Brody Index Research Articles

Disability and Quality of Life Measures in older frail and prefrail people with type 2 diabetes. The MIDFRAIL-Study

AimTo explore the individual response to a multimodal intervention on quality of life (QOL) and disability. Methods843 (77.83 years, 50.65 % men) prefrail and frail individuals ≥ 70 years with type 2 diabetes mellitus. Participants were randomized to the usual care group (UCG) or the multicomponent intervention (IG). Intervention consisted in 16-week progressive resistance training program, 7 educational sessions and the achievement of HbA1c (7–8 %, 53–64 mmol/mol)) and BP (<150 mmHg) targets. QOL (EuroQol EQ-5D-5L), basic (Barthel Index, BI) and instrumental (Lawton and Brody Index) activities of daily living (ADL) were assessed. Multivariate binomial and multinomial logistic regression models were used to explore the effect of the IG, and adherence on the outcomes studied. ResultsThe IG was associated with a significant higher probability of improvement in the QOL [OR(95 %CI): 1.75 (1.20, 2.54), p-value 0.004] and a lower probability of deterioration in QoL [0.61 (0.87, 0.54), 0.006] and Barthel Index [0.59 (0.37, 0.93), 0.023]. A high adherence (≥93 %) was needed to achieve benefits in the QOL while > 84.38 % was needed for achieving the benefits in Barthel Index. ConclusionsIG has proven to be effective in increasing QOL and avoiding the worsening of QOL and basic ADL.

P41: Valladolid Multicenter Study: Factors related to time to referral and length of hospital stay in old psychiatry patients in seven general hospitals in Spain

Objective:Older patients (≥65yo) admitted to general hospitals have increased in the past years. This resulted in an increase in hospitalization periods, health costs, and morbi-mortality rates in this group of patients.Previous evidence points that the reduced time to referral (TTR) to Consultation-Liaison Psychiatry Units (CLP) leads to a reduced length of stay (LOS) in GH improving long-term prognosis of medical conditions.This study aims to explore whether a prior disability in older patients leads to delay the search for psychiatric help. And to explore whether early referral to CLP is associated with reduced LOS in general hospitals.Methodology:This is an observational, cross-sectional, multicentre study. We obtained a complete data set from a sample of 152 patients (≥65 years old) admitted to 7 general hospitals in Spain referred to CLP unit for 1,5 months.Results:Mean age of the sample was 76.3 (±6.4). TTR was 14.5 (±18.0) days. LOS was 26.7 (±22.4) days, and length of stay after consultation was 12.3 (±10.3) days. Barthel Index before admission was 87.3 (±18.0) and Lawton&amp;Brody Index before admission was 5.3 (2.7). We found a significant positive association of Barthel Index (r=0.17, p=0.042) and Lawton&amp;Brody Index (r=0.20, p=0.014) before admission with TTR, which indicates that patients with a worse clinical status were attended earlier. Similarly, antecedents of both falling episodes (r=-0.2, p= 0.013) and walking difficulties (r=-0.24, p= 0.003) were associated with shorter TTR. TTR in Medical Departments was 11.7 (±15.0) days and in Surgical Departments was 24.0 (±22.8) days (t=-3.5, p= 0.001). TTR showed a highly significant positive correlation with LOS (r=0.89, p&lt;0.0001) and a more discrete positive correlation with length of stay after consultation (r=0.20, p=0.016).Conclusion:We confirm that a shorter TTR to CLP was related to a shorter LOS. Also, patients in medical wards had shorter TTR. In contrast to our hypothesis, we found that a higher disability prior to hospitalization led to earlier referral to CLP, meaning that these patients were assessed and treated earlier leading to better long- term prognosis and lower health costs.

Recurrent lower urinary tract infections: more than an infection for older women.

Older adults tend to have more urinary tract infections (UTIs). The frequency of recurrent lower urinary tract infections (rLUTIs) increases with age. rLUTIs are associated with long-term chronic effects on geriatric syndromes in older adults. We aimed to investigate possible risk factors that influence rLUTIs in older adults based on comprehensive geriatric assessment (CGA). This cross-sectional study included 235 older adults admitted to Gaziantep University's Geriatric Outpatient Clinic between June 1 and November 30, 2022. All patients underwent CGA. The Geriatric Depression Scale (GDS), the European Quality of Life-Five Dimension (EQ-5D) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Katz Index of Activities of Daily Living (ADL), the Lawton and Brody Index of Instrumental Activities of Daily Living (IADL), and the Mini Nutritional Assessment (MNA) tool were,administered. Handgrip strength (HGS) and gait speed were also measured, and the number of falls in the last year was recorded. The mean age of the participants was 72.8 ± 6.8 years and 61.3% were female. Sixty-four patients had rLUTIs. The rLUTI group had higher frequencies of sarcopenia, hypertension, and diabetes; higher numbers of comorbidities and medications; higher GDS and PSQI scores; and more reported falls. They had lower ADL, MNA, EQ-5D, and gait speed scores. HGS was found to be lower in women with rLUTIs. Higher numbers of comorbidities and GDS scores and lower HGS were independent predictors of rLUTIs in women (p = 0.011, OR: 1.75; p = 0.018, OR: 1.14; and p = 0.042, OR: 0.91, respectively). We revealed that decreased HGS, higher GDS, and the number of comorbidities in older women were independent risk factors for rLUTIs. Our findings offer a new perspective on the importance of CGA in diagnosing and preventing rLUTIs.

Polypharmacy in the Elderly: A Double-Edged Sword

Aim: Polypharmacy is a very important geriatric syndrome related to critical health conditions. The purpose of this study is to research the association of polypharmacy with comprehensive geriatric assessment’s (CGA) various parameters which are indicators of health and life quality in older individuals. Material and Methods: 515 older adults admitted to a university hospital were included in this cross-sectional study. Along with CGA, European Quality of Life (EQ-5D) was performed on the participants. Geriatric Depression Scale (GDS) was used to evaluate depressive symptoms. Daily living activities were assessed by using Lawton &amp;amp; Brody index of Instrumental Activities of Daily Living (IADL) and Katz Index of Activities of Daily Living (ADL). The Full Mini-Nutritional Assessment (MNA) questionnaire was performed to evaluate nutritional status. Results: The participants’ mean age was 72.2±6.3 years and 58.6% of them were female. 242 participants using 5 or more drugs were included in the polypharmacy group. The polypharmacy group had lower IADL, MNA, EQ-5D, Hand Grip Strength (HGS), and gait speed scores and higher GDS scores compared to those without polypharmacy. According to the correlation analysis results, the number of the medications had a moderate positive correlation with GDS scores and a moderate negative correlation with EQ-5D and MNA. Conclusion: As the number of medications increases; patients tend to have depression, malnutrition, and a decline in functional status. Polypharmacy also impairs the quality of life. We should address polypharmacy as a crucial health problem, optimize the number of medications and thereby make the health condition better.

INSTRUMENTOS UTILIZADOS NA AVALIAÇÃO DA CAPACIDADE FUNCIONAL, FRAGILIDADE E SARCOPENIA EM IDOSOS: REVISÃO INTEGRATIVA

ABSTRACT Objective: to analyze the knowledge produced in the scientific literature on the instruments used to assess functional capacity, frailty, and sarcopenia in older adults. Method: integrative literature review, in the Cinahl, MEDLINE/PubMed, Embase, Web of Science and Scopus databases, from 2012-2021. Data were extracted: authors, year, country of publication, type of study, sample characteristics, objective, results, and instruments. In addition, the methodological quality and level of evidence were assessed. Results: The final sample included 13 articles. The most used instruments were Lawton and Brody Index for functional capacity assessment; conceptual model of the frailty phenotype; and the conceptualization and diagnosis of the European Working Group on Sarcopenia. Conclusion: The scientific evidence demonstrated the importance of using instruments to screen for these conditions that can interfere with the health of the elderly population, reinforcing the need to strengthen interprofessional care practices.

Reliability and Validity of the Motor Activity Log (MAL-30) Scale for Post-Stroke Patients in a Spanish Sample.

The validation of assessment instruments is of great importance when they are applied in clinical and healthcare settings, since their safe and reliable use is essential for the application of appropriate and high-quality treatments. The motor activity log (MAL-30) is an instrument widely used by professionals in the clinic, which has been validated in different countries, languages and populations. The aim of this study was to determine the reliability and validity of the MAL-30 scale for post-stroke patients in a Spanish sample. For this purpose, internal consistency tests were carried out using Cronbach's alpha, item-item and item-total correlations, and a half-and-half test for reliability. For the validation, criterion validity tests were performed using the Fugl-Meyer assessment scale as the gold standard, and the convergent validity tests were carried out by correlation with the action research arm test (ARAT), box and block test (BBT), functional independence measure (FIM)-functional assessment measure (FAM), Lawton and Brody index and stroke quality of life scale (ECVI-38). The results showed good internal consistency, as well as a good criterion and convergent validity. The MAL-30 instrument can be considered a valid and reliable tool for assessing the quantity and quality of the use of the affected upper limb in the performance of the activities of daily living and the instrumental activities of daily living after stroke in a Spanish sample.

MO854: Implementation of a Geriatric Assessment in Elderly Hemodialysis Patients

Abstract BACKGROUND AND AIMS Elderly patients who are on hemodialysis (HD) have a higher burden of multimorbidity and geriatric syndromes, that are underdiagnosed. These aspects affect quality of life and may lead to higher hospitalization rates and mortality rates. Despite guideline recommendations, geriatric assessment is not part of standard clinical care. The aim of this study was to assess the prevalence of geriatric impairments and frailty in patients ≥ 65 years old on maintenance HD by means of a geriatric assessment (GA). METHOD Cross-sectional study involving patients ≥ 65 years old on maintenance HD at a secondary Hospital in Ecuador between March and April 2021. Baseline demographic data, clinical and dialysis characteristics were collected from the medical charts and during the baseline assessment. All participants underwent a GA, including 5 domains: (1) comorbidity burden: Charlson comorbidity Index, (2) assessment of basic and instrumental activities of daily living (ADL: Barthel Index and iADL: Lawton and Brody index), (3) cognition: Pfeiffer Short Portable Mental Status Questionnaire, (4) mood: 5-item version of the Geriatric Depression Scale and (5) nutrition: Mini Nutritional Assessment (MNA) score. In addition, 3 frailty screening tools were applied: Frail-VIG Index (IF-VIG), Clinical Frailty Scale (CFS) and the clinical judgment of the nephrologist (surprise question). For the clinical judgment, the treating physician was asked to indicate if he would be surprised if the patient died in the next 6 months. Data were summarized using means with standard deviation or proportions when appropriate. Differences regarding baseline characteristics and outcomes between fit and frail patients stratified according to the Frail-VIG Index were assessed using Chi-squared tests and t-tests as appropriate. RESULTS Thirty-two patients were included, mean age 72.2 ± 5.83 years and 78.1% (n = 25) were men. Geriatric impairments were highly prevalent. Most frequently impaired geriatric domains were: functional performance (ADL 71.9% and iADL 75%), depression (40,6%), risk for malnutrition (68.8%), symptoms of cognitive decline (25%) and severe comorbidity (Charlson Index = 5.6 ± 2.3). The prevalence of frailty differed widely according to the different frailty screening tools. According to the IF-VIG, CFS and the clinical judgment, 56.2%, 37.7% and 35% of the patients were found frail, respectively. No differences between frail and fit patients were found in demographics nor in the prevalence of impairment in cognition, symptoms of depression, malnutrition, severe comorbidity or impairment in basic activities of daily living. Frail patients were more care dependent in their instrumental iADL compared with the fit group (P = 0.024) (Figure 1). CONCLUSION Geriatric impairments are highly prevalent in patients ≥ 65 years old on chronic HD. Since impairments can be missed when not searched for in regular dialysis care, the first step of improving nephrologic care is awareness of the extensiveness of geriatric impairment.

Malnutrition and Depressive Symptoms in Elderly Palliative Care Patients.

Objective: The aim of this study is to determine the prevalence of and relationship between malnutrition and depressive symptoms in older palliative care inpatients. Methods: One hundred and thirty-six older adults were included in the study. The Geriatric Depression Scale, Mini Nutritional Assessment Short Form, Mini Mental State Examination, Barthel index, and Lawton & Brody index were used to evaluate the mood, nutrition status, mental status, and activities of daily living of the patients. Results: The mean age of the patients was 74.88 ± 8.82 years, and 63.2% of the patients were female. According to the nutritional assessment, 39.7% of the patients suffered from malnutrition, while 47.1% were at risk for it, and depressive symptoms were detected in 79.4% of the patients. A strong negative correlation was found between the scores for nutritional and depressive symptoms (r = -.750, 95% CI = -.834 to -.668). Conclusion: Malnutrition, risk of malnutrition, and depressive symptoms were found to occur often among the patients, and the relationship between them was statistically significant. Our results highlight that the quality of life of palliative care patients could be improved by providing adequate nutrition and psychological support.

P1203DEGREE OF FUNCTIONAL DEPENDENCE IN PATIENT IN SUBSTITUTE RENAL TREATMENT IN HGUCR

Abstract Background and Aims Elderly patients and comorbidity present more frequently deterioration of their cognitive and / or functional capacity, and consequently worse quality of life related to health and the need for help to perform their basic activities. It has been described in the literature that peritoneal dialysis (PD) is a protective factor in the patient's survival against hemodialysis (HD). Quality of life is an important parameter in patients undergoing renal replacement therapy, which influences the choice of dialysis modality. We analyzed and compared the degree of functional dependence of patients on PD versus HD. Method Descriptive and cross-sectional study. A total of 84 patients belonging to the General University Hospital of Ciudad Real were included. Demographic variables (age, sex), associated comorbidity, etiology of CKD, among others, were collected. To assess the degree of dependence, the Barthel index and Lawton and Brody were performed. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and have been compared using the Chi2 test. Quantitative variables are expressed as mean +/- standard deviation, and the T-student was used to compare them. Statistical significance for a value of p &amp;lt;0.05. Results Of the 84 patients, 40.5% received PD and 59.5% HD. 60.7% were male and 39.3% female, with an average age of 60.90 years. 75% were hypertensive, 38.1% diabetic, 61.9% dyslipidemic, 27.4% obese and 61.9% had peripheral vasculopathy. The most frequent causes of CKD were diabetic nephropathy (22.6%), glomerular etiology (21.4%), unfiltered (20.2%) and nephroangiosclerosis (14.3%), among others. The degree of functional dependence according to the Barthel index was 63.1.9% for total independence, 29.8% mild dependence, 4.8% moderate dependence and 1.2% total dependence; and for the Lawton and Brody index, 42.9% total independence, 14.3% mild dependence, 27.4% moderate dependence, 11.9% severe dependence and 3.6% total dependence. When comparing the degree of functional dependence between both dialysis techniques, we observed that patients in PD had a lower degree of functional dependence compared to patients in HD, these differences being statistically significant (Lawton and Brody 73.5% in PD vs. 22% in HD, p &amp;lt;0.001 and Barthel index 85.3% in PD vs 48% in HD, p = 00.4). Conclusion In our experience, the degree of functional dependence in patients in PD is lower compared to patients in HD with less comorbidity, being able to condition the choice of the technique of renal replacement therapy.

The effectiveness of a mobile high-frequency chest wall oscillation (HFCWO) device for airway clearance.

IntroductionHigh‐frequency chest wall oscillation (HFCWO) is a commonly prescribed airway clearance technique (ACT) for patients whose ability to expectorate sputum is compromised. This study aimed to assess the effectiveness of a newly developed mobile ACT device (mHFCWO—The Monarch Airway Clearance System) in patients with cystic fibrosis (CF). A standard nonmobile HFCWO device (sHFCWO) was used as a comparator.MethodologyThis was a randomized, open‐label, crossover pilot study. CF patients were treated with each device. Sputum was collected during and after each therapy session, while spirometry tests, Brody score assessment and functional respiratory imaging were performed before and after treatments.ResultsWet weight of sputum collected during and after treatment was similar for mHFCWO and sHFCWO (6.53 ± 8.55 vs 5.80 ± 5.82; P = .777). Interestingly, the mHFCWO treatment led to a significant decrease in specific airway volume (9.55 ± 9.96 vs 8.74 ± 9.70 mL/L; P < .001), while increasing specific airway resistance (0.10 ± 0.16 vs 0.16 ± 0.23 KPA*S; P < .001). These changes were heterogeneously‐distributed throughout the lung tissue and were greater in the distal areas, suggesting a shift of mucus. Changes were accompanied by an overall improvement in the Brody index (57.71 ± 16.55 vs 55.20 ± 16.98; P = .001).ConclusionThe newly developed mobile device provides airway clearance for CF patients comparable to a nonmobile sHFCWO device, yielding a change in airway geometry and patency by the shift of mucus from the more peripheral regions to the central airways.

Sensory and cognitive functions, gait ability and functionality of older adults

Objective:to know the relationship between the sensory function, gait ability, and cognitive function with dependency in older adults.Method:a descriptive cross-sectional design, 146 older adults took part.Measurements:Snellen chart, Audiometer, Stereognosia tests, Semmes-Weinstein monofilament, basic aromas and flavors, GAITRite system, Montreal Cognitive Assessment Test, the Barthel Index, and the Lawton and Brody Index.Results:sensory function, cognitive function and gait explain 25% dependence on basic activities of daily life and 21% dependence on instrumental activities of daily life. The variables that influence dependence on basic activities were taste (p=.029), gait speed (p=.009), cadence (p=.002) and step length (p=.001) and, in instrumental activities, gait speed (p=.049), cadence (p=.028) and step length (p=.010).Conclusion:gait speed, cadence and stride length are variables that influence both dependence on basic and instrumental activities of daily life.

Frailty, disability and comorbidity: different domains lead to different effects after surgical aortic valve replacement in elderly patients.

Frailty syndrome predicts adverse outcomes after surgical aortic valve replacement. However, disability or comorbidity is frequently associated with preoperative frailty evaluation. The effects of these domains on early and late outcomes were analysed. A prospective study including patients aged ≥75 years with symptomatic severe aortic stenosis who received aortic valve replacement with or without coronary artery bypass grafting was conducted. We used the Cardiovascular Health Study Frailty Phenotype to assess frailty, the Lawton-Brody index to define disability and the Charlson comorbidity index (CCI) to evaluate comorbidity. Frailty was identified in 57 (31%), dependence in 18 (9.9%) and advanced comorbidity (CCI ≥ 4) in 67 (36.6%) of the 183 enrolled patients. Operative mortality (1.6%), transfusion rate and duration of stay increased in patients with CCI ≥4 (P < 0.005). There was a non-significant trend for these adverse outcomes among the frail patients. Follow-up was achieved in all patients (median/interquartile range 869/699-1099 days). Kaplan-Meier univariable analysis showed a reduced survival rate for frail and dependent patients and for those with multiple comorbidities (P < 0.05). According to multivariable analysis, frailty and comorbidity were independent risk factors for 1-year mortality, while disability and comorbidity, but not frailty, were risk factors for 3-year mortality (P < 0.05). Surgical aortic valve replacement in patients aged ≥75 years is a safe procedure with low mortality rates. Operative outcomes are mainly affected by comorbidities. The main influence of survival occurs throughout the first year, and an improved functional status prevents any progression towards disabilities, which could potentially benefit long-term outcomes. NCT02745314.

The Erasmus Frailty Score is associated with delirium and 1-year mortality after Transcatheter Aortic Valve Implantation in older patients. The TAVI Care & Cure program

BackgroundFrailty in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) has been associated with an increased 1-year mortality rate but the relation of frailty and short term outcomes yields conflicting results. This study investigated the association of a novel and self-developed Erasmus Frailty Score with both short and long term outcomes after TAVI. MethodsTAVI Care & Cure is an observational ongoing study, which includes consecutive patients undergoing TAVI at the Erasmus University Medical Centre. Prior to the TAVI, frailty status was assessed. The Erasmus Frailty Score (EFS) was defined as follows: 1 point assigned if: MMSE was <27 points, MUST ≥2 points, grip strength <20 kg for females, <30 kg for males, KATZ index ≥1 limited activity, Lawton and Brody index ≥2 limited activity. The maximum score was 5. Patients were classified as frail when the score was ≥3. Presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and post-TAVI. Mortality data were obtained from the Dutch Civil Registry. The impact of frailty on short and long term outcomes was evaluated. Results213 patients were included for analysis. Frailty was present in 28.6% (n = 61), (EFS ≥ 3). Baseline frailty was associated with patients developing a delirium [OR 3.3 (95% CI 1,55–7,10), p = 0.002] and with increased risk of 1-year mortality [HR 2.1 (95% CI 1.01–4.52), p = 0.047]. ConclusionThe Erasmus Frailty Score is associated with delirium and 1 year mortality in older patients after TAVI and can be used as a complement to traditional risk factors.

Assessing Mild Behavioral Impairment with the Mild Behavioral Impairment-Checklist in People with Mild Cognitive Impairment.

Neuropsychiatric symptoms (NPS) are non-cognitive, behavioral, or psychiatric symptoms, common in mild cognitive impairment (MCI) and associated with a higher risk of dementia. Mild behavioral impairment (MBI) is a validated diagnostic entity, that describes the emergence of later life NPS in pre-dementia states. The Mild Behavioral Impairment Checklist (MBI-C) is the first measure developed to assess MBI. To estimate the prevalence of MBI in people with MCI and to study the score distribution, sensitivity, specificity, diagnostic utility of the MBI-C, and its correlations with neuropsychological tests. One hundred eleven MCI participants were evaluated with the Questionnaire for Subjective Memory Complaints (QSMC), Mini-Mental State Examination, Cambridge Cognitive Assessment-Revised, Neuropsychiatric Inventory-Questionnaire (NPI-Q), Geriatric Depression Scale-15 items (GDS-15), Lawton and Brody Index, and the MBI-C, which was administered by phone to participants' informants. Descriptive, logistic regression, ROC curve, and bivariate correlations analyses were performed. MBI diagnosis prevalence was 14.2%. The total MBI-C score differentiated people with MBI at a cutoff-point of 6.5, optimizing sensitivity and specificity. MBI-C total score correlated positively with NPI-Q, QSMC, GDS-15, and Lawton and Brody Index. The total MBI-C score, obtained by phone administration, is sensitive for detecting MBI in people with MCI. The MBI-C scores indicated that MCI participants had subtle NPS that were correlated to their subjective memory complaints reported by informants, depressive symptoms, and negatively with Instrumental Activities of Daily Living. Further research should be done to clarify the predictive role of NPS in MCI for incident dementia.

Oral bisphosphonate prescription and non-adherence at 12 months in patients with hip fractures treated in an acute geriatric unit.

Low adherence to treatment is a problem in post-fracture secondary prevention. We aimed to analyze the prognostic factors (related and predictive) associated with non-adherence to oral bisphosphonate prescription for hip fracture due to bone fragility (HFBF) 12months after discharge from an acute geriatric unit. Prospective study of bivariate data analyzing related and multivariate factors predicting non-adherence of oral bisphosphonates at 12months after treatment for HFBF. The statistical study was performed with SPSS 19.0.0. We attended 368 patients with HFBF. At discharge, oral bisphosphonates were prescribed to 226 (61.42%) patients. At 12months, we followed up 160 (70.7%) patients, 104 (65%) of whom had non-adherence to oral bisphosphonates. Bivariate analysis (adherent vs. non-adherent): age (83.79 ± 5.82 vs. 85.78 ± 5.80, p = .029); Lawton and Brody Index (4.29 ± 3.40 vs. 2.67 ± 3.31, p = .004); baseline Barthel Index (BI) (85.89 ± 21.99 vs. 74.18 ± 26.70) (p = .004); BI at admission (18.84 ± 10.00 vs. 14.47 ± 11.71, p = .004); BI at discharge (34.20 ± 15.40 vs. 27.45 ± 16.71, p = .011); baseline Functional Ambulation Classification (5.66 ± 0.98 vs. 5.43 ± 0.99, p = .025). Multivariate analysis: BI 0.980 (0.965-0.995, p = .007). Discriminatory capacity of the AUC model (± 95% CI): 0.634 (0.545-0.722). At 12months, there was low adherence to treatment with oral bisphosphonates in our model. A lower BI prior to treatment is a predictive factor for non-adherence treatment with oral bisphosphonate.

Assessing mild behavioral impairment with the mild behavioral impairment checklist in people with subjective cognitive decline.

Correlational study with a convenience sampling. Descriptive, logistic regression, ROC curve, and bivariate correlations analyses were performed. Primary care health centers. 127 patients with SCD. An extensive evaluation, including Questionnaire for Subjective Memory Complaints, Mini-Mental State Examination, Cambridge Cognitive Assessment-Revised, Neuropsychiatric Inventory-Questionnaire (NPI-Q), the Geriatric Depression Scale-15 items (GDS-15), the Lawton and Brody Index and the MBI-C, which was administered by phone to participants' informants. MBI prevalence was 5.8% in those with SCD. The total MBI-C scoring was low and differentiated people with MBI at a cut-off point of 8.5 (optimizing sensitivity and specificity). MBI-C total scoring correlated positively with NPI-Q, Questionnaire for Subjective Cognitive Complaints (QSCC) from the informant and GDS-15. The phone administration of the MBI-C is useful for detecting MBI in people with SCD. The prevalence of MBI in SCD was low. The MBI-C detected subtle Neuropsychiatric symptoms (NPS) that were correlated with scores on the NPI-Q, depressive symptomatology (GDS-15), and memory performance perceived by their relatives (QSCC). Next steps are to determine the predictive utility of MBI in SCD, and its relation to incident cognitive decline over time.

Frailty in older adults with type 2 diabetes mellitus and its relation with glucemic control, lipid profile, blood pressure, balance, disability grade and nutritional status

frailty identifies a subgroup of people with higher risk of morbidity and mortality. our first aim was to determine the prevalence of frailty in older adults with type 2 diabetes mellitus; our second aim was to establish which factors are associated with frailty in these patients. cross-sectional study in non-institutionalized people (288 patients), over 65 years of age, and diagnosed with diabetes mellitus type 2. Frailty was defined according to Freid's criteria. The following variables were assessed: blood pressure, glycosylated hemoglobin, total cholesterol, HDL and LDL cholesterol, triglycerides, Lawton and Brody index, balance through unipodal support, and nutritional status by using the Mini Nutritional Assessment questionnaire. the prevalence of frailty syndrome was 14.6%. The frailty group showed lower systolic blood pressure (p < 0.001), higher triglycerides levels (p = 0.007), and lower Lawton and Brody values (p < 0.001) than the non-frailty one; moreover, lower monopodal balance was observed with higher frailty levels (r = -0.306, p < 0.001). None frailty-subject was able to perform five seconds or more in balance (r = -0.343, p < 0.001). Moreover, higher frailty was related with poorer Mini Nutritional Assessment results (p = 0.013). the prevalence of frailty syndrome in patients with diabetes was higher compared with those in general population over 65 years of age. Frailty was related to lower systolic blood pressure, higher triglycerides concentrations, poorer nutritional status, and lower independency to perform instrumental activities of daily living and poorer balance.

Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry

Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton-Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.

Functionality on mild, moderate and severe Alzheimer's disease: a cros-sectional study

Objective: To evaluate the functionality of patients with Alzheimer's disease (AD) living in a community, in the city of Guarapuava PR, South of Brazil. Methods: A cross-sectional study was performed with patients with AD living in the community. Participants were classified according to Clinical Dementia Rating as CDR 1 (mild AD), CDR 2 (moderate AD) and CDR 3 (severe AD). The mental state was assessed by the Mini Mental State Examination; the basic activities of daily living (ADLs) was determined by the Barthel Index and instrumental activities of daily living (IADLs) via by Lowton and Brody Index. Results: 49 elderly patients with AD diagnosis were evaluated, 14 (24.1%) of which were classified as CDR 1, 21 (36.2%) as CDR 2, and 23 (39.7%) as CDR 3. There was a significant difference between the levels of dependence for the performance of the basic ADLs and IADLs among all phases of AD (p <0.001). The dependence was higher in both CDR 2 and CDR 3. Conclusion: Functional dependence for basic activities of daily living becomes more frequent in the most advanced stages of AD, whereas dependence for IADLs is onset since early stages of AD, even more noticeable than dependence for basic ADLs, what suggests a progressive loss of functionality.

Motor-Cognitive Intervention in Mexican Older Adults

Two motor-cognitive interventions were implemented to evaluate their efficacy in cognitive improvement in Mexican older adults 65 years and more. The intervention group received a dance video games plus a cognitive task (dual-task); the comparison group received only the dance video game, in sessions of 45 minutes, 3 times a week, for 12 weeks. The Barthel Index and Lawton and Brody Index, the Center for Epidemiologic Studies Depression Scale-Revised were applied the Digit Span Test, the Stroop Test, and Color Trail Making. Gait parameters were assessed by GAITRite? electronic walkway (CIR Systems). The design was quasi-experimental. Sites were randomly assigned to intervention groups. The intervention group started with 32 participants and finished with 15; the comparison group started with 20 participants and finished with 18. Participants in the intervention group had to mimic the dance movement of a video game and, after the second week to name progressively three objects without stopping dancing. A multivariate repeated measures model (MANO-VA) was fit with four variables. A time-by-group interaction was observed in the Stroop test, and Digits Span Backwards was in favor of the dual task group. The Stroop test, Digit Span Backwards, gait speed, and step length showed effect time. Both groups improved in gait speed and step length by the end of the intervention. Results show it is feasible for Mexican older adults with little schooling to perform dual tasks and improve cognitive tasks and gait speed. Limitations were high attrition due to unforeseen situations and small sample size.