Académico de Postgrado de Geriatría y Gerontología, Universidad de Costa . Los métodos y enfoques clínicos que se recomiendan en este manual están. Manual de Geriatría y Gerontología – para alumnos- paginas/udas/. Manual de geriatría y gerontología(Book) 2 editions published in Ensenanza de la geriatria en la escuela de medicina by Pedro Paulo Marín L.() 2 editions.
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Evaluation of frailty, functional capacity and quality of life of the elderly in geriatric outpatient clinic of a university hospital. Cross-sectional, geriatriw and analytical study. The mean age was The highest criteria of phenotype were muscle weakness and physical inactivity. Muscle weakness and physical inactivity were most striking in the development of frailty, which was associated with worse QOL and FC, despite most seniors be independent.
These data are important for early detection of determinants of frailty, since the criteria discussed here are reversible. Population aging, which is a major phenomenon in Brazil, is related to an increase in chronic diseases and geriatric syndromes, such as the syndrome of frailty.
Functional independence is understood as the capacity to perform essential living activities, including caring for oneself, living manhal in a house, and carrying out activities that are important for one’s QOL 4 while QOL in old age means a perception of well-being through an evaluation of to what extent an individual has realized that which is seen gerontoloogia important for a good life gerontopogia the degree of satisfaction with what has been achieved until that moment.
As such, the frailty syndrome has the potential to affect all aspects of life of the elderly.
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Furthermore, it is an event whose effects extend beyond the elderly themselves, placing a burden on relatives and caregivers, and resulting in high health service costs. Although there is some heterogeneity, currently the most commonly used definition of the frailty syndrome among the scientific community geristria that proposed by Fried et al.
These authors 4 proposed a frailty phenotype that involves five factors: A frail elderly individual is someone gfrontologia exhibits three or more such components, while individuals with one or two components are classified as pre-frail, and have twice the risk of becoming frail. Early identification of the predictive characteristics that define the syndrome allows the creation of measures that improve the QOL of the elderly person and avoid adverse events, thereby preventing, slowing or stopping re progression of frailty, by improving the care of the elderly.
An observational, cross-sectional, descriptive and analytical study was performed. Sampling was carried out by the convenience method and included elderly men and women aged 60 years or older who attended the geriatric clinic of the HUJBB between June and September Elderly individuals with cognitive conditions that would make answering questions difficult or impossible were excluded, as determined by scores below the cutoff points established by the Mini-Mental State Examination MMSE adjusted for the level of education Those with motor impairments that prevented the assessment of gait and who complained of pain, severe dyspnea or other acute symptoms at the time of evaluation were also excluded from the study.
Elderly persons who used walking, visual or hearing aids were not excluded. After signing a Free and Informed Consent Form FICFthe elderly persons considered fit for the study responded to an interview containing of sociodemographic age, gender, education, marital status, and others and clinical comorbidity, living habits data, history of falls and self-perceived health condition; followed by an evaluation of frailty using the phenotype proposed by Fried et al 8 Functional Capacity FCusing the Functional Independence Measure FIM validated for the Brazilian population, 11 and QOL, using the World Health Organization WHOQOL-Old scale 12 were measured.
The assessments were made by a single trained researcher based on the parameters determined by literature. For frailness testing, unintentional weight loss was considered the self-reporting of weight loss equal to or greater than 4. Muscle strength was measured by grip strength of the dominant hand measured with Saehan TM brand equipment, with which three measures were taken and the arithmetic average used, with a cut-off point adjusted for body mass index BMI and gender.
Self-reported fatigue was evaluated by agreeing “always” or “mostly” criteria 3 or 4 to two statements: Finally, level of physical activity feriatria measured by the short version of the International Physical Activity Questionnaire IPAQ15 adapted for Brazilian elderly individuals, 16 with a time of minutes or less per week spent in moderate beriatria intense activities counting towards a definition of frailty.
After the evaluations, the elderly were classified as frail FRpre-frail PF and not frail NF according to the phenotype. The binomial test was used to verify age and comorbidities between the groups. The Kruskal-Wallis nonparametric analysis of variance test was used to compare the groups for gerontoligia, FC, perception of health and history of falls. The study consisted of a sample of elderly persons with a mean age of A total of In terms of educational level, All the subjects had at least one comorbidity Table 1the most common of which were visual disorders Number of comorbidities reported by elderly persons treated at the geriatric outpatient clinic of HUJBB, classified according to degree of frailty.
In terms of degree of frailty, The mean age of the three groups was similar.
The FR group had on average 3. Analysis of FC found that Functional capacity of elderly persons treated at the HUJBB geriatric outpatient clinic by frailty group. Only 95 elderly persons were assessed for QOL, as interviews that were incomplete or where there was intrusion by companions were excluded. The facets with the highest score were intimacy The elderly persons in the FR group had lower scores than those of the other scores Figure 2.
Quality of life of elderly persons treated at the HUJBB geriatric outpatient clinic by frailty group. In terms of the self-reported health of the elderly, the majority said that they had regular Numerous studies of frailty have argued that women are more susceptible to the development of comorbidities and frailty itself.
Although the presence of comorbidities not mean frailty, it may indicate higher chances for the development of the syndrome by altering the health status of the elderly individudal. In terms of number of comorbidities, FR elderly persons had more comorbidities than PF individuals, however, there was no significant difference when compared with the NF group, demonstrating that the severity of illness or even treatment aimed at the same may be more associated with frailty than the number of comorbidities only.
The prevalence of frailty identified in the present study was When evaluating elderly patients from a geriatric outpatient clinic, Remor et al 9 argued that the occurrence of frailty tends to increase with age, unlike in this study, where there was no significant difference in age between the groups analyzed here. However, in the above study 9 the average age was higher and caregiver reports were considered, which may have influenced the results and caused them to differ from the present findings.
Among the Gerriatria and NF elderly, the highest scoring criteria were muscle weakness and physical inactivity, data ratified by Viana et al. However, unintentional weight loss was less frequent.
Despite the practicality of assessing the nutritional status of the elderly, the effectiveness of this item is compromised in cases of overweight frail elderly individuals, which may explain this result.
As has been described by other scientific studies, 2123 frail elderly persons have a lower FC than non-frail elderly individuals.
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However, there are differences between the present study and other works 2123 regarding the argument that frail elderly persons display an incapacity for ADL.
The results of the present study support the conclusion that elderly persons can remain independent, even when already at risk of developing frailty, or when already considered frail, as only three of elderly persons here presented minimal dependence. This data reinforces the results of the present study and emphasizes the importance of assessing all elderly persons, even those who are most active in their daily lives, to ensure the early detection or even prevention of the gefiatria of frailty.
Nevertheless, it is important to note that advanced activities of daily living AADLswhich were not analyzed in this study, are impaired earliest in life, followed by instrumental activities IADL and, lastly, basic activities of daily living BADL 26 and that the FIM scale used here places greater emphasis on BADL and some IADLs, which in this case are related to getting around and climbing stairs.
In general, while the latter domain provided the lowest score among the elderly, these individuals retained their functional independence. Further studies employing specific scales to each of these CF domains to confirm such evidence are suggested. Among the phenotype criteria, slowness of gait is the factor that most affects the physical component of QOL, while fatigue most influences the emotional component.
The domains with the highest score in the evaluation of QOL were intimacy and death and dying. Intimacy revealed a good ability to deal with feelings of love and companionship and good family relationships, 29 which could be related to the degree of interaction of elderly persons who have an average of four people in their homes.
The domain death and dying displayed a coping capacity in relation to death, and a greater concern about the risk of suffering that precedes it.
On the other hand, the lowest score was associated with social participationsimilar to the findings of Torres et al. An important finding was the similarity of FC and QOL results between PF and NF elderly persons, or in other words those at risk of developing frailty had the same scores as elderly individuals without this risk, indicating that preventive interventions can be extremely effective even among pre-frail elderly persons.
There was a correlation between FC and QOL in the PF and NF groups, showing that being functionally independent is a good determinant of both the physical and mental aspects of quality of life. A negative perception of health is strongly associated not only with the development of the syndrome of frailty, but also with high rates of morbidity and mortality. While this finding agreed with the aforementioned studies, 1931 there was no difference between FR and NF and between PF and NF individuals, suggesting that even elderly individuals not at risk of frailty may have a negative opinion of their health, or in other words, in this sample perception of health was not decisive for frailty and vice versa.
This is possibly due to the low number of reports of poor Although literature has identified a relationship between a history of falls and frailty, 33 this was not observed in this sample, as there was no difference between the F, PF and NF groups.
This study was limited by the exclusion of elderly people with cognitive impairment, which is considered a factor for the development of the syndrome of frailty. Instead, the focus was aimed at the reports of the elderly persons themselves in relation to their health and well-being.
It is believed that in this way the data becomes more reliable. The reduced sample size is another limitation that hinders the generalization of the results presented here to other populations, and also meant that it could not be determined whether frailty can cause functional incapacity, or vice versa.
In fact, either situation can occur, depending on the context and the life history of the elderly. What is known is that both can affect QOL, and so each case must be assessed individually, considering the lifestyle of each person, to reach correct conclusions, requiring studies with larger sample sizes and longitudinal approaches.
Therefore, the results indicate the need to recognize risks related to frailty even in older people who do not have clear manifestations of the condition, in order to prevent the advance or the emergence of the syndrome, and to ensure a better QOL for as long as possible, as for elderly persons it is more important to live with quality, than simply to live for a long time. Compared to other Brazilian studies, the degree of frailty was relatively high among the elderly population studied.
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Muscle weakness and physical inactivity proved to be the most significant factors for the development of the syndrome, which was associated with reduced gerontologua capacity and quality of life, although most elderly persons remained independent. Thus, the most important findings of the present study relate to the need to recognize the determinants of frailty, even those that are subclinical, in order to detect the emergence of this syndrome as early as possible, since the biological criteria discussed herein are reversible.
Epidemiologia e o Envelhecimento no Brasil. Tratado de geriatria e gerontologia. Rev Bras Fisioter ;13 5: Untangling the concepts of disablity, frailty and comorbidity: Qualidade de vida do idoso: Frailty in older adults: Sci Med ;21 3: J Psychiatr Res ;12 1: Power M, Schmidt S. World Health Organization; [acesso 22 ago. Universidade Federal de Minas Gerais; Validity of the center for epidemiological studies: Marshall A, Buman A. The international physical activity questionnaire: Rev Bras Cineantropom Desempenho Hum ;12 6: Acta Paul Enferm [Internet] [acesso em 20 jun.
Gait variability is associated geriattia frailty in community-dwelling older adults. Texto Contexto Enferm ;21 4: Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: