Brazilian Older People Research Articles

Towards adopting serious games for cognitive tests with Brazilian older people

Serious games are a promising tool in different scenarios, such as education and health; however, there has been little research reported on their specialized use for older adults. We created a digital cognitive test – with the characteristics of a serious game – using Unified Design aiming to reproduce digitally the results of clinical cognitive evaluation in older people. The digital cognitive test was submitted to two validation experiments targeting an older public (n=40) with little experience in dealing with tablets or smartphones. The first experiment did not show significant correlation, but from it, we implemented initiatives to simplify the tests, which brought a positive result regarding convergence analysis in the second experiment. We concluded that it is possible to use digital games as cognitive tests adapted to the needs of older adults to achieve similar results as those of paper-based cognitive tests.

Factors that influence the oral impact on daily performance of older people in Brazil: A cross-sectional population-based study.

To investigate factors that influence the oral health-related quality of life of older people (65years and over) in Brazil. Population-based studies should be conducted to support health-planning interventions. Data from the São Paulo State Survey on Oral Health (SBSP-2015), which consisted of 5951 individuals, were used. A theoretical-conceptual model was built based on the impact of family socio-economic characteristics, individual social-demographic features and self-perceived and clinical oral health status on the oral impact on daily performance (OIDP). Multivariate binary logistic regression analysis was conducted at 5% significance level. Statistically significant variables included within the adjusted logistic regression model entered the multiple correspondence analysis (MCA). Oral health impact on daily activities was observed in 34.6% of older people. Characteristics significantly related to impact on OIDP score were as follows: family income up to R$ 500 (OR=2.73), self-perceived treatment need (OR=1.33), self-perceived toothache (OR=1.52), self-perception of denture replacement need (OR=1.27), dissatisfaction (OR=1.50) or very dissatisfied (OR=2.57) with own oral health, partial lower denture use (OR=1.34) and needing partial lower dentures (OR=1.28). Increased number of people living in the same house (B=0.05, OR=1.06), number of bedrooms in the house (B=-0.10, OR=0.90), age (B=-0.03, OR=0.97) and number of teeth needing treatment (B=0.08, OR=1.08) contributed significantly to OIDP. Prevalence of OIDP of older people in the state of São Paulo was related to factors other than their clinical and self-perceived oral health status.

Alcohol Consumption by Older People in Brazil: A Systematic Review of Population-based Studies

Alcohol Consumption by Older People in Brazil: A Systematic Review of Population-based Studies

Utility of handgrip strength cut-offs for identification of weakness and disability in community-dwelling older people with mild cognitive impairment and Alzheimer’s disease

ABSTRACT Objectives To evaluate the utility of handgrip strength cut-offs for the identification of weakness and Instrumental Activities of Daily Living (IADL) disability in elderly people with neurocognitive disorders. Methods Cross-sectional study of community-dwelling elderly individuals with Alzheimer’s disease (AD, n = 40) and mild cognitive impairment (MCI, n = 22); healthy individuals (n = 36) were recruited as controls. Handgrip cut-offs included European Working Group for Sarcopenic Older People (EWGSOP2), Cardiovascular Healthy Study (CHS) and the Frailty in Brazilian Older People Study from Rio de Janeiro (FIBRA RJ) cut-offs. Handgrip strength indexes were calculated by dividing handgrip strength values by cut-off values and the weakness prevalence for each cut-off value was compared among groups. Correlation analyses were employed to evaluate the relationship between Lawton Scale and handgrip strength (crude value and indexes). Results All handgrip strength indexes were lower in the AD group (p < 0.05), whereas the prevalence of weakness was significantly higher in the AD group only when the CHS cut-off was applied (AD = 47.5%, MCI and control = 18.2%, p < 0.01). Significantly positive correlations were identified between the Lawton ADL scale and handgrip indexes for all cut-offs (p < 0.05), but not between Lawton scale and crude handgrip (p = 0.75). Conclusions Only the CHS cut-off allowed proper differentiation of the weakness prevalence between groups. In addition, adjusting handgrip strength values according to cut-offs was necessary to determine the correlation between strength and disability in cognitively impaired elderly individuals.

Psychosocial factors associated with perceived social support in Brazilian older people

EnglishThe social support has been reported as playing an important role in the older people life due to its protection effect for health in this specific people. This paper aims to identify psychosocial predictors for perceived social support in Brazilian older people. The sample is constituted by 144 patients (Mage=69.3; SD=6.61). The data were collected through a questionnaire that included sociodemographic questions and scales for psychological variables (e.g. self-efficacy) studied. Lower age, higher level of education, being married or living in a stable union, low levels or absence of depression and high levels of self-efficacy are significant predictors of perceived social support in older people who were studied. Future interventions in older people health promotion context may consider these determinants portuguesO suporte social tem sido referido como de central importância na vida dos idosos devido ao seu efeito protetor para a saude. Este artigo objetivaidentificar os preditores psicossociais para o suporte social percebido em idosos brasileiros.A amostra e constituida por 144 idosos pacientes (M idade=69.3; DP=6.61). Os dados foram colhidos atraves de um questionario que incluiu questoes sociodemograficas e escalas para as dimensoes psicologicas do estudo (eg. auto-eficacia). Menor idade, maior nivel de educacao, ser casado ou viver unido, baixos niveis e ausencia de depressao e elevados niveis de auto-eficacia sao preditores significativos do suporte social percebido nos idosos estudados. Futuras intervencoes no âmbito da promocao da saude dos idosos devem atender a estes determinantes

Association of dynapenia, obesity and chronic diseases with all-cause mortality of community-dwelling older adults: A path analysis.

The objective of the present study was to evaluate the effect of dynapenia, central obesity and the presence of chronic diseases in 8-year mortality of community-dwelling older adults. Participants comprised 610 older adults, aged ≥65 years at baseline, who participated in the "Frailty in Brazilian Older People" study carried out in 2008. Baseline data, such as weight, height, waist circumference, muscle strength, sex, self-reported diseases and physical activity, were assessed. Vital status in 2016 was assessed by Mortality Information System database of Campinas. The χ2 -test and Mann-Whitney U-test were used to compare categorical and continuous variables, respectively. Path analysis was carried out to study the factors associated with mortality. There was a statistical difference between alive and deceased groups for the variables sex, age group, physical activity, waist circumference and dynapenia. Path analysis explored the relationship among the studied variables. Direct paths showed a positive association to mortality for those who presented the combination of more diseases (β = 0.105), male sex (β = 0.108), low physical activity (β = 0.121), low handgrip strength (β = 0.090) and no central obesity (β = -0.143). When indirect paths were concerned, variables "central obesity", the presence of "more diseases" and dynapenia had a mediator role. Central obesity was not positively associated with higher mortality, unless it was associated with the presence of chronic diseases. Dynapenia showed a direct effect on mortality, but not combined with central obesity. The findings of this study shed light on complex relationships between nutritional status and elderly mortality through the use of simple measurements. Geriatr Gerontol Int 2019; 19: 108-112.

The role of education on the association between disability and depressive symptoms among community-dwelling older adults: Evidence from Frailty in Brazilian Older People (Fibra) study

ObjectivesTo explore whether higher socioeconomic status attenuates the effects of depressive symptoms on disability among older adults. MethodsWe conducted a cross-sectional study based on 596 older adults, aged 65 and over, from a large city (Belo Horizonte) in Brazil. Disability was defined as limitation in activities such as Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Covariates were age, comorbidities, Body Mass Index (BMI) and grip strength. Statistical analyses were based on Ordinal Logistic Regression and calculated separately for men and women. ResultsElderly women with disability and higher education levels have similar prevalence of depressive symptoms compared to those without disability (17.9% and 16.1%, respectively), but lower compared to those disabled with lower education (37.2%). A positive gradient trend was observed for depressive symptoms across disability categories among women (OR = 2.61; 95% CI 1.52, 4.48). However, these patterns were not observed among men. ConclusionA higher level of education attenuates odds of depressive symptoms in elderly women with disability but does not eliminate it. Therefore, screening for depressive symptoms in low-educated elderly women is important in order to identify them and start early prevention care for target risk population and decrease the disability expenses for health services.

Trends in socioeconomic inequalities in the prevalence of functional dentition among older people in Brazil.

The objective of this research was to evaluate trends in socioeconomic inequalities in the prevalence of functional dentition among community-dwelling older adults in Brazil. This was a cross-sectional study with data from the last two SBBrasil Project surveys conducted in 2003 and 2010. Functional dentition was defined as the presence of 20 or more natural teeth and was assessed during the clinical examination of dentition status. Schooling was used as the socioeconomic position measure. Socioeconomic inequality was measured using two complex measures; the slope index of inequality (SII) and the relative index of inequality (RII). The prevalence of functional dentition was 10.8% (95%CI: 8.1-14.2) in 2003 and 13.6% (95%CI: 11.1-16.5) in 2010. The prevalence of functional dentition increased significantly over the educational rank in both years. Absolute inequalities were significant for both years and remained unaltered between 2003 and 2010. Significant relative inequality in the prevalence of functional dentition was found in both years of the survey. Socioeconomic inequalities in the prevalence of functional dentition among older adults in Brazil persisted significantly between both national oral health surveys.

Depression and cancer were independently associated with quality of life in Brazilian older people.

To analyse the factors associated with low health-related quality of life (HRQoL) in older people living in Brazil. In this cross-sectional study of the Jewish community residing in Sao Paulo, Brazil, we extensively evaluated the characteristics - including clinical, functional and sociodemographic - of 496 older people. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), while the Geriatric Depression Scale (GDS) was used to measure depressive symptoms. After adjusting for potential confounders, we found that GDS score (β = -0.07; P = 0.04) and cancer (β = -0.47; P = 0.05) were associated with a low WHOQOL-BREF score. Depressive symptoms and cancer were independently associated with low HRQoL among older people living in Brazil.

Prevalence of and factors associated with successful aging in Brazilian older adults: Frailty in Brazilian older people Study (FIBRA RJ).

We aimed to estimate the factors associated with the biomedical dimension of successful aging (SA) and its prevalence in older Brazilian individuals. The conceptual framework for this approach relies on the considerable variation in the biophysiological effects of aging and the need to understand the factors that influence this process. Data from a total of 845 older adults were analyzed. SA operationalization included the following criteria: good physical and cognitive performance, absence of disabilities, and good health conditions. Descriptive analyses were used to estimate the prevalence of SA, and the factors associated with SA were assessed using multivariate logistic regressions. The overall prevalence of SA was 25%, and the associated factors were the absence of (OR 10.5, 95% CI 5.2-21.1) or fewer than two physical morbidities (OR,3.5, 95% CI 2.1-5.9), body mass index in the overweight range (OR 1.8, 95% CI 1.02-3.3), absence of depression (OR ,2.1, 95% CI 1.07 = 4.1), high levels of physical activity (OR 1.88, 95% CI 1.14-3.2), high levels of social participation (OR 2.07, 95% CI 1.16-3.4) and younger age (65-74 years, OR 4.27, 95% CI 1.79-10.1; 75-84 years, OR 2.7, 95% CI 1.18-6.41). A small proportion of older adults met the criteria defining successful aging. Despite the great impact of biological determinants, modifiable social and lifestyle factors predicted successful aging in this population, suggesting that health promotion targeting behavioral changes might lead to tangible benefits for health and well-being in old age. Geriatr Gerontol Int 2018; 18: 1280-1285.

Designing for a diversity of older people in Brazil and the UK

Designing for a diversity of older people in Brazil and the UK

Common mental disorder among family carers of demented older people in Brazil.

ABSTRACTObjective:Population aging is a global phenomenon associated with a rising prevalence of chronic degenerative diseases such as dementia. Dementia poses a challenge not only for patients but also their family caregivers who, in exercising this role, are at higher risk of mental illness. The present study investigated the prevalence of common mental disorders (CMD) in family caregivers of demented elderly seen at a geriatric outpatient clinic of a Brazilian teaching hospital.Methods:A cross-sectional study was conducted in which the following assessment instruments were applied: the Self Reporting Questionnaire, Zarit Burden Interview, Hospital Anxiety and Depression Scale and Mini-Mental State Examination (caregivers aged ≥65 years) plus a sociodemographic questionnaire.Results:The sample comprised 90 caregivers; 83 (92.2%) women, 51 (56.7%) married, 60 (66.7%) son/daughter of elder and 62 (68.6%) holding another job besides caring for the demented elder. Caregivers had a mean age of 57.3 (±11.7) years and mean education of 9.5 (±4.9) years; 62.2% of caregivers were diagnosed with common mental disorder, 50% exhibited anxiety symptoms, 52.2% depression symptoms and 66.7% reported burden. Caregivers with common mental disorder had higher scores on the anxiety, depression and burden scales (p<0.01). Logistic regression showed that caregivers with anxiety symptoms were 15 times more likely to present common mental disorder (OR: 15.0; 95% CI: 3.5-71.2) and caregivers with symptoms of depression were 8 times more likely to have CMD (OR: 8.0; 95% CI: 2.1-31.1).Conclusion:Results revealed a high prevalence of common mental disorder in the population studied.

Objectively Measured Physical Activity and Healthcare Expenditures Related to Arterial Hypertension and Diabetes Mellitus in Older Adults: SABE Study

Research using questionnaires has shown that physical activity level (PAL) is associated with healthcare costs. The purpose of this study was to examine the association between objectively measured PAL and healthcare costs among hypertensive and diabetic noninstitutionalized Brazilian older people. The method consisted of a cross-sectional study forming part of the SABE Study, composed of 377 older people interviewed in 2010. Expenditures were estimated taking into account self-reported medicine prescription, outpatient service, and hospitalizations, with the highest quartile of expenditures considered as a risk category. PAL was estimated using an Actigraph accelerometer. Associations were expressed as odds ratios and 95% confidence intervals, adjusted for covariates. Overall expenditures were higher in the sedentary group. The insufficiently active group presented greater odds for higher total, outpatient, and hospitalization expenditure. It was concluded that healthcare expenditures were lower in more active hypertensive and diabetic older people. The promotion of physical activity could be relevant in the attenuation of the burden of chronic diseases in economic losses.

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain

ObjectiveLow back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care. MethodsWe sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55–74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more). ResultsParticipants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity. ConclusionsThis was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status.

Body composition and frailty profiles in Brazilian older people: Frailty in Brazilian Older People Study-FIBRA-BR

ObjectiveTo determine the association between body composition and frailty in older Brazilian subjects. Material and methodsThis is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n=5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio. ResultsThe lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9kg/m2. Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR)=3.10; 95% CI: 2.06–4.67) and (OR=1.15; 95% CI: 1.03–1.27), respectively. Being overweight was protective for pre-frailty (OR=0.48; 95% CI: 0.4–0.58) and frailty (OR=0.77; 95% CI: 0.67–0.9). Obese older people presented a higher risk of pre-frailty only (OR=1.29; 95% CI: 1.09–1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range. ConclusionUndernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI.

Factors associated with fear of falling in community-dwelling older adults with and without diabetes mellitus: Findings from the Frailty in Brazilian Older People Study (FIBRA-BR)

PurposeThis study aimed to investigate the associated factors with fear of falling in community-dwelling older adults with and without diabetes mellitus. MethodsData from the Frailty in Brazilian Older People Study (FIBRA-BR), involving 4449 individuals aged 65years or older (19.2% with diabetes), were analyzed. The potential factors associated with fear of falling included sociodemographic data, chronic diseases, health-related variables and functional capacity measures. Logistic regression analysis was performed to identify the factors associated with fear of falling. ResultsFemale gender, arthritis or rheumatism, negative health self-perception, frailty, lower Lawton Scale score and reduced gait speed were independently associated with fear of falling in both groups. Factors associated with fear of falling specific to non-diabetic older adults were depression, visual impairment, falls in the previous 12months, obesity, depressive symptoms, higher Katz Index score and decreased handgrip strength. Lower Mini-Mental State Examination score was an associated factor with fear of falling only in those with diabetes. ConclusionThe factors associated with fear of falling did differ between non-diabetic and diabetic older adults. Health care professionals should consider such differences when planning their therapeutic approaches for a successful management of fear of falling in these older populations.

Body Mass Index and Its Relationship with Disability, Chronic Diseases and Frailty in Older People: A Comparison of the Lipschitz and Who Classifications.

Anthropometric parameters are closely associated with the pathophysiology of frailty and with clinic and functional parameters assessed for its diagnosis. To evaluate the possible association of the nutritional status of older people as assessed by Body Mass Index (BMI) and functional disability, self-reported chronic diseases and frailty, comparing the use of two different classifications of BMI. Cross-sectional study. The sample was selected among community-dwelling older people from the city of Ribeirão Preto/ Brazil. 326 independent older people (mean age 73.8±6.4 years) who participated in the FIBRA (Frailty in Brazilian Older People) study. Weight and height were collected for BMI analysis and frailty criteria were applied according to Fried et al. Participants were also evaluated for self-reported activities of daily living (Katz Index and Lawton and Brody Scale), and the presence of chronic diseases. The prevalence of frailty was 12.3%. Regardless of the classification of BMI applied, most of the sample was classified as overweight (50.9% and 39.3% in the Lipschitz and WHO classifications, respectively). For both classifications, low weight was the only BMI classification associated with frailty status (OR Lipschitz: 4.12(1.53-11.14); OR WHO: 6.21 (1.26-30.58). Comorbidities and dependence in activities of daily living (ADLs) were associated with BMI ≥ 30kg.m2. Regardless of the classification adopted, low weight is associated with frailty. However, when the WHO stratification is employed, high BMI is also associated to increased functional disability and the presence of comorbidities, coexisting factors of frailty.

How functional disability relates to dentition in community-dwelling older adults in Brazil.

To assess the association between dentition status and functional disabilities among community-dwelling older individuals. A total of 5012 individuals aged 65-74 were interviewed in 2013 during a nationwide community-based survey. This cross-sectional study used a questionnaire including information on dentition, locomotion impairment, difficulties in basic and instrumental activities of daily life, socio-demographic characteristics, behaviour and general health status. Poisson regression models assessed prevalence ratios (PR) and 95% confidence intervals (95% CI). About 31.3% of older people in Brazil reported having ≥21 preserved teeth, the condition for a functional dentition without prosthetic appliances. This proportion was significantly lower among individuals with locomotion impairment and difficulties in basic and instrumental activities of daily life. After adjusting for relevant covariates, functional dentition remained statistically associated with severe (PR=0.69, 95% CI=0.15-0.63) and total (PR=0.69, 95% CI=0.26-0.44) locomotion impairments, and difficulties in basic activities of daily life (PR=0.70, 95% CI=0.53-0.93). Having a functional dentition was significantly less prevalent among those affected by functional disabilities, and this association is unlikely to be due to insufficient control for relevant covariates. The association between dentition and functional disability is bidirectional and involves a complex interplay of one upon the other, and of factors that influence both outcomes.

Going Beyond Telecenters to Foster the Digital Inclusion of Older People in Brazil: Lessons Learned from a Rapid Ethnographical Study

Telecenters take on a prominent role within the current information and communications technology (ICT) ecosystem in Brazil. They are seen by a great many as a key means to foster the digital inclusion of the older population in the country. This paper draws upon a rapid ethnographic study conducted with 78 older people in a center that teaches computer classes to seniors in Brazil. The results show that providing older people with technological infrastructures is not enough to strengthen their digital inclusion if their basic and non-instrumental needs are not taken into consideration in defining educational activities to be carried out in public centers. Participants’ basic needs when it comes to interacting with ICT, such as coping with accessibility issues, were dynamic, whilst non-instrumental needs, fulfilled by using these technologies, such as interacting with relevant others, remained fairly constant throughout the study. Drawing on the results of the study, strategies for fostering the digital inclusion and well-being of older people in Brazil that go beyond telecenters are suggested.

Relationship between Sense of Coherence and oral health in adults and elderly Brazilians.

The purpose of this study was to investigate the relationship between Sense of Coherence (SOC) and oral health clinical variables (number of teeth present and absence of need for dental prostheses). The sample consisted of 720 adults and elderly Brazilians. The data were collected at home using the SOC-13 scale - a form of clinical examination for the evaluation of oral conditions - and a questionnaire evaluating socioeconomic aspects and the use of dental services. Statistical analysis, both univariate and multivariate, was performed by Poisson regression with robust variance adjustment. The average age of the participants was 60.2 years, and they were predominantly female (57.8%). Among the participants who had a strong SOC, the absence of the need for dental prostheses was 34% higher than among those with a weak SOC, demonstrating a significant difference between the groups (PR = 1.34, 95%CI = 1.06-1.70; p = 0.015). Individuals who had a strong SOC had a 5% higher prevalence of 14 or more existing teeth than those with a weak SOC, which was statistically significant after adjustment for co-factors (PR = 1.05, 95%CI = 1.01-1.11, p = 0.033). A strong personal Sense of Coherence has a beneficial influence on the oral health of adults and older people in Brazil.