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OBJETIVO Analisar a associação entre a síndrome da fragilidade e desempenho cognitivo em idosos e respectivo efeito da escolaridade e da idade. MÉTODOS Foram analisados dados seccionais da fragilidade de idosos brasileiros da Fase 1 do Estudo FIBRA-RJ, relativos a 737 indivíduos residentes na cidade do Rio de Janeiro, RJ, com 65 anos ou mais, clientes de uma operadora de saúde, avaliados entre janeiro de 2009 e janeiro de 2010. Foram coletadas informações sobre características socioeconômicas e demográficas, condições médicas e capacidade funcional. O desempenho cognitivo foi avaliado através do Mini Exame do Estado Mental. Foram considerados frágeis os indivíduos que apresentaram três ou mais das seguintes características: perda de peso não intencional (≥ 4,5 kg no último ano); sensação de exaustão autorrelatada; baixo nível de força de preensão palmar; baixo nível de atividade física e lentificação da marcha. A associação entre fragilidade e desempenho cognitivo foi avaliada por regressão logística multivariada, com ajuste por condições médicas, atividades da vida diária e variáveis socioeconômicas. Idade e escolaridade foram avaliadas como possíveis modificadoras de efeito dessa associação. RESULTADOS Os idosos frágeis apresentaram maior prevalência de baixo desempenho cognitivo comparados aos idosos não frágeis ou pré-frágeis nas três faixas etárias estudadas (65 a 74; 75 a 84; ≥ 85 anos), p < 0,001. Após ajuste, a associação entre fragilidade e desempenho cognitivo foi encontrada em idosos com 75 anos ou mais, com OR aj = 2,78 (IC95% 1,23;6,27) para 75 a 84 anos e OR aj = 15,62 (IC95% 2,20;110,99) para 85 anos ou mais. A idade se comportou como modificadora de efeito na associação entre fragilidade e desempenho cognitivo, χ 2 (5) = 806,97, p < 0,0001; o mesmo não ocorreu com a escolaridade. CONCLUSÕES A síndrome da fragilidade associou-se ao desempenho cognitivo em idosos. A idade mostrou-se como modificadora de efeito nessa associação. Os idosos com idade mais avançada apresentaram associação mais expressiva entre os dois fenômenos.

The aim of the present study was to describe the conceptual and operational definitions of the frailty syndrome recommended by the Brazilian Consensus on Frailty in Older People. In 2015, a task force consisting of Brazilian specialists on human aging conducted a bibliographical review on frailty among older people in Brazil and established a consensus on the main findings through periodic meetings. A total of 72 articles were included in the analysis, comprising one systematic review, two conceptual discussions, two methodological descriptions, four longitudinal studies focusing on mortality and worsening of the frailty profile, eight cross-cultural adaptation studies, and 55 cross-sectional or prevalence studies. Forty-five studies (62.5%) used the Cardiovascular Health Study (CHS) frailty scale, of which seven (15.2%) used unadjusted cut-off points for their samples and 17 (36.9%) modified at least one of the five items of the instrument. The prevalence of frailty varied between 6.7 and 74.1%. When the CHS frailty scale was used, the wide range of prevalence — from 8 to 49.3% — depended on the cut-off points used to classify changes in gait speed and handgrip strength, as well as the research setting. The studies were based on four major conceptual models of frailty. Frailty in older people represents a state of physiological vulnerability and should not be confused with disabilities or multi-morbidities. In the Brazilian population, the prevalence of frailty has not yet been adequately estimated, and the cut-off points of the items of the frailty scales should be adapted to the parameters of this population.

OBJECTIVE: To investigate the construct validity of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR), which measures the functional capacity of the elderly, based on an informant's report. METHODS: A cross-sectional study was performed with 525 non-hospitalized elderly and their respective informants. Pearson's and Kendall's tau correlation coefficients with a statistical significance level of < 0.05 were used to evaluate the correlation between the FAQ-BR score and sociodemographic and health condition variables. RESULTS: All correlations were compatible with the underlying theory, with a statistical significance (p value < 0.001): age (r = 0.522); income (r = - 0.148); years of schooling (r = - 0.191); living alone (r = - 0.175); self-rated health (r = - 0.149); chronic self-reported diseases (r = 0.125) and; cognitive impairment (r = 0.350). CONCLUSION: Although the FAQ-BR demonstrates construct validity, future complementary studies should be done to further measure elderly people's functional capacity, based on an informant's report.

Rapidly progressive dementias are conditions that worsening the patient’s life; however they are not always considered during the investigation of dementia syndrome. This report describes the case of a patient with rheumatoid arthritis and chronic use of corticosteroid therapy, who developed rapidly progressive dementia within 5 months. During the investigation, the primary lymphoma of the central nervous system was evidenced as the cause of its dementia syndrome. Importantly, prolonged use of corticosteroids may be associated with a state of immunosuppression, which is a risk factor for the onset of central nervous system lymphoma.

Introduction: The World Health Organization (WHO) has proposed to monitor intrinsic capacity (IC) in the older population as a public health strategy through the Integrated Care for Older People (ICOPE) program. Although the program has been developed based on solid concepts, scientific evidence on its practical applicability is still scarce. Objectives: To evaluate IC in Brazilian older adults, its progress over time, and its association with sociodemographic and health factors and outcomes. To evaluate the psychometric properties of the WHO/ICOPE screening tool. Methods: This is a prospective multicenter cohort study with a 36-month follow-up. We will recruit 3838 people aged ≥ 60 years, registered in the health care units included in the study by the participating centers. We will collect sociodemographic and health data and will administer tools to assess IC domains, both those provided for in the ICOPE screening tool and the sequence of confirmatory assessments provided for in the program. Participants will be reassessed every 6 months for 36 months. Expected results: To establish the profile of IC in the study population and to understand its progress and the variables associated with the clinical outcomes of interest. To reveal the diagnostic and psychometric properties of the WHO/ICOPE screening tool. The project is funded by the Brazilian National Council for Scientific and Technological Development (CNPq). Relevance: Understanding the potential use of the ICOPE public health strategy proposed by the WHO within the scope of the Brazilian Unified Health System (SUS) by integrating several research centers in the field of Geriatrics and Gerontology throughout Brazil.

ABSTRACT Introduction: The Karnofsky Performance Status (KPS) is one of the most widely used tools for assessing the prognosis of oncology patients, providing an estimate of treatment efficiency and survival. Despite this, it is commonly used in free translations without validation. The objective of the present study was to perform the cross-cultural adaptation of the KPS instrument to Brazilian Portuguese (KPS-BR) through the stages of conceptual, semantic, operational, measurement, and functional equivalences. Methods: To assess consistency, we used Cronbach’s alpha and kappa coefficients. The Chi-square test was performed to evaluate the association between scores and the number of deaths. The relationship with survival and mortality was explored with Kaplan-Meier curves. Results: A total of 316 patients participated in the study. The internal consistency analysis resulted in a Cronbach’s alpha coefficient of 0.9265. For the inter-rater analysis, the correlation coefficient was 1, as was the kappa coefficient, indicating perfect agreement between observers. The correlation coefficient between the KPS-BR scale in the test-retest was 0.8631. We observed a 100% death rate at KPS-BR scale score 20 and a gradual decrease as the KPS-BR scale score increases up to KPS-BR 40 (p

Objective: The objective was to evaluate the relationship between protein consumption, physical activity, and muscle mass in individuals aged ≥ 60 years. Methods: This prospective study was based on the baseline and second wave of the ELSA-Brazil study. Protein consumption was assessed using a semiquantitative food frequency questionnaire. Physical activity was measured using the International Physical Activity Questionnaire. Muscle mass was estimated using a prediction equation, and the difference in MM between the first and second waves was calculated. Bivariate analyses were performed, with p < 0.05 considered significant. Multivariate analysis consisted of 4 Poisson regression models including covariates with p < 0.20. The statistical analysis was performed in IBM SPSS Statistics 21. Results: The sample included 2216 older adults, 55.10% of whom were women, with a mean age of 65.20 (SD, 4.15). Participants whose muscle mass decreased between the waves were in the first quartile of protein consumption. Mean physical activity significantly differed between the groups, while leisure-time physical activity differed only for women (p < 0.05). After adjusting for sociodemographic, health, and lifestyle variables, participants with lower protein intake had a 1.45 (1.29–1.63) relative risk of muscle mass loss. Conclusions: Lower protein consumption and higher physical activity were associated with decreased muscle mass, and those with protein consumption in the first and second quartiles are at higher risk of muscle mass loss.

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Justification and objective: The physiological changes that accompany human aging increase the risk of disease and care dependence. To meet the health needs of older adults, care must go beyond diagnosing specific diseases and assess the impact of these conditions on functionalcapacity. The concepts of intrinsic capacity and physical resilience aim to explain the trajectory of various health outcomes in older adults. The case presented below illustrates the positive impact of intrinsic capacity, together with external resources, on the prognosis of an older patient during a catastrophic health event. Case description: A 91-year-old widower was diagnosed with severe dehydration, delirium, pneumonia, and a grade IV pressure injury after lying in his home for 6 days. He remained hospitalized for 87 days and was discharged with almost complete recovery of his functional capacity. Discussion:The main point of this case is the positive health outcome experienced by a nonagenarian patient given the severity of the events. From the perspective of intrinsic capacity, he was functionally independent, had good sensory function, excellent cognition and vitality, and his psychological status was positive. He is currently progressing towards complete functional recovery.

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Objective: To assess the prevalence of fecal incontinence and its association with clinical, functional, and cognitive-behavioral variables, medication use, frailty, falls, and quality of life in community-dwelling older adults (aged 65 years or older). Methods: Cross-sectional, multicenter study carried out across 16 Brazilian cities. The question “In the last 12 months, did you experience fecal incontinence or involuntary passage of stool?” was defined as the indicator variable for fecal incontinence. Bivariate analyses were carried out to assess the prevalence of fecal incontinence and sociodemographic characteristics, comorbidities, cognition, functional capacity, depression, frailty, quality of life, and falls. Logistic regression analysis was also performed, with fecal incontinence as the dependent variable. Results: Overall, 6855 subjects were evaluated; 66.56% were female, 52.93% white, and the mean age was 73.51 years. The prevalence of fecal incontinence was 5.93%. It was associated with worse self-care (OR 1.78 [1.08–2.96]), dependence for basic activities of daily living (OR 1.29 [1.01–1.95]), and urinary incontinence (OR 4.22 [3.28–5.41]). Furthermore, the absence of polypharmacy was identified as a protective factor (OR 0.61 [0.44–0.85]). Conclusion: The overall prevalence of fecal incontinence was 5.93%. On logistic regression, one quality of life variable, dependence for basic activities of daily living, and polypharmacy were significantly associated with fecal incontinence.

Alzheimer's disease (AD) is a neurodegenerative and progressive disease that predominantly affects women and has no cure. Obstacles to the dental care of people with AD differ in each phase, but the dental surgeon should remember to include the caregivers, formal or informal, in the treatment. Some skills need to be considered in the planning process, and dental health indices can be very helpful for the professional to assess the patient's ability to undergo treatment and how the older person can benefit from it. The dental surgeon should evaluate each person's specific needs so that personalized oral hygiene protocols can be established. The suggested adaptations must be by the reality of the older adult with AD, the family context, and daily routine, and they must contemplate the information provided by the caregiver. In this article, we invite the dental surgeon to understand the continuum of AD to properly plan treatment, considering the individual's limitations, future perspectives, and safety, always keeping the older adult free of oral infections and comfortable with his or her oral health condition.

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ObjectiveTo investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.MethodsDementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben’s advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.ResultsPwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.ConclusionResults reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.

Abstract Background Frailty is a predictor of negative health outcomes in older adults. The physical frailty phenotype is an often used form for its operationalization. Some authors have pointed out limitations regarding the unidimensionality of the physical phenotype, introducing other dimensions in the approach to frailty. This study aimed to create a multidimensional model to evaluate frailty in older Brazilian adults and to compare the dimensions of the model created among the categories of the physical frailty phenotype. Methods A cross-sectional study was conducted using data from 3569 participants (73.7 ± 6.6 years) from a multicenter and multidisciplinary survey (FIBRA-BR). A three-dimensional model was developed: physical dimension (poor self-rated health, vision impairment, hearing impairment, urinary incontinence, fecal incontinence, and sleeping disorder), social dimension (living alone, not having someone who could help when needed, not visiting others, and not receiving visitors), and psychological dimension (depressive symptoms, concern about falls, feelings of sadness, and memory problems). The five criteria of the phenotype created by Fried and colleagues were used to evaluate the physical frailty phenotype. The proposed multidimensional frailty model was analyzed using factorial analysis. Pearson’s chi-square test was used to analyze the associations between each variable of the multidimensional frailty model and the physical phenotype categories. Analysis of variance compared the multidimensional dimensions scores among the three categories of the physical frailty phenotype. Results The factorial analysis confirmed a model with three factors, composed of 12 variables, which explained 38.6% of the variability of the model data. The self-rated health variable was transferred to the psychological dimension and living alone variable to the physical dimension. The vision impairment and hearing impairment variables were dropped from the physical dimension. The variables significantly associated with the physical phenotype were self-rated health, urinary incontinence, visiting others, receiving visitors, depressive symptoms, concern about falls, feelings of sadness, and memory problems. A statistically significant difference in mean scores for physical, social, and psychological dimensions among three physical phenotype categories was observed (p

OBJECTIVE: The prevalence of falls and associated factors were determined in a large cohort of community-dwelling older adults. METHODS: The sample included adults at least 65 years old who resided in the city of Rio de Janeiro, Brazil. A total of 742 individuals were investigated by inverse random sampling and were stratified by gender and age. The prevalence of falls was calculated by the history of falls in the last year. Data on clinical, psychosocial, sociodemographic and functional characteristics were also gathered. After bivariate analysis, statistically relevant variables were included in groups in 4 models for multivariate analyses. RESULTS: The prevalence of falls was 29%. The mean age was 76.7; 70.2% were female; 43.4% were married; 80.3% had ≥ 5 years of education; 48.3% had an income, of which ≥ 5.1 were minimum wage. All of the variables were associated with falls, except fair self-rated health. In contrast, when all these variables were adjusted (model 2), almost all lost the statistical significance, except for functional dependency-IADL (OR = 1.51; 95%CI 1.02–2.21) and poor/very poor self-rated health (OR = 2.36; 95%CI 1.06–5.25). For psychosocial variables in model 1, only fear of falling and activity level were significantly associated with falls. However, when these variables were adjusted (model 3), only fear of falling remained significant. In the final model, functional dependency (OR = 1.48; 95%CI 1.01–2.17), poor/very poor self-rated health (OR = 2.33; 95%CI 1.05–5.21) and fear of falling (OR = 2.14; 95%CI = 1.47–3.12) were associated with falls. CONCLUSION: The prevalence of falls is high among community-dwelling older adults. Associations with socio-demographic and biological factors have been identified and confirmed in the literature. Social activities were considered a protective factor.

[This corrects the article DOI: 10.1371/journal.pone.0250925.].

Introduction One of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge.Methods and analysis This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses.Ethics and dissemination Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines.PROSPERO registration number CRD42020218231.

ABSTRACT OBJECTIVE To investigate the risk of mortality associated with sarcopenic obesity (SO), obesity (OB), and sarcopenia in elderlies. METHODS We analyzed longitudinal data from 270 participants > 65 years of age of Phase III of the Study on Frailty in Brazilian Older People (FIBRA–RJ–2012). Socioeconomic, demographic, lifestyle, morbidity, and functional data were collected by home based interviews. DXA and body composition assessment was conducted in a laboratory. In women, OB was diagnosed when body fat percentage ≥ 38% and sarcopenia by an Appendicular Lean Mass Index (ALMI) < 6.00 kg/m2 and muscle strength < 16 Kgf. In men, OB was diagnosed when body fat percentage ≥ 27%, and sarcopenia was diagnosed with ALMI < 7.00 kg/m2 and muscle strength < 27 Kgf. SO was assessed by combining variables used to diagnose obesity and sarcopenia. The probabilistic linkage method was used to obtain deaths in the 2012-January 2017 period from the Brazilian Mortality Registry. Cox regression models were tested, and crude and adjusted hazard ratio calculations were conducted. RESULTS After adjusting for sex, age, race/skin color, walking as an exercise, and hypertension, individuals with sarcopenia were 5.7 times more likely to die (95%CI: 1.17–27.99) than others without sarcopenia and obesity. CONCLUSION A high risk of death was observed in individuals with sarcopenia. These results show the need for preventive strategies of early detection and treatment in order to increase survival employing multimodal interventions.

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RESUMO A velocidade da marcha (VM) tem sido considerada um marcador de saúde em idosos capaz de predizer desfechos adversos de saúde, mas a compreensão de fatores associados a ela ainda é limitada e controversa. O objetivo deste trabalho é identificar desfechos adversos de saúde relacionados ao declínio da velocidade de marcha em idosos comunitários. Trata-se de estudo transversal e multicêntrico, que avaliou o autorrelato de doenças crônicas e de hospitalização no último ano, polifarmácia e velocidade de marcha. Utilizou-se análise de regressão logística para estimar os efeitos de cada variável independente na chance de os idosos apresentarem declínio na velocidade de marcha inferior (VM

Resumo Introdução: A avaliação geriátrica atual utiliza amplamente escalas de avaliação funcional e cognitiva. No Brasil, as características psicométricas do Mini-Exame do Estado Mental (MEEM) não foram adequadamente avaliadas em populações idosas atendidas em ambulatórios gerais. Objetivo: Determinar a confiabilidade teste-reteste da versão em português do MEEM em indivíduos com 65 ou mais anos de idade atendidos em um ambulatório geral. Métodos: Foram selecionados 306 indivíduos com 65 anos ou mais, que procuraram um ambulatório geral de saúde, e foram submetidos a uma avaliação geriátrica com vários instrumentos, entre os quais o MEEM, que foi reaplicado em 105 indivíduos, pelos mesmos examinadores, com intervalo de uma semana. A confiabilidade foi estimada pelos coeficientes kappa e de correlação intraclasse. O alfa de Cronbach estimou a consistência interna da escala. Resultados: Não houve diferenças significativas socioeconômicas ou de morbidades entre a amostra selecionada para o estudo de confiabilidade e a população de estudo. O coeficiente kappa para um ponto de corte 23/24 foi 0,79, considerado “substancial”. O coeficiente de correlação intraclasse foi calculado em 0,80, e o alfa de Cronbach foi de 0,71. Conclusão: A versão para o português do MEEM utilizada neste estudo foi considerada confiável para a avaliação cognitiva de idosos em ambulatórios gerais.

Leprosy is an infectious disease that remains endemic in approximately 100 developing countries, where about 200,000 new cases are diagnosed each year. Moreover, multibacillary leprosy, the most contagious form of the disease, has been detected at continuously higher rates among Brazilian elderly people. Due to the so-called immunosenescence, characterized by several alterations in the quality of the immune response during aging, this group is more susceptible to infectious diseases. In view of such data, the purpose of our work was to investigate if age-related alterations in the immune response could influence the pathogenesis of leprosy. As such, we studied 87 individuals, 62 newly diagnosed and untreated leprosy patients distributed according to the age range and to the clinical forms of the disease and 25 healthy volunteers, who were studied as controls. The frequency of senescent and memory CD8+ leukocytes was assessed by immunofluorescence of biopsies from cutaneous lesions, while the serum levels of IgG anti-CMV antibodies were analyzed by chemiluminescence and the gene expression of T cell receptors' inhibitors by RT-qPCR. We noted an accumulation of memory CD8+ T lymphocytes, as well as reduced CD8+CD28+ cell expression in skin lesions from elderly patients, when compared to younger people. Alterations in LAG3 and PDCD1 gene expression in cutaneous lesions of young MB patients were also observed, when compared to elderly patients. Such data suggest that the age-related alterations of T lymphocyte subsets can facilitate the onset of leprosy in elderly patients, not to mention other chronic inflammatory diseases.

BackgroundLeprosy continues to be a public health problem in Brazil. Furthermore, detection rates in elderly people have increased, particularly those of multibacillary (L-Lep) patients, who are responsible for transmitting M. leprae. Part of the decline in physiological function during aging is due to increased oxidative damage and change in T cell subpopulations, which are critical in defense against the disease. It is not still clear how age-related changes like those related to oxidation affect elderly people with leprosy. The aim of this work was to verify whether the elderly leprosy patients have higher ROS production and how it can impact the evolution of leprosy.Methodology/principal findings87 leprosy patients, grouped according to age range and clinical form of leprosy, and 25 healthy volunteers were analyzed. Gene expression analysis of antioxidant and oxidative burst enzymes were performed in whole blood using Biomark's microfluidic-based qPCR. The same genes were evaluated in skin lesion samples by RT-qPCR. The presence of oxidative damage markers (carbonylated proteins and 4-hydroxynonenal) was analyzed by a DNPH colorimetric assay and immunofluorescence. Carbonylated protein content was significantly higher in elderly compared to young patients. One year after multidrug therapy (MDT) discharge and M. leprae clearance, oxidative damage increased in young L-Lep patients but not in elderly ones. Both elderly T and L-Lep patients present higher 4-HNE in cutaneous lesions than the young, mainly surrounding memory CD8+ T cells. Furthermore, young L-Lep demonstrated greater ability to neutralize ROS compared to elderly L-Lep patients, who presented lower gene expression of antioxidant enzymes, mainly glutathione peroxidase.Conclusions/significanceWe conclude that elderly patients present exacerbated oxidative damage both in blood and in skin lesions and that age-related changes can be an important factor in leprosy immunopathogenesis. Ultimately, elderly patients could benefit from co-supplementation of antioxidants concomitant to MDT, to avoid worsening of the disease.

BackgroundHandgrip strength (HGS) is an indicator of muscle strength, suited for evaluating the aging process. Its use depends on the availability of reliable normative reference values (NRV). The main objective of this study is to provide NRV of HGS for Brazilians aged 65 to 90 years.MethodsParticipants were from the Frailty in Brazilian Older People research. 2,999 successful aging (SA) participants comprised the development sample. HGS was measured using a hydraulic dynamometer. Obtaining NRV involved regressing HGS on age per sex-height strata, fitting separate fractional polynomial (FP) models for the mean and coefficient of variation. Model fit was assessed via standardized residuals, probability/quantile plots, and comparing observed to normal expected percentages of participants falling within specified centile intervals. For validation, the latter procedure was applied to 2,369 unsuccessfully aging (UA) participants.ResultsAcross strata, the best-fitting models for the means were FP of power 1. FP models for the CV indicated age invariance, entailing steady heteroscedastic age decline in SD since coefficients for the means were negative and SD = CV×mean. All models adjusted well. Centiles distributions for the SA and UA populations showed anticipated patterns, respectively falling on and below the normative expected centile references. Results (NRV) are presented in tables and centile charts. Equations are also provided.ConclusionNRV/charts may be endorsed for routine use, while still tested further. They would aid professionals caring for older people, not only to identify those at risk and eligible for immediate provisions, but also in planning prevention and rehabilitation measures.

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OBJECTIVES: To assess the prevalence of sarcopenic obesity and its association with functionality, lifestyle, biomarkers, and morbidities in older adults. METHODS: The study analyzed cross-sectional data from 270 older adults who participated in phase III of the Frailty in Brazilian Older People Study (Fragilidade em Idosos Brasileiros—Rio de Janeiro, FIBRA-RJ study-2013). They took part in a home interview surveying socioeconomic, demographic, lifestyle, morbidities, and functional data. Blood was collected for biochemical marker analysis and participants’ body composition was determined by dual-energy X-ray absorptiometry. For women, the diagnosis of sarcopenic obesity was defined at a body fat percentage ≥38% and appendicular skeletal muscle mass index (ASMMI)

ABSTRACT OBJECTIVE To evaluate the incidence and persistence of fear of falling in older adults and the clinical/functional, psychosocial and lifestyle-related risk factors. METHODS A longitudinal study with 393 community-dwelling older adults aged 65 years and over (110 men/ 283 women) resident in the North Zone of the city of Rio de Janeiro, Brazil. The fear of falling was assessed by the Falls Efficacy Scale-I-BR. The explanatory variables assessed were: number of comorbidities and medicines, history of falls, fracture from falling, use of walking aids, functional dependence in basic and instrumental activities of daily living, hearing and visual impairment, hand grip strength, walking speed, self-rated health, body mass index, depressive symptoms, cognitive impairment, living alone and activity level. Incidence, persistence and risk factors were estimated. Multivariate analysis was performed using Poisson Regression, obtaining relative risks (RR) and corresponding to 95% confidence intervals. RESULTS Among the 393 participants, fear of falling occurred in 33.5% and was persistent in 71.3%. Incidence was found to associate with using seven or more medicines and reporting worse activity level than the prior year. Risk factors for persistent fear were: using seven or more medicines, a history of one or two falls, reduced walking speed, hearing impairment, cognitive impairment, depressive symptoms and poor or very poor self-rated health. CONCLUSION Fear of falling is a frequent and persistent condition. Many factors related to persistent fear showed no association with the incidence of fear, emphasizing the need for focused strategies to reduce risk factors that may be associated with the chronification of fear of falling.

Enquadramento: Instrumentos de aferição da capacidade funcional do idoso, como o Functional Activities Questionnaire, podem ser utilizados para a deteção e predição de demência. Objetivo: Avaliar a acurácia da versão brasileira do Functional Activities Questionnaire (FAQ-BR) no rastreio de demência. Metodologia: Estudo transversal realizado com 265 idosos e seus respetivos informantes. O desempenho do FAQ-BR foi comparado ao diagnóstico clínico de demência e a sua pontuação comparada à de instrumentos de rastreio de declínio cognitivo/demência. A curva receiver operating curve (ROC) foi utilizada para determinar a sensibilidade e a especificidade do melhor ponto de corte. Resultados: A área sob a curva ROC indicou acurácia de 79,7% com ponto de corte ≥ 14, que mostrou as máximas sensibilidade (80,0%) e especificidade (72,0%). A pontuação do FAQ-BR apresentou correlações altas com as pontuações dos instrumentos de rastreio de declínio cognitivo/demência. Conclusão: A área sob a curva ROC, a sensibilidade e a especificidade do FAQ-BR mostraram-se inapropriadas, não permitindo recomendar o seu uso no rastreio de demência.

OBJECTIVES: Sarcopenia is a common treatable geriatric condition. The aim of this study was to estimate the prevalence of sarcopenia and its associated factors in community-dwelling elderly living in Rio de Janeiro, Brazil, and to discuss the impact of different muscle mass, handgrip strength and gait speed cut-off values on the reported frequency of sarcopenia. METHODS: The health habits, functional capacity, and anthropometric measurements of 745 individuals aged ≥65 years from the Frailty in Brazilian Older People study were analyzed. The participants were classified into the following four groups: no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia. Univariate and multivariate regression analyses were performed. Muscle mass, handgrip strength and gait speed cut-off thresholds tailored to the sample and those proposed by the European Working Group on Sarcopenia in Older People were used to compare the prevalence rates of sarcopenia. RESULTS: Seventy-three percent of the participants were female, 61.9% were Caucasian, and the mean age was 76.6 years. The prevalence rates of sarcopenia were 10.8% and 18% using the sample-tailored and European consensus cut-off values, respectively. Sarcopenia was associated with advanced age (OR: 37.2; CI95%12.35-112.48), Caucasian race (OR: 1.89; CI 95% 1.02-3.52), single marital status (OR:6; CI95% 2.2-16.39), low income (OR:3.64; CI 95% 1.58-8.39), and the presence of comorbidities (OR:3.26; CI 95%1.28-8.3). CONCLUSION: In this study, the estimated prevalence of sarcopenia was similar to that reported in most studies after the tailored handgrip strength and gait speed cut-off values were adopted. A higher prevalence was observed when the cut-off values suggested by the European consensus were used. This indicates that the prevalence of sarcopenia must be estimated using population-specific reference values.

Resumo: Este estudo teve por objetivo avaliar a estrutura dimensional e a consistência interna da versão brasileira do Functional Activities Questionnaire (FAQ-BR) para aferição da capacidade funcional do idoso, com base no relato de informante. Trata-se de um estudo seccional desenvolvido com 525 informantes de idosos não institucionalizados, em que análises fatoriais confirmatórias (AFC) e análises fatoriais exploratórias (AFC/E), modeladas segundo os princípios da AFC, foram usadas para identificar o modelo mais parcimonioso e mais bem ajustado. A consistência interna do FAQ-BR foi avaliada pela confiabilidade composta, e correlações entre suas dimensões foram examinadas a fim de investigar validade fatorial discriminante. A AFC não corroborou a estrutura unidimensional originalmente proposta. Em seguida, a AFC/E ajustou uma estrutura bidimensional que foi reavaliada por AFC, evidenciando um modelo sem cargas cruzadas como o mais parcimonioso e com adequados índices de ajuste. A consistência interna do FAQ-BR foi considerada satisfatória, e a correlação entre suas dimensões, aceitável. Esses achados são importantes, pois revelam a capacidade de a escala capturar o construto capacidade funcional do idoso em um contexto sociocultural distinto daquele em que foi desenvolvido. Portanto, o FAQ-BR pode ser considerado um instrumento bidimensional apropriado para aferir a capacidade funcional do idoso com base no relato do informante, e seu uso em pesquisas com populações semelhantes é recomendado.

Introduction: A number of studies have shown the impact of cognitive abilities on instrumental activities of daily living, in particular executive functions. Nevertheless, it is not clear to what extent these results can be generalized, given that most samples studied have not included people with a low educational level. Objectives: The current study aims to investigate the association between cognitive abilities and activities of daily living in older adults - with and without dementia - from a middle-income country. Sample: The sample consisted of 48 healthy older adults and 29 people with dementia, who were evaluated in an Outpatient Care Unit in a University Reference Center in Rio de Janeiro. Results: Regression analyses indicated that the best predictors for activities of daily living were performance in immediate verbal memory in the case of controls and in a categorical fluency task in the patient group. The educational level itself was not a significant predictor of functional ability in either sample, but showed moderate correlation with the predictors. Conclusions: These results suggest that educational level may be a mediating factor in the association of cognitive variables and activities of daily living, and indicate a potential dissociation in terms of predictors according to the diagnostic status, pointing to relevant treatment directions.

OBJECTIVE: Frailty syndrome can be defined as a state of vulnerability to stressors resulting from a decrease in functional reserve across multiple systems and compromising an individual's capacity to maintain homeostasis. The purpose of this study was to determine the prevalence of frailty and its association with social and demographic factors, functional capacity, cognitive status and self-reported comorbidities in a sample of community-dwelling older individuals who are clients of a healthcare plan. METHODS: We evaluated 847 individuals aged 65 years or older who lived in the northern area of the city of Rio de Janeiro, Brazil. The subjects were selected by inverse random sampling and stratified by gender and age. To diagnose frailty, we used the scale proposed by the Cardiovascular Health Study, which consisted of the following items: low gait speed, grip strength reduction, feeling of exhaustion, low physical activity and weight loss. The data were collected between 2009 and 2010, and the frailty prevalence was calculated as the proportion of individuals who scored positive for three or more of the five items listed above. To verify the association between frailty and risk factors, we applied a logistic regression analysis. RESULTS: The prevalence of frailty syndrome was 9.1% (95% confidence interval [CI], 7.3-11.3); 43.6% (95% CI, 40.3-47) of the individuals were considered robust, and 47.3% (95% CI 43.8-50.8) were considered pre-frail (p

O objetivo do estudo foi determinar o perfil de risco e fatores associados à fragilidade em idosos da comunidade. A população-fonte constituiu-se de indivíduos com 65 anos ou mais, residentes nos bairros da zona norte da cidade do Rio de Janeiro, Brasil, e clientes de uma operadora de saúde. O estudo foi transversal, na linha de base de uma coorte, com amostra estratificada por sexo e idade, composta por 764 indivíduos. Para a estratificação de risco, utilizou-se o instrumento de rastreio probabilidade de internações repetidas (PIR). A análise de regressão logística foi realizada para estudar a associação entre a PIR e um conjunto de variáveis sociodemográficas, de estado de saúde, funcionais e cognitivas, após a análise bivariada. Encontraram-se 6,7% de idosos com alto risco de internação. Associaram-se ao risco de internação câncer, quedas, doença pulmonar obstrutiva crônica e medicamentos usados, bem como as seguintes condições: receber visita de profissional da saúde, ter estado acamado no domicílio, morar só e praticar as atividades de vida diária. O instrumento parece ser útil na estratificação de risco dos idosos.

FUNDAMENTO: A hipertensão arterial tem sido associada à redução do desempenho cognitivo, contudo a literatura é conflitante. OBJETIVO: Comparar o desempenho cognitivo entre idosos normotensos ("N"; n = 17; idade 68 ± 1; pressão arterial = 133 ± 3/74 ± 2 mmHg) e hipertensos ("H"; n = 28; idade 69 ± 1, pressão arterial = 148 ± 4/80 ± 1 mmHg) com pelo menos cinco anos de escolaridade. MÉTODOS: A avaliação neuropsicológica ampla constou do "Cambridge Cognition-Revised" (CAMCOG-R), dos "Trail Making Test A and B" (TMT A e B) e do "Rey Auditory Verbal Learning Test" (RAVLT). RESULTADOS: Os idosos hipertensos apresentaram menor escore do CAMCOG-R (N = 87,6 ± 1,8; H = 78,6 ± 1,4; p = 0,002). Os idosos hipertensos necessitaram de maior tempo para realizar o TMT A e B (TMT A: N = 39 ± 3s; H = 57 ± 3,4s; p = 0,001; TMT B: N = 93 ± 7s; H = 124 ± 7s; p = 0,006), o que também é demonstrado pelos percentis significativamente menores obtidos nestes testes. O somatório do RAVLT foi significativamente menor nos idosos hipertensos (N = 51,8 ± 1,7; H = 40,7 ± 1,5; p < 0,0001). Mesmo ajustado para idade, sexo, escolaridade e sintomas de depressão, a hipertensão arterial foi um fator preditor independente do desempenho cognitivo medido pelo CAMCOG-R, TMT A e o somatório do RAVLT. CONCLUSÃO: O desempenho cognitivo em idosos hipertensos é menor do que em idosos normotensos.BACKGROUND: Essential hypertension has been associated with decreased cognitive performance; however, the literature is conflicting. OBJECTIVE: This study aims at comparing cognitive performance between elderly normotensives ("N"; n = 17; age 68 ± 1; blood pressure = 133 ± 3/74 ±2 mmHg) and hypertensives ("H"; n = 28; age 69 ± 1, blood pressure = 148 ± 4/80 ± 1mmHg) with at least 5 years of education. METHODS: The comprehensive neuropsychological assessment was comprised of the Cambridge Cognition-Revised (CAMCOG-R), the Trail Making Test A and B (TMT A and B) and the Rey Auditory Verbal Learning Test (RAVLT). RESULTS: Elderly hypertensives presented lower CAMCOG-R global scores (N = 87.6 ± 1.8; H = 78.6 ± 1.4; p = 0.002). The hypertensive's performance was slower in the TMT A and B (TMT A: N = 39 ± 3s; H = 57 ± 3s; p = 0.001; TMT B: N = 93 ± 7s; H = 124 ± 7s; p = 0.006), which was also reflected in smaller percentiles achieved by hypertensives in these tests. Hypertensive subjects exhibited a significantly lower RAVLT summation score (N = 51.8 ± 1.7; H = 40.7 ± 1.5; p < 0.0001). Even when adjusted for age, sex, education and depression symptoms, hypertension was an independent predictor of cognitive performance as measured by CAMCOG-R global score, TMT A and RAVLT summation score. CONCLUSION: Cognitive performance is lower in elderly hypertensives as compared with elderly normotensives.

FUNDAMENTO: A hipertensão arterial tem sido associada à redução do desempenho cognitivo, contudo a literatura é conflitante. OBJETIVO: Comparar o desempenho cognitivo entre idosos normotensos ("N"; n = 17; idade 68 ± 1; pressão arterial = 133 ± 3/74 ± 2 mmHg) e hipertensos ("H"; n = 28; idade 69 ± 1, pressão arterial = 148 ± 4/80 ± 1 mmHg) com pelo menos cinco anos de escolaridade. MÉTODOS: A avaliação neuropsicológica ampla constou do "Cambridge Cognition-Revised" (CAMCOG-R), dos "Trail Making Test A and B" (TMT A e B) e do "Rey Auditory Verbal Learning Test" (RAVLT). RESULTADOS: Os idosos hipertensos apresentaram menor escore do CAMCOG-R (N = 87,6 ± 1,8; H = 78,6 ± 1,4; p = 0,002). Os idosos hipertensos necessitaram de maior tempo para realizar o TMT A e B (TMT A: N = 39 ± 3s; H = 57 ± 3,4s; p = 0,001; TMT B: N = 93 ± 7s; H = 124 ± 7s; p = 0,006), o que também é demonstrado pelos percentis significativamente menores obtidos nestes testes. O somatório do RAVLT foi significativamente menor nos idosos hipertensos (N = 51,8 ± 1,7; H = 40,7 ± 1,5; p < 0,0001). Mesmo ajustado para idade, sexo, escolaridade e sintomas de depressão, a hipertensão arterial foi um fator preditor independente do desempenho cognitivo medido pelo CAMCOG-R, TMT A e o somatório do RAVLT. CONCLUSÃO: O desempenho cognitivo em idosos hipertensos é menor do que em idosos normotensos.

Este artigo enfoca a primeira fase da adaptação transcultural da seção A do Cambridge Examination for Mental Disorders of the Elderly - Revised Version (CAMDEX-R), que é uma entrevista para o diagnóstico de demência. A avaliação da equivalência conceitual e de itens envolveu revisão bibliográfica e discussões com especialistas. A avaliação da equivalência semântica constou de: traduções do inglês para o português e retrotraduções, com análise das versões e do texto original; encontros com experts; discussão com 52 idosos através da técnica de grupos focais; nova reunião de especialistas; pré-teste com 35 idosos; produção da versão final. Para avaliar a estabilidade, a versão final foi aplicada a 160 pacientes. A confiabilidade interavaliador foi quase perfeita nas subseções do estado clínico atual e nos itens individuais da história patológica pregressa. A confiabilidade teste-reteste foi moderada ou superior nas subseções e foi quase perfeita ou substancial em 70% dos itens da história patológica progressa. A versão brasileira apresentou boa equivalência com o original e bons níveis de confiabilidade.This article concerns the first phase of the cross-cultural equivalence of Section A in the Cambridge Examination for Mental Disorders of the Elderly - Revised Version (CAMDEX-R), a clinical interview for dementia diagnosis. Evaluating conceptual and item equivalences involved a literature review and expert groups. Semantic equivalence involved translations of the original into Portuguese and back-translations, with analysis of the versions and the original text; meetings with experts; discussions with 52 elders using the focus group technique; further meeting with experts; pretesting on 35 elders; and elaboration of the final version. For the reliability analysis, the version was applied to 160 patients. Inter-observer reliability was nearly perfect in all sub-sections of present state and in individual items of past medical history. Test-retest reliability was moderate or higher in the sub-sections and substantial or nearly perfect in 70% of the items in past history. The Brazilian version shows satisfactory equivalence to the original and good reliability levels.

Este artigo apresenta os resultados das quatro primeiras etapas (equivalências de conceito, de item, semântica e operacional) do processo de adaptação para o português do Cambridge Cognitive Examination-Revised (CAMCOG-R). O processo teve como base o modelo teórico proposto por Herdman et al., que, além das quatro etapas supracitadas, inclui as equivalências de mensuração e funcional, não avaliadas no presente trabalho. Um grupo de especialistas avaliou se todas as dimensões abarcadas pelo CAMCOG-R estavam presentes na realidade brasileira; duas traduções e retro-traduções foram realizadas, assim como a técnica de "grupos focais". A versão brasileira do CAMCOG-R (Br-CAMCOG-R) foi elaborada mantendo os 69 itens do instrumento original, com níveis variados de dificuldade. Esta versão foi então aplicada em 196 idosos, nos quais a duração média foi de 43 ± 9,4 minutos, e a média do escore total foi de 67 ± 14,8 pontos. Os achados do estudo mostram que a Br-CAMCOG-R pode ser uma ferramenta útil na avaliação cognitiva de idosos que foram positivos em testes de rastreamento.This paper presents the results of the first four steps (conceptual, item, semantic, and operational equivalences) of cross-cultural adaptation to Portuguese of the Cambridge Cognitive Examination-Revised (CAMCOG-R). The process was based on the theoretical model proposed by Herdman et al., which includes not only the four steps described above, but also measurement and functional equivalences, not evaluated in the current study. A panel of experts evaluated whether all dimensions that comprise the CAMCOG-R were present in Brazilian reality. Two translations and back-translations were performed, in addition to the "focus group" technique. The Brazilian Portuguese version of the CAMCOG-R (Br-CAMCOG-R) was developed, maintaining the 69 items from the original instrument, with different levels of difficulty. It was then applied to 196 elders, with the test lasting an average of 43 ± 9.4 minutes, and an average total score of 67 ± 14.8 points. The Br-CAMCOG-R can be a useful tool for the cognitive evaluation of elders that tested positive during initial screening.

This study aimed to estimate the quartile distribution on the cognitive assessment of normal elderly with low education as measured by the Cambridge Cognitive Examination (CAMCOG). A sample of 292 elderly (> 65 years of age), screened for dementia and depression, were assessed using the CAMCOG. The CAMCOG scores of normal subjects (n = 206) were stratified according to age (65-69, 70-74, 75-79, > 80) and schooling (illiterate, 1-4, and > 5 years of formal education). Mean age was 72.8 (± 3.5) and mean schooling was 3.5 years (± 3). The mean score on the CAMCOG was 71 (± 12.7). The scores at the first quartile for illiterate/1-4 years of schooling were 58/62 (65-69 years), 52/63 (70-74 years), 48/67 (75-79 years) and 46/64 (> 80 years), respectively. There was a significant difference in the CAMCOG quartiles according to education and age. This study provides normative data on the CAMCOG of elderly people with low educational levels which may be clinically useful.Este estudo objetivou estimar a distribuição em quartis do Cambridge Cognitive Examination (CAMCOG) de idosos normais com baixa escolaridade. Foram selecionados 292 idosos (> 65 anos) que fizeram avaliação para detectar demência ou depressão (DSM-IV). Os resultados do CAMCOG dos indivíduos normais (n = 206) foram estratificados por idade (65-69, 70-74, 75-79 e > 80) e escolaridade (sem escolaridade, 1-4 anos e > 5 anos de estudo formal). A média de idade foi 72,8 anos (± 3,5), a de escolaridade 3,5 (± 3) anos e a pontuação do CAMCOG foi 71 (± 12,7). Os escores do quartil inferior do CAMCOG de analfabetos/1-4 anos de estudo foram 58/62 (65-69 anos), 52/63 (70-74 anos), 48/67 (75-79 anos) e 46/64 (> 80 anos), respectivamente. Verificou-se diferença significativa no desempenho dos quartis do CAMCOG quanto à escolaridade e relação inversamente proporcional com a idade. Este estudo oferece dados normativos do CAMCOG para idosos brasileiros com baixa escolaridade que podem ser úteis no contexto clínico.

O presente trabalho tem como objetivo apresentar os resultados do processo de tradução e adaptação transcultural do Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) e da confiabilidade teste-reteste de uma versão para uso no Brasil. Um comitê para revisão do instrumento analisou a equivalência conceitual e de itens. Para análise de equivalência semântica, foram realizadas três traduções e três retrotraduções; elaboração de uma versão síntese; pré-teste e elaboração de uma versão teste. A consistência interna e a confiabilidade teste-reteste foram mensuradas pelo coeficiente ± de Cronbach e o coeficiente de correlação intraclasse (CCI), respectivamente. Dos 169 informantes avaliados, 97 foram retestados. O ± de Cronbach foi 0,94 e o CCI foi de 0,92. Os níveis de confiabilidade obtidos permitem concluir que a versão do IQCODE-BR se mostrou de fácil compreensão, sendo observada uma boa equivalência com a versão original.This article presents the results of the translation and cross-cultural adaptation of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the test-retest reliability of a version to be used in Brazil. An instrument review committee analyzed the conceptual and item equivalence. In order to analyze semantic equivalences, three translations and three back-translations were performed; a summary version was devised and pre-tested, and a test version elaborated. The Cronbach's ± coefficient and intraclass correlation coefficient (ICC) were used to measure the internal consistency and test-retest reliability, respectively. Of the 169 informants assessed, 97 were retested. A Cronbach's ± of 0.94 and an ICC of 0.92 were found. The reliability levels lead to the conclusion that the IQCODE-BR version is easy to comprehend. Satisfactory equivalence to the original version was observed.

The study' goal was to evaluate the reliability of the Cambridge Cognitive Examination Revised-Brazilian version (Br-CAMCOG-R), a neuropsychological battery measuring the global cognitive function. It was applied on 123 elders and retested at a mean interval of 30.7 days; 60 were evaluated by two raters at the same time. The intraclass coefficient for the set of items and for the subscales varied from 0.93 to 0.98. In the retests the agreement was nearly perfect for the set of items. There was no expressive range in the stability of the instrument for sex, age, schooling, or for the presence of dementia. The Cronbach' alpha of the set of items of the test was high (0.89). The Br-CAMCOG-R has obtained a high level of stability with time, agreement among raters, and optimum internal consistency; it can be useful for epidemiological studies and in specialized clinics to evaluate cognitive functions in elders.O objetivo deste estudo foi avaliar a confiabilidade da versão brasileira do Cambridge Cognitive Examination Revised (Br-CAMCOG-R), uma bateria neuropsicológica que mede a função cognitiva global. Ele foi aplicado em 123 idosos e reaplicado no intervalo médio de 30,7 dias; 60 destes idosos foram avaliados por dois aferidores ao mesmo tempo. O coeficiente de correlação intraclasse para o conjunto dos itens do teste assim como das subescalas variou de 0,93 a 0,98. No reteste a concordância foi quase perfeita para o conjunto dos itens. Não houve variação significativa na estabilidade do instrumento entre os sexos, idade, escolaridade ou presença de demência. O alfa de Cronbach para o conjunto dos itens do teste foi alta (0,89). O Br-CAMCOG-R teve altos níveis de estabilidade no tempo, entre os examinadores e ótima consistência interna; pode ser útil em estudos epidemiológicos assim como em clínicas especializadas na avaliação das funções cognitivas dos idosos.

OBJECTIVE: To compare the accuracy of four scales, and to determine the inter-rater reliability and the influence of schooling on Clock Drawing Test performance in screening for dementia in elderly with low educational level. METHOD: Design: Criterion validation, concurrent type. Setting: Outpatient unit of Universidade do Estado do Rio de Janeiro Hospital, Brazil. Participants: A total of 306 individuals (> 65 years) were assessed by a geriatrician and a neuropsychologist using functional and cognitive instruments. The diagnosis of dementia was established by consensus in a meeting between these professionals. Four different researchers blinded as to the cognitive status of the patients scored the Clock Drawing Test using Shulman's, Sunderland's, Manos', and Wolf-Klein's methods; and a fifth researcher assessed Manos' method for an inter-rater reliability study. RESULTS: The data of 211 individuals (≤ 4 years of schooling) were analyzed. The sensitivity and specificity of the four methods were similar (about 65%). The inter-rater reliability of Manos' method was excellent (ICC = 0.944). The areas under the ROC curves were small (0.657 to 0.681), and the differences between them were not statistically significant. CONCLUSIONS: The Clock Drawing Test is a reliable but not valid test to screen for dementia in older outpatients with 4 or less years of formal schooling.OBJETIVO: Comparar a acurácia de quatro escalas de avaliação e determinar a confiabilidade inter-aferidor e a influência da escolaridade, no desempenho do Teste do Desenho do Relógio para detecção de demência em idosos com baixo nível educacional. MÉTODO: Delineamento de estudo: Validação de critério, tipo concorrente. Local de estudo: Ambulatório do Hospital da Universidade do Estado do Rio de Janeiro, Brasil. Participantes: 306 indivíduos (> 65 anos) submetidos à avaliação funcional e cognitiva por um geriatra e um neuropsicólogo; uma reunião de consenso entre estes profissionais avaliou a presença de demência. Quatro pesquisadores, que desconheciam o status cognitivo dos indivíduos, pontuaram o Teste do Desenho do Relógio - métodos de Shulman, Sunderland, Manos e Wolf-Klein, e um quinto pesquisador repetiu o método de Manos para o estudo de confiabilidade inter-aferidor. RESULTADOS: 211 indivíduos (≤ 4 anos de escolaridade) tiveram seus dados analisados. A sensibilidade e a especificidade dos quatro métodos foram similares e variaram em torno de 65%. A confiabilidade inter-avaliador foi excelente (ICC = 0,944). As áreas sob as curvas ROC foram pequenas (0,657 a 0,684) e as diferenças entre elas não foram estatisticamente significativas. CONCLUSÕES: O Teste do Desenho do Relógio é um instrumento confiável, mas não é válido para o rastreio de demência em pacientes idosos com quatro anos ou menos de escolaridade.

OBJETIVO: Poucos estudos no Brasil investigaram a validação de testes cognitivos em amostras populacionais de idosos e nenhum deles analisou as propriedades psicométricas do Teste do Relógio de Tuokko. O objetivo do estudo foi traduzir e adaptar o modelo desse teste ao contexto brasileiro e avaliar sua validade de construto. MÉTODOS: Estudo transversal com uma amostra populacional constituída por 353 sujeitos de Juiz de Fora (MG), 2004-2005. Para avaliar as validades convergente e discriminante, utilizou-se a correlação de Pearson. Os subtestes do Teste do Relógio foram correlacionados com os instrumentos de referência: cubos e dígitos, e mini-exame do estado mental para avaliar a validade convergente. A validade discriminante foi investigada por meio da correlação dos subtestes com a Center for Epidemiologic Studies Depression Scale. RESULTADOS: Da amostra, 74,1% eram do sexo feminino, com idade entre 63 e 107 anos (73,8+8,5) e média de escolaridade foi 7,4 anos (DP=4,7). Obteve-se validade convergente, com correlações estatisticamente significativas entre todos os subtestes (pOBJETIVO: Pocos estudios en Brasil investigaron la validez de las pruebas cognitivas en muestras poblacionales de ancianos y ninguno analizó las propiedades psicométricas de la Prueba del Reloj de Tuokko. El objetivo del estudio fue traducir y adaptar el modelo de dicha prueba al contexto brasilero y evaluar su validez de construcción. MÉTODOS: Se realizó un estudio transversal con una muestra poblacional constituida por 353 individuos de la ciudad de Juiz de Fora (Sureste de Brasil), 2004-2005. Para evaluar la validez convergente y discriminante, se utilizó la correlación de Pearson. Las subpruebas de la Prueba del Reloj se correlacionaron con los instrumentos de referencia: cubos y dígitos, y mini-prueba del estado mental para evaluar la validez convergente. La validez discriminante fue investigada por medio de la correlación de las subpruebas con Center for Epidemiologic Studies Depresión Scale. RESULTADOS: De la muestra, 74,1% eran del sexo femenino, con edad entre 63 y 107 años (73,8+8,5) y promedio de escolaridad de 7,4 años (DP= 4,7). Se obtuvo validez convergente, con correlaciones estadísticamente significativas entre todas las subpruebas (pOBJECTIVE: In Brazil, not many studies have investigated the validation of cognitive tests in the ageing population and none of them has analyzed the psychometric properties of Tuokko's Clock Test. The objective of the study was to translate and adapt the test to the Brazilian context, and to assess its construct validation. METHODS: This is a cross-sectional population-based study, involving 353 elderly patients from Juiz de Fora (Southeastern Brazil), from 2004-2005. To assess convergent and divergent validities Pearson's correlation statistics was used. The Clock Test substests were correlated with theses reference instruments: mini-mental state examination, digits, block design to evaluate the convergent validity. the divergent validity was assessed by comparing the substests to the Center for Epidemiologic Studies Depression Scale. RESULTS: In the sample, 74.1% were women, aged between 63 and 107 years (73.8±8.5), average schooling was 7.4 years (SD=4.7). In regard to convergent validity, significant correlations were found between all CT subtests and MMSE, Digits, and Block Design (p

OBJETIVO: A Escala de Depressão Geriátrica, utilizada para o rastreamento de sintomas depressivos em idosos, ainda não teve suas características de medida avaliadas em ambulatórios gerais no Brasil. O objetivo foi estudar a validade da Escala, com 15 itens (EDG-15), na identificação de episódio de Depressão Maior ou Distimia em idosos atendidos em ambulatório geral. MÉTODOS: A Escala foi aplicada em 302 indivíduos com 65 anos ou mais, que em seguida foram examinados, de maneira independente, por um geriatra que não tinha conhecimento dos resultados da Escala. Os diagnósticos de Depressão Maior ou Distimia foram feitos utilizando-se os critérios do Diagnostic and Statistical Manual of Mental Disorders-IV. A sensibilidade e a especificidade nos vários pontos de corte foram expressas pela curva Receiver Operating Characteristic. RESULTADOS: O ponto de corte de melhor equilíbrio foi 5/6, obteve sensibilidade de 81% e especificidade de 71%; e o valor da área sob a curva Receiver Operating Characteristic foi de 0,85 (IC 95%: 0,79-0,91). CONCLUSÕES: A Escala de Depressão Geriátrica pode ser utilizada para o rastreamento de sintomas depressivos na população geriátrica ambulatorial brasileira. O ponto de corte 5/6, sugerido inicialmente por outros autores, mostrou-se adequado.OBJECTIVE: The Geriatric Depression Scale for screening depressive symptoms in the elderly has not been assessed in elderly outpatients who seek primary health care in Brazil. The objective was to determine the validity of the Short Scale for Major Depressive Episode or Dysthymia (GDS-15) in elderly outpatients. METHODS: The scale was applied in 302 subjects with 65 years and older and then examined by an independent geriatrician, blinded to the results. Major depression and dysthymia were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Sensitivity and specificity were calculated at several cutoff values and a Receiver Operating Characteristic curve was plotted. RESULTS: The best equilibrium was at the cutoff value of 5/6 showing 81% sensitivity and 71% specificity; the area under the Receiver Operating Characteristic curve was 0.85 (95% CI: 0.79-0.91). CONCLUSIONS: The GDS-15 can be used for screening depressive symptoms in Brazilian elderly outpatients. The previously suggested cutoff value of 5/6 is adequate.

No Brasil, o rápido crescimento da população de idosos vem produzindo grande impacto no sistema de saúde, com elevação dos custos e da utilização dos serviços. A ineficiência dos modelos tradicionais de assistência ao idoso torna imprescindível a mudança no paradigma de atenção à saúde dessa população, por meio do desenvolvimento de novos modelos de atenção que incorporem a identificação, a avaliação e o tratamento de idosos com perfis mórbidos e funcionais variados, passíveis de serem aplicados nas diversas modalidades assistenciais. Propõe-se um modelo ambulatorial, em duas etapas, que se diferencia pela profundidade e abrangência das ações, organizadas em níveis crescentes de complexidade e capazes de selecionar subgrupos de indivíduos que, por suas características de risco, devem progredir, diferenciadamente, na estrutura de atenção. Descreve-se a primeira etapa, que pressupõe a captação e identificação de risco de grandes grupos de idosos, por meio de um fluxo hierarquizado de ações e o uso de instrumentos de avaliação com sensibilidades e especificidades adequadas. O indivíduo com 65 anos ou mais, captado por demanda espontânea ambulatorial, captação domiciliar ou busca telefônica, é classificado segundo avaliação de risco, denominada Triagem Rápida, composta de oito itens. Dependendo do risco encontrado, o indivíduo será encaminhado para acompanhamento clínico usual e atividades em centros de convivência de idosos (risco baixo e médio) ou para outra etapa da avaliação funcional (riscos médio-alto e alto). A segunda etapa será tema de artigo posterior.In Brazil, the rapid growth of the elderly population has been causing a great impact on the healthcare system, with increased costs and service utilization. The inefficiency of traditional models for geriatric healthcare has made it essential to change the healthcare concepts for this population. This can take place through the development of new healthcare models that include the means to identify, assess and treat elderly patients with a variety of morbid and functional conditions, and which can be applied diverse healthcare scenarios. An outpatient model is proposed, with two stages that differ in the depth and coverage of their actions. These stages are organized as increasing levels of complexity and are capable of selecting subgroups of individuals that, because of their risk characteristics, should follow different paths through the healthcare structure. This paper discusses the first stage of this model, which involves risk identification among large groups of elderly people, by means of structuring a hierarchical flow of actions and using assessment tools of adequate sensitivity and specificity. Individuals aged 65 years or over who are detected through walk-in outpatient consultation, home visits or telephone interview are classified using a rapid screening risk evaluation instrument composed of eight items. Depending upon the level of risk presented, the individual will either be referred to another level of functional evaluation (medium-high and high risk levels), or to normal clinical care and old people's community centers (low and medium risk levels). The second stage will be the subject of a subsequent paper.

Abstract Cognitive decline, particularly executive dysfunction, is observed in normal aging. In Brazil, the elderly population presents broad educational diversity. Category verbal fluency tests are frequently used to detect cognitive impairment, assessing executive function, language and semantic memory. Objective: To investigate the effects of age and education on category animal fluency task (CAF) in healthy elderly. Methods: We evaluated 319 healthy elderly from outpatient care units of two university reference centers of Rio de Janeiro and São Paulo. The sample was divided into two age, and five schooling subgroups. To be included participants had to demonstrate preservation of global cognitive functioning, independence for activities of daily living and not fulfill diagnostic criteria for dementia. All participants were submitted to neurological and neuropsychological evaluations. Results: There was a correlation between age and CAF performance (r= -0.26, p

Abstract Objective: The aim of this paper was to present the results of the first stage of cross-cultural adaptation of the Functional Activities Questionnaire (FAQ). Methods: The tool was subjected to translation and re-translation, and the test-retest reliability of a proposed version for use in Brazil was analyzed. Results: Of the 548 questionnaire respondents, a convenience sample of 68 informants was selected for retesting. Internal consistency was measured by Cronbach's alpha (0.95) while test-retest reliability was assessed using intra-class correlation (0.97). The findings have shown that FAQ is brief - averaging seven minutes to apply, easily understood and has good intra-rater test-retest reliability. Conclusion: Our results suggest this adapted version of the FAQ is a reliable and stable tool which may be useful for assessing function in Brazilian elderly. Notwithstanding, the version should be subjected to further analysis with the aim of reaching functional equivalence.