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Introdução: O envelhecimento populacional advindo da transição epidemiológica traz desafios nos cuidados aos idosos. O comprometimento cognitivo e a síndrome de fragilidade são condições de alta prevalência e são causadoras de alta morbimortalidade. A coocorrência destas condições tem sido descrita, e o entendimento do comprometimento cognitivo associados a síndrome de fragilidade é pouco descrita, principalmente em países em desenvolvimento. A queixa de memória pode ser uma porta de entrada para a melhor compreensão da evolução do comprometimento cognitivo em idosos frágeis. O diagnóstico precoce de disfunções físicas e cognitivas podem colaborar com a criação de melhores opções de tratamento. Objetivo: Avaliar a associação entre a síndrome de fragilidade e o desempenho cognitivo em idosos com queixas de memória. Métodos: Participantes idosos ambulatoriais com queixas de memória auto referida ou notada por familiares e/ou médicos, foram avaliados com uma bateria neuropsicológica que avaliou a função cognitiva global, a memória, a atenção, a linguagem, a função executiva e a habilidade visuoespacial. Foram usados os critérios fenotípicos que identificaram os frágeis, pré-frágeis ou robustos. Foram usados modelos de regressão linear com ajustes para variáveis sociodemográficas. Utilizamos também análises de interação de educação com fragilidade e seus componentes sobre o desempenho cognitivo por domínios. Resultados: Foram avaliados 160 participantes, com idade média de 80,3±6,5 anos, 73% eram mulheres, tinham 5,6±5,2 anos de escolaridade e 64% eram brancos. 16% eram robustos, 61% eram pré-frágeis e 23% frágeis. O estado de pré-fragilidade se associou a um pior desempenho no domínio de memória (Z-escore - 0,37; -0,74 a -0,01, p = 0,046). A lentificação medida por velocidade de marcha associou-se a pior desempenho cognitivo global, na memória, atenção e linguagem. A velocidade de marcha com distrator associouse com pior desempenho em todas os domínios cognitivos e global. Houve interação de menor escolaridade com a lentificação mostrando pior desempenho cognitivo global, da atenção e da função executiva. Conclusão: Em idosos com queixa de memória, a avaliação precoce do status de fragilidade e de lentificação pode colaborar para a detecção de disfunções cognitivas. Introduction: Population aging resulting from the epidemiological transition brings challenges in caring for older adults. Cognitive impairment and frailty syndrome are conditions of high prevalence and cause high morbidity and mortality. The co-occurrence of these conditions has been described, and the understanding of cognitive impairment associated with frailty syndrome is poorly described, especially in developing countries. The memory complaint can be a gateway to a better understanding of the evolution of cognitive impairment in frail elderly. The early diagnosis of physical and cognitive disorders can collaborate with the creation of better treatment options. Objective: To evaluate the association between frailty syndrome and cognitive performance in older people with memory complaints. Methods: Older outpatients with complaints of selfreported or memory complaints by family members and/or physicians, were assessed with a neuropsychological battery that assessed overall cognitive function, memory, attention, language, executive function and visuospatial ability. The phenotypic criteria that identified the frail, pre-frail, or robust were used. Linear regression models adjusted for sociodemographic variables were used. We also investigated the interaction of education with frailty and its components on cognitive performance by domains. Results: 160 participants were evaluated, with an average age of 80.3 ± 6.5 years, 73% were women, had 5.6 ± 5.2 years of schooling and 64% were white. 16% were robust, 61% were pre-frail, and 23% frail. The pre-frailty state was associated with a worse performance in the memory domain (Z-score - 0.37; -0.74 to -0.01, p = 0.046). The slowness measured by gait speed was associated with worse global cognitive performance, and with memory, attention, and language. Walking speed with a distractor was associated with worse performance in all cognitive domains. There was an interaction of less education with slowing showing worse global cognitive performance, attention, and executive function. Conclusion: In older people with memory complaints, early assessment of frailty and slowness can contribute to the detection of cognitive disorders.

Background Recently, interactive video games (IVGs) have been used as a health-care intervention that provides both exercise and cognitive stimulation. Several studies have shown that IVGs can improve postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVGs on frail and pre-frail elderly people. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit Plus™ (NWFP) interactive video games, and the functional outcomes (postural control, gait, cognition, mood, and fear of falling) in frail and pre-frail older adults. Methods This study is a randomized controlled, parallel-group, feasibility trial. Participants were frail and pre-frail older adults randomly assigned to the experimental group (EG, n = 15) or control group (CG, n = 15). Participants in the EG performed 14 training sessions, lasting 50 min each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants in the CG received general advice regarding the importance of physical activity. All participants were assessed on three occasions by a blinded physical therapist: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I). Results Participants in the EG improved their scores in all 10 games, reported that they understood and enjoyed the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared with the CG (p Conclusion The use of NWFP was feasible, acceptable, and safe for frail older adults and improved their postural control and gait. There were no effects on cognition, mood, or fear of falling. This trial was registered in the Brazilian Registry of Clinical Trials (RBR-823rst) on 11 June 2016.

Background pain is prevalent in frail older adults; however, the association of pain and frailty has not been evaluated yet by a systematic assessment of prospective longitudinal studies. Objective we aimed to assess the association of persistent pain as a risk factor for frailty incidence, using data from longitudinal studies in a systematic review and meta-analysis. Methods publications were identified using a systematic search on PubMed, Embase, Cochrane Library and clinicaltrials.gov databases from inception to October 2017. Since heterogeneity across studies was high, we used random-effects meta-analysis to calculate the pooled relative risk for the association between persistent pain and the incidence of frailty. We investigated sources of heterogeneity among studies using meta-regression and stratified analyses. Results we included five prospective longitudinal studies with 13,120 participants (46% women, mean age from 59 to 85 years old). Participants with persistent pain at baseline had twice the risk of developing frailty during the follow-up (pooled RR = 2.22, 95% CI = 1.14-4.29). No variables were related to study heterogeneity in sensitivity analyses. Conclusion persistent pain was a risk factor for the development of frailty in a meta-analysis of longitudinal studies. Better understanding of the association between pain and frailty with proper evaluation of potential confounders could allow the development of targeted interventions.

O objetivo do presente trabalho foi descrever as definições conceitual e operacional da síndrome de fragilidade recomendadas pelo Consenso Brasileiro de Fragilidade em Idosos. Em 2015, uma força-tarefa composta de especialistas brasileiros em envelhecimento humano conduziu uma revisão bibliográfica sobre fragilidade em idosos no Brasil e estabeleceu um consenso acerca dos principais achados por meio de reuniões periódicas. No total, 72 artigos foram incluídos para análise, entre os quais, uma revisão sistemática, duas discussões conceituais, duas descrições metodológicas, quatro estudos longitudinais focando mortalidade e piora do perfil de fragilidade, oito estudos de adaptação transcultural e 55 estudos transversais ou de prevalência. O Quarenta e cinco estudos (62,5%) utilizaram a escala de fragilidade do Cardiovascular Health Study (EFCHS), dos quais sete (15,2%) usaram pontos de corte não ajustados para a amostra e 17 (36,9%) modificaram pelo menos um dos cinco itens que compõem o instrumento. A prevalência de fragilidade variou entre 6,7 e 74,1%. Quando utilizada a EFCHS, a ampla variação de prevalência — de 8 a 49,3% — dependeu dos pontos de corte empregados para classificar as alterações na velocidade de marcha e na força de preensão palmar, bem como do cenário de investigação. Os estudos foram baseados em quatro grandes modelos conceituais de fragilidade. A fragilidade em idosos representa um estado de vulnerabilidade fisiológica e não deve ser confundida com incapacidades ou multimorbidades. Na população brasileira, a prevalência de fragilidade ainda não está adequadamente estimada, e os pontos de corte dos itens que compõem as escalas de fragilidade devem ser adaptados aos parâmetros dessa população. 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.

Objectives:The aim of the present study was to evaluate the association between depression and SSRI monotherapy and frailty both baseline and prospectively in older adults.Design:Prospective cohort study, 12-month follow-up.Setting:Geriatric outpatient clinic in São Paulo, Brazil.Participants:A total of 811 elderly adults aged 60 or older.Measurements:Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens ≥ 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities.Results:Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69–4.69) and after 12 months (OR 2.75, 95% CI = 1.84–4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29–3.07) and Health Status (OR 4.64, 95% CI = 2.11–10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04–2.23).Conclusion:It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.

Recently, interactive video games (IVGs) have been used as a health-care intervention that provides both exercise and cognitive stimulation. Several studies have shown that IVGs can improve postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVGs on frail and pre-frail elderly people. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit PlusThis study is a randomized controlled, parallel-group, feasibility trial. Participants were frail and pre-frail older adults randomly assigned to the experimental group (EG, n = 15) or control group (CG, n = 15). Participants in the EG performed 14 training sessions, lasting 50 min each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants in the CG received general advice regarding the importance of physical activity. All participants were assessed on three occasions by a blinded physical therapist: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I).Participants in the EG improved their scores in all 10 games, reported that they understood and enjoyed the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared with the CG (p 0.05).The use of NWFP was feasible, acceptable, and safe for frail older adults and improved their postural control and gait. There were no effects on cognition, mood, or fear of falling. This trial was registered in the Brazilian Registry of Clinical Trials (RBR-823rst) on 11 June 2016.

Objectives to evaluate the improvement in one-year mortality prediction after adding a 2-min cognitive screening to a simple 1-min frailty detection instrument. Secondary outcomes were new activities of daily living (ADL) disability and falls. Design Prospective cohort study. Setting A geriatric day-hospital for intermediate care. Participants A total of 701 older adults with an acute or decompensated disease (79.5 (8.3) years, 64% female). Measurements A rapid and simple frailty evaluation was performed using the FRAIL questionnaire. The presence of cognitive impairment was defined by previous diagnosis of dementia or a score of five or less on an education-corrected 10-point cognitive screening tool. Results Frail participants with normal (hazard risk [HR] 4.0, 95% confidence interval [CI], 1.73–9.25) and impaired cognition had a higher risk of death (HR 4.38, 95% CI, 1.95–9.87) than robust participants. The presence of cognitive impairment increased the risk of death in prefrail (HR 3.60, 95% CI, 1.55–8.34) and robust participants (HR 3.49, 95% CI, 1.22–9.96). Cognitive impairment was associated with an increased risk of incident ADL disability in all frailty categories. The presence of cognitive impairment was associated with a significantly higher risk of fall in robust seniors. The predictive accuracy of the FRAIL scale was lower than expected (between 0.58 and 0.69), and a small improvement was observed after adding the cognitive screening (between 0.61 and 0.72). Conclusion Despite of significant results in predicting relevant clinical events, the present combination of the FRAIL and 10-CS scales may not be ideal in clinical practice.

Objective Comparison of frailty instruments in low-middle income countries, where the prevalence of frailty may be higher, is scarce. In addition, less complex diagnostic tools for frailty are important in these settings, especially in acutely ill patients, because of limited time and economic resources. We aimed to compare the performance of 3 frailty instruments for predicting adverse outcomes after 1 year of follow-up in older adults with an acute event or a chronic decompensated disease. Design Prospective cohort study. Setting Geriatric day hospital (GDH) specializing in acute care. Participants A total of 534 patients (mean age 79.6 ± 8.4 years, 63% female, 64% white) admitted to the GDH. Measurements Frailty was assessed using the Cardiovascular Health Study (CHS) criteria, the Study of Osteoporotic Fracture (SOF) criteria, and the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) questionnaire. Monthly phone contacts were performed over the course of the first year to detect the following outcomes: incident disability, hospitalization, fall, and death. Multivariable Cox proportional hazard regression models were performed to evaluate the association of the outcomes with frailty as defined by the 3 instruments. In addition, we compared the accuracy of these instruments for predicting the outcomes. Results Prevalence of frailty ranged from 37% (using FRAIL) to 51% (using CHS). After 1 year of follow-up, disability occurred in 33% of the sample, hospitalization in 40%, fall in 44%, and death in 16%. Frailty, as defined by the 3 instruments was associated with all outcomes, whereas prefrailty was associated with disability, using the SOF and FRAIL instruments, and with hospitalization using the CHS and SOF instruments. The accuracy of frailty to predict different outcomes was poor to moderate with area under the curve varying from 0.57 (for fall, with frailty defined by SOF and FRAIL) to 0.69 (for disability, with frailty defined by CHS). Conclusions In acutely ill patients from a low-middle income country GDH acute care unit, the CHS, SOF, and FRAIL instruments showed similar performance in predicting adverse outcomes.

Background Frailty can be defined as a medical syndrome with multiple causes and contributors, characterized by diminished strength and endurance and reduced physiological function that increases the vulnerability to develop functional dependency and/or death. Studies have shown that the most commonly studied exercise protocol for frail older adults is the multimodal training. Interactive video games (IVGs) involve tasks in virtual environments that combine physical and cognitive demands in an attractive and challenging way. The aim of this study will be to evaluate the feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM (NWFP) for frail older adults. Methods/design The study is a randomized controlled, parallel group, feasibility trial. Participants will be randomly assigned to the experimental group (EG) and control group (CG). The EG will participate in 14 training sessions, each lasting 50 min, twice a week. In each training session, the participants will play five games, with three attempts at each game. The first attempt will be performed with the assistance of a physical therapist to correct the movements and posture of the patients and subsequent attempts will be performed independently. Scores achieved in the games will be recorded. The participants will be evaluated by a blinded physical therapist at three moments: before and after intervention and 30 days after the end of the intervention (follow-up). We will assess the feasibility, acceptability, safety, and clinical outcomes (postural control, gait, cognition, quality of life, mood, and fear of falling). Discussion Due to the deficiencies in multiple systems, studies have shown that multimodal interventions including motor-cognitive stimulation can improve the mobility of frail elderly adults. IVGs, among them the NWFP, are considered as a multimodal motor-cognitive intervention that can potentially improve motor and cognitive functions in the frail elderly. However, there is still no evidence in the literature that proves the feasibility, safety, acceptability, and functional outcomes of this intervention in frail elderly individuals. Trial registration Brazilian Registry of Clinical Trials (RBR-823rst). World Health Organization Trial Registration Data Set (Additional file 1). Electronic supplementary material The online version of this article (10.1186/s40814-017-0184-1) contains supplementary material, which is available to authorized users.

Background Reliable and valid frailty screening instruments are lacking. The aim of the present study was to compare the diagnostic properties of the FRAIL-BR with Fried's frailty phenotype (CHS), which has not been done. Methods Cross-sectional observational study of 124 older adults aged 60 or older from 2 university-based geriatric outpatient units in the state of Sao Paulo, Brazil. In ROC analyses, we evaluated different cutoff points and AUC areas of the FRAIL-BR compared with the CHS criteria. Also, components of both diagnostic strategies had head-to-head comparisons whenever possible. Results The sample was composed mostly of overweight (mean BMI = 29.5 kg/m 2 ) women (83%) with mean age of 78.6 (±7.1) years. Prevalence of frailty varied according to the FRAIL-BR (23.3%) and the CHS criteria (14.5%) ( P = .04). A cutoff of 3 points in the FRAIL-BR presented a sensitivity of 28% and specificity of 90% ( P = .049). A cutoff of 2 points resulted in a sensitivity of 54% and specificity of 73% ( P = .01). Comparisons of 4 FRAIL-BR items (ie, weight loss, aerobic capacity, fatigue, and physical resistance) to the respective CHS components showed an independent diagnostic property of all measures, with the exception for weight loss. Conclusion The FRAIL scale can be used as a screening instrument for frailty (time and cost-effective).

The aim of the present study was to (1) evaluate a geriatric outpatient sample with the FRAIL scale; (2) investigate the psychometric properties of the scale; and (3) characterize different associations of the subdimensions of the scale with demographic and clinical data.Cross-sectional observational study.Geriatric outpatient center a university-based hospital in São Paulo, Brazil.A total of 811 men and women aged 60 years or older evaluated between March 2015 and September 2015.A translated version of the FRAIL scale was used to evaluate frailty. A review of sociodemographic data, medical records, medication, and laboratory data was conducted. A multivariate ordinal logistic regression model was used to investigate the association between frailty categories and clinical variables. Exploratory factor analysis and 2-parameter logistic item response theory was used to evaluate the psychometric properties of the FRAIL scale.The sample was distributed as 13.6% robust, 48.7% prefrail, and 37.7% frail older adults. Most participants reported fatigue (72.3%). Frailty was associated with older age (P = .02), depression (P = .02), dementia (P .001), and number of medications taken (P .001). A 2-factor model of the FRAIL scale ("ambulation" and "resistance" namely physical performance; "fatigue," "weight loss," and "illnesses" namely health status) provided independent classifications of frailty status. Physical performance (ambulation and resistance) was strongly associated with higher age and dementia, whereas health status (fatigue, weight loss, and illnesses) was more associated with female sex and depression.Our results suggest the existence of 2 subdimensions of the scale, suggesting different pathways to frailty. Frailty was associated with older age, depression, dementia, and number of medications in this outpatient sample.

Objective To investigate age and sex differences in orofacial sensory detection. Methods One hundred and twenty-six (126) healthy subjects were divided into five groups according to their ages. They were assessed with a quantitative sensory testing protocol for gustative, olfactory, thermal (cold/warm), mechanical (tactile/vibration/electric), and pain (deep/superficial) detection thresholds. The corneal reflex was also evaluated. Data were analyzed with the one-way ANOVA, chi-squared, Fisher's exact, Mann–Whitney, and Kruskal–Wallis tests. Results The groups of subjects over 61 years old had higher olfactory (P

Polypharmacy is a concern in geriatric practice. This study evaluated if there is difference in pharmacological treatment in a community dwelling frail population. Observational transversal study in a geriatric outpatient facility of tertiary hospital. Patients evaluated from March till September of 2015 were included. Being unable to answer telephone call, FRAIL questionnaire, or having no medical records were excluded. Review of medical records provided: age, sex, schooling level, hypertension, diabetes, dyslipidemia, heart failure, ischemic heart disease, stroke, osteoporosis, depression, dementia, cancer, chronic obstructive pulmonary disease, asthma, Mini Mental, Geriatric Depression Scale, and body mass index. Laboratory included hemoglobin, creatinine, fasting glucose, glycosylated hemoglobin. Medication dispensing program provided medication in use. Data was collected admitting 12 months before the frailty assessment which used FRAIL questionnaire, (robust = 0, pre-frail = 1–2 and frail 3–5). Proxy or patient were interviewed by telephone call. Logistic regression with adjustment for age and sex was performed to evaluate difference in medication.

Este trabalho e um estudo de caso, preliminar e interdisciplinar que relata as solucoes implementadas na confeccao e implantacao de um sistema computacional para registro de consultas clinicas nos centros de geriatria Centro de Saude Escola Geraldo de Paula Souza, Grupo de Atendimento Multidisciplinar ao Idoso Ambulatorial (GAMIA), Centro de Desenvolvimento para Promocao do Envelhecimento Saudavel (Cedpes), Casa Ondina Lobo, todos vinculados ao Servico de Geriatria do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. Os objetivos gerais deste sistema sao o de melhorar o atendimento medico e fornecer dados para pesquisas e protocolos medicos. As principais diretrizes seguidas no caso foram: o sistema deve apoiar a pratica medica, deve dinamizar o processo de registro de consultas, deve organizar os registros consistentemente para uso em pesquisas medicas e deve coexistir com recursos de hardware limitados. O sistema comecou a ser projetado em agosto de 2011, sua fase de implantacao e testes foi iniciada em outubro de 2011 e atualmente, janeiro de 2012, possui 1086 casos registrados no banco de dados, cumprindo com os objetivos propostos e tendo solucionado dificuldades reportadas em estudos anteriores.