demographic, clinical, functional and otoneurological data in elderly patients with chronic vestibular disorder. Method A sequential study of 120 patients with chronic vestibular disorder. Simple descriptive analyses were undertaken. Results Most of the patients were female (68.3%) with a mean age of 73.40±5.77 years. The average number of illnesses associated with the vestibular disorder was 3.83±1.84; the patients were taking on average 3.86±2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8%) and the most prevalent etiology was metabolic vestibulopathy (40.0%) followed by benign paroxysmal positional vertigo (36.7%). Fifty-two patients (43.3%) had experienced dizziness for 5 years or more. Sixty-four patients (53.3%) had at least one fall in the last year and thirty-five (29.2%) had recurrent falls. Conclusions Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.
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Affiliation(s)
- Juliana Maria Gazzola
- Physical therapist. Gerontology specialist trained at UNIFESP - EPM. Graduate student (Master's degree) of Sciences at the UNIFESP - EPM Otorhinolaryngology and Head & Neck Surgery graduate course. FAPESP scholarship. Voluntary observing physical therapist at the Vestibular Rehabilitation Unit of the UNIFESP Otoneurology Department
| | - Fernando Freitas Ganança
- Physical therapist. Gerontology specialist trained at UNIFESP - EPM. Voluntary observing physical therapist at the Vestibular Rehabilitation Unit of the UNIFESP
- Address for correspondence: Fernando F. Ganança - Rua dos Otonis 700 Vila Clementino 045025-002 São Paulo SP. Tel/Fax: (0xx11) 5083-4654
| | - Mayra Cristina Aratani
- Physical therapist. Doctor in Rehabilitation Science graduated at UNIFESP - EPM. Coordinating Professor of the Physical Therapy Master's degree at the Sao Paulo City University. Voluntary observing physical therapist at the Vestibular Rehabilitation Unit of the UNIFESP
| | - Monica Rodrigues Perracini
- Full Professor of Otorhinolaryngology at UNIFESP - EPM. Senior Researcher of the Graduate Program Stricto Sensu (Master's degree) on Neuromotor Rehabilitation Science at UNIBAN. Responsible for the Otoneurological Assessment Unit of the Otorhinolaryngology Sector at the Fleury Medical Diagnostic Center - Sao Paulo (SP)
| | - Maurício Malavasi Ganança
- Physician, ENT specialist, Doctor in Medicine trained at UNIFESP - EPM. Affiliated Professor of the Otoneurology Service at UNIFESP - EPM. Professor of the Neuromotor Rehabilitation Graduate Course at UNIBAN. Otoneurology Service at UNIFESP - EPM
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Gazzola JM, Ganança FF, Aratani MC, Perracini MR, Ganança MM. Circumstances and consequences of falls in elderly people with vestibular disorder. Braz J Otorhinolaryngol 2007; 72:388-92. [PMID: 17119777 PMCID: PMC9500538 DOI: 10.1016/s1808-8694(15)30974-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 04/05/2006] [Indexed: 11/10/2022] Open
Abstract
Aim To investigate the circumstances and consequences of falls in the chronically dizzy elderly and to correlate them with the number of falls (one/two and more). Method Transversal descriptive analytic study with 64 patients aged 65 or over, with history of falls and diagnostic of chronic vestibular dysfunction. We performed a descriptive analysis and Qui-Square test (χ<0.05). Results The sample was constituted by a female majority (76.6%) with a mean age of 73.62±5.69 years. The vestibular examination showed peripheral vestibulopathy in 81.5% of the cases and the most prevalent diagnostic hypothesis were benign paroxysmal positional vertigo (43.8%) and metabolic inner ear disease (42.2%). Recurrent falls were seen in 35 elderly (53.1%). In relation to the last fall, 39.1% of the patients had fallen in their homes, 51.6% of them occurred during the morning, 51.6% with some propulsion mechanism, 53.1% when walking, 25.0% caused by dizziness and 23.4% by stumbling. Activity restriction was significantly greater in patients that have already had two and more falls, when compared with those who had fallen only once (p=0.031). We found a significant association between the number of falls and their causes (p<0.001). Falls that have happened by slipping were more frequent in the elderly that reported one fall (p=0.0265) and falls that had happened because of dizziness were more frequent in the elderly that complained of two or more falls (p=0.0012). Conclusions Fear and tendency to fall are referred by the majority of chronically dizzy elderly. Fall are more frequent in the morning, in the home and during walking. The propulsion direction is mentioned by half of the elderly and the most common cause for falls are dizziness and stumbling. The number of falls is significantly associated with activity restrictions after the last fall and with the causes for falling (slipping and dizziness).
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