Clinical-Functional Vulnerability Research Articles

Clinical-functional vulnerability index in older people of a family health strategy team in the central zone of Rio de Janeiro

AimTo evaluate the applicability of the Clinical-Functional Vulnerability Index (IVCF-20) in monitoring the health of older people in primary health care (PHC), estimate the prevalence of functional decline and identify associated factors. MethodsCross-sectional descriptive study, with individuals aged 60 or over, from a PHC unit in Rio de Janeiro. The instrument included sociodemographic, health and lifestyle variables and the IVCF-20. A descriptive analysis was carried out, prevalence ratios (PR) were calculated, and Poisson multiple analysis was performed. ResultsThe sample consisted of 120 individuals, mean age of 72.9 years (SD= 0.75), the majority were female. According to IVCF-20, 61 (50.8 %) of the individuals were robust, 41 (34.2 %) were in potential functional decline and 18 (15.0 %) were in established functional decline. In the bivariate analysis, not performing regular physical activity (RP 2.60 CI95 % 1.21–5.57), not believing that you live a healthy life (RP 4.39 CI95 % 1.92–10.06), not being satisfied with the way you live (RP 6.74 IC95 % 2.51–18.11) and reference to chronic illness (RP 4.57 IC95 % 1.22–17.14) showed an association with functional decline. In the Poisson model, the variables age (RP 1.37 95 % CI 1.07–1.75), not believing that you live a healthy life (RP 1.54 95 % CI 1.01–2.33) and lack of satisfaction with the way you live (RP 1.75 CI95 % 1.18–2.60) remained associated. ConclusionThe study made possible to draw a profile of the older adults accompanied by a team at PHC, contributing to discussions on care proposals for the older people with a focus on preventing functional decline.

Clinical-functional vulnerability index in elderly individuals participating in a supervised physical exercise program

The article aimed to assess the clinical-functional vulnerability index (CFVI) of elderly individuals participating in a supervised physical exercise program (SPEP) lasting 16 weeks. A total of 105 volunteers (X̅ = 67 ± 6.50 years) participated in the study, and they were assessed using the CFVI-20 instrument before and after the 16-week intervention with SPEP. A reduction in CFVI was observed (∆% = -7.30%), but it remained in the Moderate Risk range (7 to 14). Reductions were noted in mobility subfacets (∆% = -100%), highlighting a decrease in frailty concerning reach, grip, pinch, aerobic and/or muscular capacity, gait, and sphincteric continence. This resulted in an increase in the Robust classification (∆% = 16.25%) and a decrease in the Risk (∆% = -13.60%) and Fragile (∆% = -24.21%) classifications. The findings indicate the importance of SPEP for health and reducing public spending on elderly individuals.

Risk of frailty and associated factors among community older adults during the COVID-19 pandemic

Introduction: Functional decline represents the main determinant of negative outcomes in the health of older adults, such as the development of other disabilities, which may result in frailty, institutionalization, hospitalization and death. Aim: To determine the prevalence of risk of frailty among community older adults during the covid-19 pandemic and identify its association with health risk behaviors. Methods: An epidemiological screening type research, with cross-sectional design and sample representative of the Federal District, Brazil, was carried out. Data were collected through electronic questionnaire. In order to answer the problem question, the Clinical-Functional Vulnerability Index – IVCF-20 instrument was used (with risk ≥7 points), complemented by questions about demographic factors, socioeconomic factors and health risk behaviors. For data analysis, descriptive (frequency distribution and confidence interval) and association (crude and adjusted binary logistic regression) procedures were used. Results: Data from 1,363 older adults were analyzed (66.0%=female; 34.0%=male), the majority aged 60-74 years (82.2%), with higher education level (50.1%), who did not live alone (76.6%). There was high prevalence of older adults exposed to risk of frailty (30.7%; CI 95%=26.3-35.1), insufficiently active (45.6%; CI 95%=41.7-49.5) and who did not practice physical exercises before (30.2%; CI 95%=25.8-34.6) and during the physical distancing resulting from the covid-19 pandemic (53.4%; CI95%=49.8-57.0). Risk of frailty was associated with insufficient level of physical activity (OR=3.37; 95% CI 2.59-4.39) and with not practicing physical exercise before (OR=1.54; 95% CI 1. 17-2.03) and during physical distancing resulting from the covid-19 pandemic (OR=2.07; 95% CI 1.58-2.69). Conclusions: Considering the relevance and potential of physical exercise for older adults in contributing to functional improvement and health conditions, strategies to maintain active habits, even in periods of physical distancing as imposed by the covid-19 pandemic, are needed.

Polifarmácia, medicamentos potencialmente inapropriados e a vulnerabilidade de pessoas idosas

Abstract Objective To analyze the frequency of polypharmacy and the prescription of Potentially Inappropriate Medications (PIM) according to the Beers Criteria and CBMPI in older adults with clinical-functional vulnerability. Method This is a cross-sectional study where the medical records of 496 participants aged 60 and older, seen in their first appointment at a Gerontological Polyclinic, were analyzed. Sociodemographic data, medications, the Clinical-Functional Vulnerability Index-20 (IVCF-20), and falls were extracted from the medical records. Polypharmacy was defined as the simultaneous use of five or more medications. Participants were classified into three groups: robust, at risk, and vulnerable. Results The analysis revealed that 69 (13.91%) participants were using polypharmacy. Among polypharmacy users, 40 (57.97%) were using at least one PIM. The most commonly found PIM were glibenclamide and omeprazole, respectively. Older adults with vulnerability were three times more likely to have polypharmacy (OR 3.59; 95% CI 2.109-6.092). Conclusion The use of polypharmacy and PIM in this study was associated with the vulnerability of older adults, emphasizing the need for a thorough evaluation of medication prescriptions for this population.

The ICOPE-WHO and the IVCF-20: a critical view of the Handbook for Multidimensional Geriatric Assessment in Primary Care

Rapid population aging is driving initiatives aimed at optimizing the health of older populations worldwide. In Brazil, the National Council of State Secretaries of Health (CONASS) recently published the Handbook for Multidimensional Geriatric Assessment in Primary Care, which proposes the combined, large-scale adoption of the World Health Organization (WHO) ICOPE screening tool and the Clinical-Functional Vulnerability Index-20 (IVCF-20) instrument to define care pathways for older people. Although there is a pressing need for initiatives of this nature, the proposed instruments have not yet been adequately validated in the Brazilian population, and their use for the purpose of establishing countrywide health guidelines appears hasty and risky. Therefore, we propose a broad, urgent debate among experts in the field with the aim of planning effective and safe public health policies for the Brazilian older population.

Rastreamento da fragilidade em pessoas idosas com hipertensão arterial sistêmica por instrumentos diferentes

Abstract Objective To compare the degree of agreement, correlation, and accuracy between the Edmonton Frail Scale (EFS) and the Clinical-Functional Vulnerability Index-20 (IVCF-20) instruments in older adults with systemic arterial hypertension (SAH). Method Cross-sectional household study with older adults from Montes Claros, MG. This study included only individuals with SAH whose data were collected from November 2016 to February 2017. Sensitivity, specificity, and predictive values were determined. The Kappa statistic analyzed agreement and reliability, while the Pearson coefficient evaluated the correlation between the instruments. Results A total of 281 individuals with hypertension were included in this study. It was found that the prevalence of frailty was 31.3% according to the EFS and 22.1% according to the IVCF-20. The Kappa statistic was 0.604, and the Pearson correlation coefficient was 0.621 (p<0.001). The accuracy was 84.34%. Conclusion The EFS and IVCF-20 instruments verified moderate agreement and reliability, strong positive correlation, and good accuracy. The results confirm the importance of standardizing the instrument to assess frailty in older adults with hypertension. The appropriate assessment of frailty aims to provide care focused on prevention and promotion that can prevent worsening health status and complications of arterial hypertension.

Effects of a remotely supervised physical training program combined with cognitive training for older individuals at increased risk of clinical-functional vulnerability: study protocol for a randomized clinical trial.

Despite the robust body of evidence for the benefits of home-based physical exercise, there is still a paucity of data on the benefits of home-based cognitive training for older adults, especially in those at increased risk of clinical-functional vulnerability. As such, the present study aims to compare the chronic effects of a telehealth-delivered physical training intervention alone or combined with a cognitive training program in older adults at increased clinical-functional vulnerability risk. A randomized clinical trial will be conducted including 62 sedentary older individuals classified as at increased risk of clinical-functional vulnerability based on their Clinical-Functional Vulnerability Index score. Participants will be randomly allocated in a 1:1 ratio to one of two groups, an intervention group including physical training combined with cognitive training, or an active control group including physical training alone. Both groups will receive home-based supervised training remotely for 12weeks and will be assessed for the primary and secondary outcomes of the study before and after the training period. Primary outcomes include cognitive function and dynamic balance with a dual task. Secondary outcomes encompass physical, cognitive, and occupational performance, functional capacity, quality of life, and anxiety and depression symptoms, as well as hemodynamic measures. Data analysis will be performed by intention-to-treat and per protocol using mixed linearmodels and Bonferroni's post hoc (α = 0.05). Our conceptual hypothesis is that both groups will show improvements in the primary and secondary outcomes. Nevertheless, we expect physical combined with cognitive training to improve cognitive function, dual task, and occupational performance to a greater degree as compared to physical training alone. NCT05309278. Registered on April 4, 2022.

Association of frailty with cognitive impairment and functional disability in older adults with affective disorders: a brief research report.

The Clinical-Functional Vulnerability Index (IVCF-20) is a validated multidimensional instrument that has been used in Brazil to evaluate functional disability in frail older adults. The main aim of this study was to assess frailty using this novel screening tool. In addition, to investigate whether frailty was associated with cognitive impairment and functional disability in older adults with affective disorders. Participants included were over 60 years old, with affective disorders (depressive or anxiety disorders), from two specialized outpatient clinics. The sample was comprised of 46 patients (30% of a total from 153). The following instruments were applied: Clock Drawing Test (CDT), Mini Mental State Examination (MMSE); Verbal Fluency Test (VFT); Pfeffer Questionnaire or Functional Assessment Questionnaire (FAQ); Katz Index; Geriatric Depression Scale (GDS-15); Geriatric Anxiety Inventory (GAI), and IVCF-20 as well as sociodemographic and clinical questionnaires. The association between the variables of interest was estimated using Spearman correlation. This study found a negative correlation between frailty and cognitive decline (MMSE; rs = -0.58; p < 0.001); (VFT; rs = -0.60; p < 0.001); (CDT; rs = -0.47; p = 0.001) and a positive correlation between frailty and depressive symptoms (GDS-15; rs = 0.34; p = 0.019) as well as disability for IADLs (FAQ; rs = 0.69; p < 0.001). However, there was no statistical difference in the association between frailty and anxiety symptoms (GAI; rs = 0.24; p = 0.103) or disability for BADLs (Katz; rs = -0.02; p = 0.895). Our data support that the associations between frailty, cognitive and functional disability are prevalent issues in Psychogeriatrics. Assessing frailty in a multidimensional context is essential using a rapid assessment frailty tool in clinical practice.

Comparison of the Clinical-Functional Vulnerability Index and the frailty phenotype for the identification of falls in older individuals: A cross-sectional study.

Frailty increases the risk of falls, disability and death in older adults. The Cardiovascular Health Study identified a frailty phenotype (the Fried Phenotype) that was primarily based on physical domains. Instruments that incorporate additional domains (e.g., cognitive, disability or mood) may more accurately identify falls. The study aimed i) to evaluate the association between falls and the number of phenotypes identified by the Fried Phenotype and CFVI-20 scores and ii) to compare the strength of the association between falls and each frailty instrument. This study used the CFVI-20 and the Fried Phenotype and reported falls during the last twelve months. Logistic regression models, odds ratios (ORs), and ROC curves were used to identify associations and perform comparisons (p<0.05). The reporting of the study followed the Strobe guidelines. This study included 1,826 individuals (mean 70.9 (SD 7.3) years old). Prevalence of pre-frailty and low vulnerability was high (72% and 69%) and comparable between frailty instruments. The number of Fried phenotypes increased the odds of having fallen in the past 12 months (OR: 1.5 to 29.5) and the CFVI-20 scores (11% increase/unit change). The CFVI-20 identified falls more accurately than the Fried Phenotype (AUC: 0.68 vs. 0.60, p < 0.001). The number of phenotypes and the CFVI-20 scores were associated with falls; continuous scores identified falls more accurately than categorical classifications. The CFVI-20 was more strongly associated with falls in community-dwelling older adults than the Fried Phenotype.

Clinical-Functional Vulnerability of Elderly Users of Primary Healthcare: Cross-sectional Study

Clinical-Functional Vulnerability of Elderly Users of Primary Healthcare: Cross-sectional Study

Comparison of frailty in oldest-old people using the Clinical-Functional Vulnerability Index-20 (IVCF-20) and Edmonton Frail Scale (EFS)

Resumo Objetivo Comparar os escores do Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) e da Edmonton Frail Scale (EFS) entre pessoas idosas com 80 anos ou mais de idade que vivem na comunidade, considerando a prevalência e o grau de concordância. Método Trata-se de estudo transversal, aninhado a uma coorte de base populacional. A amostragem na linha de base foi probabilística, por conglomerados, em dois estágios. No primeiro, utilizou-se como unidade amostral o setor censitário. No segundo, definiu-se o número de domicílios segundo a densidade populacional de pessoas idosas. Foram determinados a sensibilidade, a especificidade e os valores preditivos. A estatística Kappa analisou o grau de concordância entre os instrumentos. Resultados Foram avaliadas 92 pessoas idosas longevas. A prevalência do alto risco de vulnerabilidade clínico-funcional, considerado pessoa idosa frágil, foi de 45,7% pelo IVCF-20 e a prevalência de fragilidade pela EFS foi de 44,6%. Os valores de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo foram, respectivamente, 88,23%, 87,80%, 90,0% e 85,71%. A acurácia foi de 88,04%. A estatística Kappa foi 0,759 (p&lt;0,001). Conclusão Os instrumentos IVCF-20 e EFS possuem boa acurácia e concordância forte, quando aplicado em pessoas idosas longevos que vivem na comunidade. A identificação da fragilidade foi superior, quando utilizado o IVCF-20. O resultado indica que os instrumentos avaliados possuem similaridade na prevalência da fragilidade em pessoas idosas longevas comunitárias.

Clinical-Functional Vulnerability of Elderly Users of Primary Healthcare: Cross-sectional Study

Clinical-Functional Vulnerability of Elderly Users of Primary Healthcare: Cross-sectional Study

Comparação da fragilidade em pessoas idosas longevas pelo Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) e pela Edmonton Frail Scale (EFS)

Abstract Objective To compare Clinical-Functional Vulnerability Index-20 (IVCF-20) and Edmonton Frail Scale (EFS) scores among community-dwelling older people aged ≥80 years for prevalence and degree of agreement. Method A cross-sectional study nested within a population-based cohort, was conducted. Baseline sampling was probabilistic by two-stage clustering. In the first stage, the census tract was used as the sampling unit. In the second stage, the number of households was defined according to the population density of individuals aged ≥60 years. Sensitivity, specificity and predictive values were determined and Kappa statistics expressed degree of agreement between the instruments. Results 92 oldest-old people were evaluated. The prevalence of high risk of clinical and functional vulnerability on the IVCF, indicating frailty, was 45,7%, whereas the prevalence of frailty using the EFS was 44,6%. Sensitivity, specificity, positive predictive value and negative predictive values were 88,23%, 87,80%, 90,0% and 85,71%, respectively. Accuracy was 88,04% and the Kappa statistic 0.759 (p&lt;0.001). Conclusion The IVCF-20 and EFS instruments showed good accuracy and strong agreement when applied to community-dwelling oldest-old people. The identification of frailty was superior using the IVCF-20. These results show that the instruments detected similar frailty prevalence in community-dwelling oldest-old people.

Sedative use and incidence of falls and hip fractures among older adults in an outpatient geriatric clinic

Objective: To investigate the use of sedatives by older adults attending a private outpatient geriatric clinic in Belo Horizonte (MG), Brazil, and its association with falls and hip fractures. Methods: Using a longitudinal design, the prevalence of benzodiazepine and nonbenzodiazepine (“z-drugs”) intake by older adults was described and their association with the incidence of falls and fractures (30 days after the initial visit) was evaluated through logistic regression. Results: A total of 7821 older adults were included in the study, most of them women (72.50%), with a mean age of 77.5 years and a mean Clinical-Functional Vulnerability Index (IVCF-20) score of 16.5. The overall prevalence of sedative use (any sedative) was 6.19%, with 4.48% benzodiazepines and 1.98% z-drugs. The most widely used sedatives were clonazepam (29.04%), zolpidem (28.65%), and alprazolam (23.44%). Falls were reported for 182 patients (2.33%), with a higher incidence among users of any sedatives (4.34; p = 0.002; OR = 1.94, adjusted for sex, age, and IVCF-20) and benzodiazepines (5.14%; p &lt; 0.001; OR = 2.28) than among non-users (2.19%). Hip fractures occurred in 33 patients (0.42%), and again were more frequent among users of sedatives (1.03%; p = 0.032; OR = 2.57) and benzodiazepines (1.43%; p = 0.003; OR = 3.45) than among non-users (0.38%). Conclusions: The use of sedatives, especially benzodiazepines, is associated with an increased incidence of falls and hip fractures in older adults.

Factors Associated With PIM use in the Frail Elderly: A Cross-sectional Study

Background: The use of potentially inappropriate medications (PIM) by the elderly is commonly studied, but studies evaluating the use of PIM by frail elderly covered by prepaid health plans are still lacking. Objective: To identify the prevalence of use and the factors associated with the use of PIM by the elderly patients with high and moderate risk of clinical-functional vulnerability, according to the Beers criteria 2019. Methods: A cross-sectional study was developed with elderly people from a private health plan in Vitória-ES, Brazil. Socioeconomic, demographic and clinical data were collected through a digital platform and a structured questionnaire through an interview, from October 2018 to June 2019. The association between the use of PIM and independent variables was verified by univariate logistic regression with their respective confidence intervals (CI) 95%. The Multiple Model included the variables with P ≤ .20. Results: 332 elderly patients were interviewed (mean age 81.5 years, gender 237 female, 95 male). A 65% prevalence of PIM use was identified. In the multiple logistic regression model, the variables associated with the use of PIM were self-medication (P = .004), high risk of clinical-functional vulnerability (P = .022), use of psychotropic medications (P = .000001), musculoskeletal medications (P = .04) and alimentary tract medications (P = .03). Physical exercises were considered a protection factor (P = .02). Conclusion: The high prevalence of PIM use indicates the need for improvement in elderly private health care, to increase pharmacotherapy safety for this population.

Clinical-Functional Vulnerability, Functional Capacity, and Falls in Octogenarians with Different Physical Activity Levels-A Cross-Sectional Study.

Aim: To compare differences between frailty, functional capacity, and fall prevalence among community-dwelling oldest-old adults regarding their physical activity levels. Methods: Two hundred and thirty-nine octogenarians (80+ years) were allocated according to their physical activity as insufficiently active (<150 min week−1; n = 98; 84.4 ± 3.7 years), active (150 to 300 min week−1, n = 81, 83.9 ± 3.1 years), and very active (>300 min week−1, n = 60; 83.8 ± 3.4 years). Frailty (CFVI-20 questionnaire), functional capacity (Five Times Sit-to-Stand Test, Timed Up and Go, Balance, and handgrip strength), fall history, and physical activity were assessed. Results: The insufficiently active group was the frailest and presented the worst functional performance compared to the other groups. The fall prevalence was higher in the insufficiently active (60.9%) compared to the active (26.4%) and very active (12.7%) groups. Conclusions: The group of insufficiently active octogenarians showed the greatest frailty, worst functional capacity, and higher fall prevalence than the active and very active groups. The engagement in physical activity of at least 300 min week−1 is essential to reverse or minimize the deleterious effects of aging on frailty, functional capacity, and falls in octogenarians.

Association between Domains of the Clinical-Functional Vulnerability Index and Falls History in Older Adults: A Cross-Sectional Study.

Objectives: The study aimed to determine which domains, sets, and isolated or combined questions of the Clinical-Functional Vulnerability Index (CFVI-20) are associated with falls history in older adults. Methods: Instruments used were the CFVI-20 assessment and reported falls during the last year. The receiver operating characteristics (ROC) curves identified the performance of the CFVI-20 domains and questions in identifying older adults with and without falls history, while logistic regression identified relevant questions to identify fall history. Results: This study included 1725 individuals (71.9 ± 7.3 years). The area under the curve (AUC) between the CFVI-20 and fall history was 0.69. The mobility domain presented the largest AUC (0.71; p < 0.01), and most isolated domains showed low AUCs (0.51 to 0.58). Isolated questions were limited to identifying fallers. The regression analysis identified 7 questions of the CFVI-20 with falls. Conclusions: The CFVI-20 general score identified older adults with a fall history. When considered in isolation, most domains were limited to identifying falls, except for the mobility domain. Combining the CFVI-20 questions enabled identification of fallers.

Multidimensional analysis of frailty in older people of a Brazilian community: a cross-sectional study

In Brazil, the aging process takes place under unfavorable economic, social and health conditions. Therefore, a better understanding of the functionality patterns of different elderly populations becomes essential, especially in times of Covid-19. The objective of study is to assess the functionality of institutionalized and community older people. Cross-sectional study with 51 older people, divided into two groups: Institutionalized Older People Group (GII) and Community Older People Group (GIC), assessed by the Mini Mental State Examination, Clinical Functional Vulnerability Index-20 (IVCF-20), Barthel Scale, Lawton Scale and Tinneti Scale, descriptive analysis, multivariate multiple correspondence technique, multinomial and binomial logistic regression, with the R software were performed. The results showed: the quartiles: robust GIC (IVCF-20=6.75), independent (Lawton=21/Barthel=100). The fragile GII (IVCF-20=18), partially dependent (Lawton=13/Barthel=100). In GII association of frail older people and high risk of falls. In the GIC there is no association. The GIC showed more chances compared to the GII: 198.34 cognitively normal; 5.48 robust; more than 100,000 independents; and 14 low risk of falls. In this way, it is concluded that older people in the community have better functional performance than older people living in the two Long Term Care Institutions.

Incidência de fragilidade e fatores associados à piora funcional na pessoa idosa longeva durante pandemia da covid-19: Estudo de Coorte

Abstract Objective To assess the incidence of frailty in oldest old during the covid-19 pandemic and to evaluate the associations between the domains of the Clinical-Functional Vulnerability Index (IVCF -20) and frailty. Methods A cohort study of 64 non-frail oldest old was conducted. Participants were evaluated at two timepoints: at baseline up to one year before the onset of the pandemic; and at follow-up, with an average interval between the two timepoints of 15 months. Frailty was assessed using the VS – Frailty (baseline) and remote application of the IVCF-20 (follow-up). Results Mean participant age was 88.7±5 years and the incidence of frailty was 20.6%. Frail participants exhibited greater dependence shopping (p&lt;0.001), controlling their own money (p&lt;0.001) and doing housework (p=0.010), as well as bathing alone (p=0.041). Cognitive decline was more prevalent in the frail individuals. The presence of despondency sadness or hopelessness proved high (92.3%) and was associated with frailty (p&lt;0.001). On the multivariate analysis, frailty was associated with worsening forgetfulness (RR=2.39; 95%CI 1.27-4.46), loss of interest and pleasure in performing activities (RR=4.94; 95%CI 1.98-12.35) and fecal/urinary incontinence (RR=2.40; 95%CI 2.91-1.53). Conclusions

Factors associated with vulnerability and fragility in the elderly: a cross-sectional study.

to assess factors associated with vulnerability and fragility in the elderly. crosssectional study with 384 elderly people in Fortaleza, Ceará. The Vulnerable Elders Survey and Clinical-Functional Vulnerability Index - 20 were used. Chi-square and Fisher's exact tests were used for associations. In the analysis of the combined influence of risk factors, the stepwise logistic regression and multinomial regression methods were adopted. 251 (65.4%) non-vulnerable and 133 (34.6%) vulnerable elders. From the vulnerable elders analyzed, 42 (30.9%) are at high risk for frailty. Factors associated with vulnerability: age, gender, presence of comorbidities, hypertension, diabetes, osteoporosis and use of polypharmacy. There is a 30% increase in the chance of vulnerability for each additional drug. Physical activity reduces the chance of vulnerability by 60%. Factors associated with frailty: educational level; self-perception of health; comorbidities; polypharmacy. it is important to pay attention to the presence of arterial hypertension, osteoporosis, polypharmacy, and encourage the practice of physical activity.