Brazilian Older People Research Articles

Reasons for nonadherence to vaccination for influenza among older people in Brazil.

This study aimed to estimate the prevalence of non-vaccination and the reasons for nonadherence to the influenza vaccine among older Brazilians according to sociodemographic characteristics. A cross-sectional study was conducted with data from older people (≥ 60 years of age; n = 23,815) who participated in the 2013 National Health Survey. Frequencies of non-vaccination and the main reasons for nonadherence were calculated with respective 95% confidence intervals. The prevalence of non-vaccination was 26.9% (approximately 7,106,730 older people). The reason rarely gets the flu was the most cited among the men (28.2%), the 60-to-69-year-old age group (29.6%), individuals with higher education (41.9%), and those with health insurance (32.3%). Fear of a reaction was the most cited reason in the northeastern region (25.4%), among women (29.3%), longer-lived individuals (≥70 years; 28.7%), and those who did not know how to read/write (26.7%). A total of 12.1% reported not believing in the vaccine’s protection, and 5.5% did not know that it was necessary to take vaccine. The proportions of the main reasons for non-vaccination varied by sociodemographic characteristics. This study’s findings highlight the need to increase older people’s knowledge regarding influenza and influenza vaccines. Healthcare providers should be encouraged to counsel older people–especially those in subgroups with lower adherence, such as residents in the Northeast region, those aged 60–69 years, those who do not know how to read/write, those without a spouse/companion, and those without health insurance–regarding the different aspects of the vaccine and formally indicate it for groups at risk.

Number of ideas in spontaneous speech predicts cognitive impairment and frailty in community-dwelling older adults nine years later

Objective To investigate the associations between linguistic parameters in spontaneous speech at baseline and cognitive impairment and frailty nine years later. Methods A prospective analysis was carried out on data of the Frailty in Brazilian Older People Study (FIBRA) Study, a population-based study on frailty. From a probabilistic sample of 384 individuals aged 65 and older at baseline (2008–2009), 124 aged 73 years and older at follow-up were selected, as they had scored above the cutoff values of cognitive screening for dementia adjusted by years of schooling at baseline and had answered to the question What is healthy aging and had no frailty at baseline. Verbal responses were submitted to content analysis and had its ideas and words counted. Number of ideas corresponded to the frequency of meaning categories and number of words to all identified significant textual elements in the text constituted by the sample answers to that question. Results Multivariate logistic regression analyses, controlling for the effects of age, sex, and education, showed that individuals with a high number of ideas at baseline had lower chance of having cognitive impairment (OR = 0.39; 95% CI 0.22 − 0.69) and frailty (OR 0.66; 95% CI 0.44 − 0.99) nine years later than those with low number of ideas. Conclusions Higher number of ideas, but not number of words, in spontaneous speech seems to be associated to a more positive prognosis in mental and physical health nine years later. Linguistic markers may be used to predict cognitive impairment and frailty in older individuals.

Evolution of inequalities in health care use among older people in Brazil: Evidence for the period 1998–2019

• Health care inequality decreased for mammography and doctor visits. • For dentist visits, inequality in healthcare increased in the period. • Income and private health insurance have a strong contribution to inequalities. • The inequities are higher in the urban area, but the health care use is higher in that area. • Differences in access between urban and rural areas are still significant. This study aimed to analyze inequalities and inequities in health care for older people (50 years or more) in Brazil, in the period 1998–2019. We sought to measure and analyze the evolution of the concentration index (CI), horizontal index (HI) and decompositions of the CI. The evolution of the indices shows that there was a decrease in health care use inequities for doctor visits and mammography; in this first case the reduction was greater for rural areas, while for mammography the reduction was greater and significant for urban areas. However, despite increases in the prevalence of going to the dentist in different income strata, inequities have increased, showing that the benefits were greater for the wealthier individuals. Regarding the decomposition of factors associated with inequality, we can see that income and private health insurance appear as important variables in all cases. Thus, considering that older people increasingly demand health care, despite the advances made in this area, there are still important challenges. The inequities, mainly for mammography and dental visits, are still high and the differences between urban and rural areas are still significant, showing that public policies can be important in the search for greater equity.

Difficulty in taking medication and stroke among older adults with systemic arterial hypertension: the Fibra Study.

This article aims to investigate whether difficulty in taking medication is associated with stroke among older adults with Systemic Arterial Hypertension (SAH) and to explore their association with living arrangements. Cross-sectional study was based on 3,502 older adults with SAH from the four universities pole of Frailty in Brazilian Older People (Fibra) Study, Brazil, including 14 municipalities of the five Brazilian regions. We used the medical diagnosis of stroke and difficulty in taking medications (self-reported difficulty and financial difficulty affording prescribed medications). Multivariate analysis was performed using logistic regression. Differently from women, older men with SAH, which report difficulty in taking medication (unintentional non-adherence), have higher odds of stroke. When stratified by living arrangements, those living with a partner have even higher odds of stroke compared to those without difficulty in taking medication and living alone. None association was found for difficulty affording prescribed medication for both men and women. Unintentional difficulty in taking medication plays a role in SAH treatment among men. Primary care strategies for controlling blood pressure should not be focus only on patients but targeting spouses as well.

Regional Differences in the Diagnosis of Sarcopenia in Older People in Brazil

Introduction: Sarcopenia is a prevalent condition, and that is strongly associated with morbimortality outcomes. The optimal way to diagnose sarcopenia is currently a matter of debate. Despite evidence suggesting differences in body composition and physical performance of individuals from different regions, the diagnosis of sarcopenia in Brazil is still conducted using cutoff values established by international consensus. Therefore, the objective of this study was to establish cutoff values for appendicular muscle mass and muscle strength in a population of elderly outpatients with cardiovascular diseases from the city of São Paulo, using this data to compare populations with sarcopenia diagnosed in Brazil with individuals diagnosed using the European consensus values. Materials and Methods: This was a cross-sectional analysis including 502 older individuals from the SARCOS-Brazil study. All subjects underwent densitometry to assess muscle mass and measure strength using a manual dynamometer. The cutoff values for the SARCOS-Brazil criteria were obtained from the 25th percentile of each variable. Results and Discussion: There was no difference in the prevalence of muscle weakness using the two methods (180 patients, 35.9% of the sample). However, a difference was observed concerning low muscle mass. According to the European criteria, a total of 215 older individuals (42.8%) had low muscle mass and 123 (24.5%) according to the SARCOS-Brazil criteria. The prevalence of sarcopenia was 20.3% according to European criteria versus 13.7% according to the SARCOS-Brazil criteria. The kappa coefficient was 0.79. Conclusion: This study suggests that weakness and muscle mass can, in isolation, predict variables related to past vulnerability outcomes, as well as highlights the possibility of using regional cutoff values for the diagnosis of sarcopenia. Keywords: Sarcopenia; Aging; Muscle mass; Muscle strength

Normative reference values of handgrip strength for Brazilian older people aged 65 to 90 years: Evidence from the multicenter Fibra‑BR study.

Handgrip 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. Participants 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. Across 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. NRV/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.

Potentially inappropriate prescriptions to Brazilian older people with Alzheimer disease: A cross-sectional study.

Older adults are the leading users of medications, where this can be associated with a high number of potentially inappropriate medications (PIMs) and of potentially inappropriate prescribing (PIP) and consequent harm to health. No Brazilian study evaluating potentially inappropriate prescribing in older patients with Alzheimer's disease (AD) was found. This study determined and analyzed the prevalence of PIP and PIM prescribed for older people with AD.A cross-sectional study was carried out at the Specialty Drugs Pharmacy in the city of Sorocaba, São Paulo State, Brazil. The MEDEX system provided the register in older people with AD and data were collected during interviews with patients and/or caregivers between June and September 2017. The PIMs were identified according to the 2019 Beers Criteria. The association between PIMs and independent variables was analyzed by Poisson regression.This study included 234 older patients with AD. The prevalence of PIP prescribed was 66.7% (n = 156). Of the 1073 medications prescribed, 30.5% (n = 327) were inappropriate with most affecting the central nervous system or cardiovascular, particularly quetiapine (12.8%) and acetylsalicylic acid (11.6%), respectively. Around 45.2% of the PIMs should be avoided in older people, especially sertraline (14.2%) and clonazepam (7.4%). After adjusted analysis, the PIMs were associated with the diagnosis of depression (P = 0.010) and the number of comorbidities (P = 0.005).There was a high number of PIMs among older people, a substantial number of which should have been avoided in this population. Health care professionals can apply these findings to improve safety in the use of medications for treating patients with AD.

Mapping Research Conducted on Long-Term Care Facilities for Older People in Brazil: A Scoping Review.

This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, EMBASE, LILACS, and Google Scholar, within the timescale of 1999 to 2018, limited to English, Portuguese, or Spanish. The reference lists were hand searched for additional papers. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of evidence. Data were reported descriptively considering the study design, using content analysis: 327 studies were included (n = 159 quantitative non-randomized, n = 82 quantitative descriptive, n = 67 qualitative, n = 11 mixed methods, n = 6 randomized controlled trials, and n = 2 translation of assessment tools). Regardless of the study design, most were conducted in a single LTCF (45.8%), in urban locations (84.3%), and in non-profit settings (38.7%). The randomized trials and descriptive studies presented the lowest methodological quality based on the MMAT. This is the first review to provide an overview of research on LTCFs for older people in Brazil. It illustrates an excess of small-scale, predominantly qualitative papers, many of which are reported in ways that do not allow the quality of the work to be assured.

Social participation and self-assessment of health status among older people in Brazil.

To estimate the prevalence of social participation (exposure) and its association with positive self-assessment of overall health status (SAH) (outcome) among 7,712 Brazilian elderly interviewed in the National Health Survey 2013. A cross-sectional study that used Propensity Score (PS) to improve comparability between the group exposed and no exposed to social participation. Poisson regression was performed to determine the prevalence and association of interest using crude and adjusted by inverse probability of selection of PS. Social participation was reported by 25.1% (CI95%: 23.4-26.9) and was lower among poor older people, who depend on public transportation and live in more precarious contexts. Most did not SAH positively, but the proportion was higher when they had social participation (48.0%; CI95%: 46.0-51.0). There was a positive association of social participation with SAH positive. The association using the adjusted model (PR: 1.15; CI95%: 1.08-1.22) attenuated the estimated in the crude model. Elderly exposed were 15% more likely to provide a positive SAH. Despite low levels in Brazil, there was a positive association between of social participation and SAH, confirming that engagement in such activities provides important gains for the health and quality of life.

Brazilian Older People Hospitalized by COVID-19: Characteristics and Prognostic Factors in a Retrospective Cohort Study.

Analyzing the survival of older people hospitalized due to COVID-19 in Brazil and identifying its main predictive factors for death. This is a retrospective, multicenter cohort study, based on 20,831 records of hospitalizations of older people due to SARS-CoV-2 in Brazil. The observation period was from February 28 to May 18, 2020. There was a reduced overall survival time of 47.70% (95% confidence interval [CI] = [46.72%, 48.67%]) in 10 days. The variables age, race, education, intensive care unit (ICU), region, day of hospitalization, time elapsed between the first symptom and hospitalization, and the municipality that provided assistance showed increased risk of death using the multiple Cox proportional-hazards model. These results emphasize the relevance of inequality and access to health services as determinants for the death of older people with COVID-19.

Frailty and mortality in long-term care facilities for older people in Brazil: a survival analysis

OBJECTIVES: To investigate the effect of frailty on 1-year mortality in long term-care facility (LTCF) residents. METHODS: This was a prospective cohort study with survival analysis of 209 participants living in 15 Brazilian LTCFs. Data on chronic diseases, age, sex, medication use, dependence in activities of daily living (ADLs; Katz index), and frailty (FRAIL scale) were collected at baseline, and death after 1 year was the outcome measure. Kaplan-Meier estimate and log-rank test were used to analyze the survival of residents. RESULTS: In the initial assessment, 65.07 of the residents were women, and the median age was 82 (interquartile range, 71–88) years, with 55% being over 80 years old. Overall, 88% had 2 or more diseases, 59.81% were using 5 or more medications, 42.11% were considered frail, 34.92% pre-frail, and 22.97% robust, and 69.94% were dependent in 3 or more ADLs. During the 12-month follow-up, 19.61% of the residents (n=41) died. In the survival analysis for death, there was a statistically significant association with frailty (p=0.03) and dependence in ADLs (p=0.04). CONCLUSIONS: In this population of LTCF residents, frailty and functional dependence were associated with death.

Food Insecurity Is Associated With Depressive Symptoms Among Brazilian Community Older Adults

Food security can be defined as when the individual has access to food consumption in adequate quality and quantity, respecting aspects such as age, physiological condition and cultural habits. While international studies showed the association of Food Insecurity (FI) and many negative health outcomes, like depressive symptoms, less is known about food insecurity among older people in Brazil, especially about its association with health. The aim of this study is to analyze the relationship between FI and Depressive Symptoms (DS) among community older Brazilian adults. Were included in this study 493 community older people with 60+. Geriatric Depression Scale were used to measure DS and for assessment of FI was used the short version of the Brazilian Food Insecurity Scale, added with one question involving functional limitations to buy food. Logistic regression was used to estimate the odds ratio (OR) adjusted for covariates (e.g., sex, education, age and familiar income). The prevalence of FI were 42.4% and the prevalence of DS were 71.5% of population. The prevalence of DS was higher in the group with FI than among those without F (78.9% vs 65.8% respectively; p=0.001). In the adjusted regression analysis, the chance of presenting positive symptomatology for depression was 1.87 times higher among the older people with FI (CI 1.18 –2.91; p=0.007). The findings demonstrate high prevalence of FI and DS indicating the importance of FI screening among community-based older people in order to avoid possible negative health outcomes in this population, such as the development of depressive symptoms.

Tailoring digital apps to support active ageing in a low income community.

Our goal was to identify requirements for designing a mobile app to encourage physical activity in a low-income community population of older people in Brazil (i.e. over 40 years old). We conducted a qualitative focus group study, involving by co-design of a physical activity application (Pacer)®. Seventeen volunteers were divided into 2 focus groups of physical active and insufficiently active, and 2 further 4 subgroups in each characterised by digital engagement. The following procedures were performed: (i) baseline assessments; (ii) a focus group with physically active older people and a focus group with insufficiently active older people (iii) design activities with both groups to re-design Pacer. Developing physical activity apps for older people should consider the following features: free application, simple interface, motivational messages using audio and visual information, sharing information among users, multimedia input and sharing and user customisation. In particular, we recommend that exercise apps in low-income communities be tailored to our four categories of users differing in baseline physical activity and digital engagement, to match the social and behavioural preferences we discovered.

Integrating health and social care in Brazil

Abstract Integrating health and social care is now a high priority for public health policy in high-income countries. It has received much less attention in low and middle-income country (LMIC) settings. There is particular value in assessing the potential to integrate care services for older adults, given the speed of population ageing in LMICs. The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil (drawing on a study co-funded by the UK MRC and CONFAP Brazil). Programa Maior Cuidado (PMC) was established in the Brazilian city of Belo Horizonte in 2011. It is jointly managed by the departments of health and of social assistance and involves close community-level collaboration between health posts and neighbourhood social service centres. A key element of PMC is the provision of paid trained lay carers to support family care for dependent older people in socially vulnerable families. We will present findings on the implementation process and operation of PMC, as well as its effects on the following outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers. Quasi-experimental analysis using spatial-based Propensity Score Matching shows promising results in terms of increasing planned attentions as well as access to rehabilitation services, which confirms the ability of the Program to improve interface with health services avoiding unplanned unnecessary attentions We will examine the implementation of similar interventions in other Brazilian cities, including Fortaleza and Contagem, and will study the role of national and international processes in dissemination, knowledge sharing and agenda-setting. Key messages The presentation provides findings of process and impact evaluations of novel local government initiatives to integrate care for older people in Brazil. Programme under evaluation lead to interesting outcomes of interest: reduced unnecessary hospitalisations, enhanced health status for older people and reduced care burden for family carers.

The HOME FAST BRAZIL self-report version: translation and transcultural adaptation into Brazilian Portuguese

ObjectiveTo translate and cross-culturally adapt the Home Falls and Accidents Screening Tool Self-report into Brazilian Portuguese and to correlate with the history of falls.MethodsThe translation and transcultural adaptation process followed international parameters. The Home Falls and Accidents Screening Tool Brazil Self-report, the Mini-Mental State Examination and the history of falls were applied to 10 elderly in the pre-test and to 41 in the final. Demographic and anthropometric data were also evaluated. Spearman correlation coefficient was performed.ResultsThe participants considered the questionnaire easy to understand and did not report any doubts to answer the final version. There was significant correlation between: Home Falls and Accidents Screening Tool Brazil Self-report score and number of falls (ρ = 0.31, p = 0.02) and the lighting and bathroom domains with presence of falls at home (ρ = 0.44, p = 0.00 and ρ = 0.33, p = 0.02, respectively). The questionnaire indicated fall’s risk scoring, 10(±2).ConclusionThe Home Falls and Accidents Screening Tool Brazil Self-report showed to be comprehensible and feasible tool for self-assessment of domiciliary falls risk in Brazilian older people. The scores indicated fall’s risk and were associated with the history of falls.

COVID-19, sedentary behavior and dynapenic abdominal obesity in brazilian older people

Letter to the Editor.

Frailty syndrome in Brazilian older people: a population based study.

This article aims to categorize elderly non-frail (NF), pre-frail (PF) and frail (FF) as to fast and slow gait speed. Compare NF, PF and FF, and analyze associations between fast or slow gait speed with clinical, functional and mental factors. 5,501 elderly (65 years or over; to the Frailty in Brazilian Older People Study), classified as NF, PF and FF (Fried´s frailty phenotype) and, in relation to fast gait speed (≥ 0.8m/s) and slow (< 0.8m/s). Age, sex, body mass index, muscular strength, advanced, instrumental and basic activities of daily living, falls, fear of falling and depressive symptoms were evaluated. Logistic regression analysis investigated associations between variables. The proportion of the slow elderly increased with fragility (NF = 12.39%, PF = 37.56%, FF = 88.83%, p < 0.01). Be woman, performance in activities of daily living, muscle strength and fall were associated with fragility syndrome. The association between frailty and adverse health outcomes reinforces its primacy as an indicator of the functional health of the elderly. Functional capacity, muscular strength, and falls should be evaluated considering their potential for reversibility.

Identifying and managing frailty in Brazil: a scoping review protocol.

The objective of this review is to scope the evidence on how researchers, health, and social care professionals in Brazil currently identify and manage frailty in older adults. The rapidly aging population and associated increased healthcare usage by older people with frailty are challenging the sustainability of healthcare for older people in Brazil. Understanding how frailty is identified, measured, categorized, and managed in Brazil is an important part of building a response to the challenge. This scoping review will consider studies that included older Brazilian adults (≥60 years old) recruited from different settings (community, primary care, health care centers, hospital, and long-term care institutions). Studies will be included if they involved any kind of frailty assessment (tools, scales, and measures) and/or interventions. This review will consider all study designs, regardless of their rigor. National policies for older people will be also be considered for analysis. Indexed and gray literature in English or Portuguese from 2001 to the present will be considered. The searches will be conducted using bibliographic databases, university repositories, and the Brazilian Government official database. The studies will be independently screened according to the inclusion criteria by two reviewers based on their title, abstract, and full text. In case of disagreement, a third reviewer will be consulted. A customized data extraction form will be used to extract data from the included studies. The results will be presented in tabular form, accompanied by a narrative summary related to the objective of the present scoping review.

Estimates of infection and mortality from COVID-19 in care homes for older people in Brazil

OBJECTIVE: To describe infection and mortality rates associated with COVID-19 in older people living in Brazilian care homes. METHODS: A descriptive cross-sectional study was conducted using primary and secondary data sources. Nationwide care home administrators were invited to report, via an online questionnaire, the occurrence of infection and mortality associated with COVID-19 from April to August 2020. State Public Prosecutor Offices, State Health Departments, and the Unified Social Security System were also contacted for information. Data were analyzed using descriptive statistics. RESULTS: Data were collected from 2154 care homes located in 14 states, covering 59 878 older residents. The incidence rate of COVID-19 was 6.57%, and 883 deaths were recorded in the period, with a case-fatality rate of 22.44%. CONCLUSIONS: The incidence and mortality rates observed in this study were lower than those observed in other (high-income) countries. Data sources related to COVID-19 outbreaks in Brazilian care homes are currently limited to self-report. Structuring and systematizing data recording and reporting in these settings is essential to better understand the spread of the virus and to protect care home residents in Brazil.

Prevalence of Sarcopenic Obesity and its Association with Functionality, Lifestyle, Biomarkers and Morbidities in Older Adults: the FIBRA-RJ Study of Frailty in Older Brazilian Adults

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) <5.45 kg/m2. For men, a fat percentage ≥27% and ASMMI <7.26 kg/m2 was defined as sarcopenic obesity. Multivariate analysis was performed using a multinomial regression model (95% confidence intervals), with sarcopenic obesity as the outcome.RESULTS:The prevalence of sarcopenic obesity was 29.3%. In the final fitted model, the variables that displayed statistically significant association with sarcopenic obesity were lower gait speed, self-reported medical diagnosis of arthrosis or arthritis, and high levels of glycemia.CONCLUSION:The study showed a high prevalence of sarcopenic obesity in non-institutionalized older adults in Brazil. The finding that this condition was associated with modifiable risk factors may provide insights into measures directed at prevention and reduction of the risk of sarcopenic obesity in this population subgroup.