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- Lower limbs strength, balance, mobility and risk of falling in community-dwelling older adultsPublication . Fernandes, Beatriz; Tomás, Maria Teresa; Quirino, DiogoIntroduction - During the last decades, there has been a rapid aging of the Portuguese population. The aging process involves several changes namely a decreasing in lower limbs strength, mobility and balance which contributes to increasing the risk of falling and the likelihood to suffer fractures or traumatic brain injuries among other injuries. Physiotherapy can develop an important intervention in identifying the factors that potentiate the risk of falling and can provide strategies to prevent or reverse this risk. The purpose of this study was to characterize the risk of falling and related factors in a sample of Portuguese community-dwelling older adults. Methods - A cross-sectional study. 74 subjects participated in the study (50 women, 24 men), aged 65-97 years, apparently healthy, independent and living in the community. The following tests were used: to assess lower limbs strength the 30s chair stand test; 8-foot up and go test to assess mobility and the Berg Balance Scale (BBS) to assess balance. The risk of falling was determined based on BBS. Results - The results of our study showed that for 30s chair stand test the mean value was 11 repetitions and for 8-foot up and go test was 8.63 seconds. For BBS the median was 53 points. 36.5% of the participants reported at least one fall during the previous year. Negative correlations have been found between 8-foot up and go test and 30s chair stand test (R=0.664; p=0.00) and between 8-foot up and go test and BBS (R=0.653; p=0.00). A weak positive correlation was also found between 30s chair stand test and BBS (R=0.475; p=0.00). Discussion - The results of the 8-foot up and go test (>8,5 seconds) indicate that this population was at risk of falling. In addition, BBS scores showed that the risk of falling was 11%. Lower limbs strength was decreased compared with reference values for Portuguese population. Assessment of these factors seems to be recommended in order to develop and implement strategies directed to increase lower limbs strength, balance, and mobility and decrease the risk of falling.
- Frailty as the future core business of public health: report of the activities of the A3 Action Group of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)Publication . Liotta, Giuseppe; Ussai, Silvia; Illario, Maddalena; O’Caoimh, Rónán; Cano, Antonio; Holland, Carol; Roller-Winsberger, Regina; Capanna, Alessandra; Grecuccio, Chiara; Ferraro, Mariacarmela; Paradiso, Francesca; Ambrosone, Cristina; Morucci, Luca; Scarcella, Paola; De Luca, Vincenzo; Palombi, Leonardo; Tomás, Maria TeresaBackground: The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. Here, we report on the activities of the A3 Action Group, focusing on managing frailty and supporting healthy ageing at community level. Methods: A three-phased search strategy was used to select papers published between January 2016 and May 2018. In the third phase, the first manuscript draft was sent to all A3-Action Group members who were invited to suggest additional contributions to be included in the narrative review process. Results: A total of 56 papers were included in this report. The A3 Action Group developed three multidimensional tools predicting short⁻medium term adverse outcomes. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. Conclusions: This review shows the importance of taking a multifaceted approach when addressing frailty at community level. From a Public Health perspective, it is vital to identify factors that contribute to successful health and social care interventions and to the health systems sustainability.
- Malnutrition and body composition in elderly populationPublication . Cebola, Marisa; Mendes, Diana; Costa-Veiga, Ana; Tomás, Maria Teresa; Coelho, André; Mendes, Lino; Rico, Miguel Toscano; Guerreiro, António SousaIntroduction: Ageing leads to an increase in chronic disease’s prevalence, change in body composition: increased fat mass and decreased lean mass that can lead to malnutrition. Objectives: The aim was relating malnutrition with depletion of lean mass and alteration of fat mass. Materials and methods: Cross-sectional study, developed in the district of Lisbon, in the period from January 1, 2019, to June 30, 2019. Elderly people (≥ 65 years) admitted to the Internal Medicine Unit of a central hospital (up to 72 hours) were eligible for the study. The elderly participants had to present the capacity to make their informed consent, without the intervention of any element of coercion, with enough knowledge and understanding of the objectives of the study that allowed free and informed decision making. The nutritional assessment was performed through the MNA-LF® and the analysis of the body composition through the measurement of the calf circumference and triceps skinfold. Results: n=38 patients, with a mean age of 78.8 + 5.8 years (70-91), 50% (n=19) males and 73.6%. At hospital admission 7.9% (n=3) were malnourished, 39.5% (n=15) presented nutritional risk, 34.2% (n=13) presented depletion of lean mass and 31.6% (n=12) depletion of fat mass. When we reported the presence of malnutrition with the calf circumference and tricipital skin fold, there was a statistically significant correlation (4=0,04; r=0,05). Malnourished patients presented the depletion of lean mass and fat mass. Discussion/Conclusion: The nutritional assessment using the body composition analysis presents extreme importance in the hospital admission, which allows better performance of the nutritional support adapted to each elderly and better nutritional goals. Signaling the patients who need intervention alert all the clinical team to the importance of nutritional intervention also in the community.
- Avaliação da aptidão física funcional de idosos hipertensos da Cidade da Praia, Cabo Verde: estudo pilotoPublication . Costa, Liliana; Tomás, Maria TeresaIntrodução – A avaliação da aptidão física permite a identificação de níveis de incapacidade e risco de perda funcional, pelo que é extremamente útil na estruturação de programas de atividade física específicos, que constituem a primeira intervenção no que toca à intervenção não-farmacológica na Hipertensão Arterial Sistémica (HAS). Objetivo – Avaliar a aptidão física funcional e os níveis de atividade física de idosos hipertensos da Cidade da Praia – Cabo Verde. Metodologia – A flexibilidade, força e resistência muscular, resistência aeróbia e composição corporal foram avaliadas através da bateria de Fullerton e dinamometria isométrica manual. O nível de atividade física foi avaliado pelo questionário Seven Day Physical Activity Recall (7D-PAR). Resultados – Participaram 75 idosos, com idades compreendidas entre os 60 e os 99 anos, 68% dos quais eram mulheres, com índice de massa corporal (IMC) de 25,2±5,4, com diagnóstico clínico de HAS. O tempo despendido em atividades de intensidade moderada encontrava-se dentro dos valores recomendados, embora a atividade intensa se encontrasse muito abaixo do recomendado e não efetuassem qualquer exercício de força e flexibilidade. A resistência aeróbia expressa pelo Teste 6 Minutos de Marcha (T6MM) apresentou valores médios baixos (293,5±112,2m), bem como a flexibilidade e a força de preensão. Esta associação é um indicador de baixa capacidade funcional. Conclusão – Os baixos níveis de aptidão física apresentados, associados a baixos níveis de atividade física indiciam baixa capacidade funcional e justificam a necessidade urgente da inserção de programas de atividade física nesta população.
- Functionality and functional capacity in a community-dwelling older adults in PortugalPublication . Tomás, Maria Teresa; Fernandes, Beatriz; Quirino, DiogoBackground and aims: Portuguese population has a higher risk of functional decline and frailty. This trend, along with a growing aging index, poses a major economic and social challenge to health in aging people. The purpose of our study was to characterize functional physical fitness in community-dwelling older adults in order to prevent functional decline and an increase in health care costs. Methods: Our sample consisted of 128 older adults (95 women, 33 men), aged 65-97 years, independent and living in Loures municipality, Portugal. Functional physical fitness was assessed with Senior Fitness Test Battery. The predicted distance was calculated with Troosters et al (1999) equation. Grip strength was assessed with hydraulic dynamometer Jamar® and functional capacity with the Composite Physical Function (CPF) Scale. A basic descriptive analysis was conducted (statistical package SPSS IBM for Windows, v22) and the sample was stratified by age. Results: Senior Fitness Test Battery and grip strength scores suggested low levels of strength, flexibility, endurance, and balance, compared with other similar populations, suggesting a higher risk for sarcopenia. Distance walked by our sample remained at 73% of the estimated distance. When stratified by age, the percentage of estimated distance shows a greater decrease. On CPF, 80% of our sample presented moderate or low levels of functional capacity. Conclusions: Functional fitness of this population appears to have lower values than expected. Distance walked shows a decrement higher than expected with a probable faster aging than the expected. Our study provides the first assessment of grip strength in an elder Portuguese population showing also lower values for this component of functionality. Compared to other populations, functional capacity (CPF) is at moderate or low level. These results are important to justify an urgent intervention in order to increase functional capacity or at least contribute to a slower decrease.
- Malnutrition, sarcopenia and current medical use in elderly populationPublication . Cebola, Marisa; Mendes, Diana; Costa-Veiga, Ana; Tomás, Maria Teresa; Coelho, André; Mendes, Lino; Rico, Miguel; Guerreiro, AntónioIntroduction: Ageing leads to an increase in chronic disease’s prevalence, progressive loss of muscle mass, muscle weakness, and polypharmacy, contributing to the establishment of malnutrition and sarcopenia. Objectives: The aim was: 1. Characterize the prevalence of malnutrition, sarcopenia, and current medication use; 2. Relate malnutrition to sarcopenia and current medication use. Materials and methods: Cross-sectional study, developed in the district of Lisbon, in the period from January 1, 2019, to June 30, 2019. Elderly people (≥ 65 years) admitted to the Internal Medicine Unit of a hospital institution (up to 72 hours) were admitted to the study. Participants in this study were the elderly with the capacity to make their informed consent, without the intervention of any element of coercion, with enough knowledge and understanding of the objectives of the study that allowed free and informed decision making. Nutritional assessment was assessed through MNA® and sarcopenia through the SARC-F® Questionnaire. The medication was counted through the number of drugs. Results: n=38 patients, with a mean age of 78.8 + 5.8 years (70-91), born in Lisbon, living in their own home, 50% (n=19) males and 73.6% (n=28) with the first cycle of basic education. At hospital admission 7.9% (n=3) were malnourished, 39.5 (n=15) presented a nutritional risk, 47.4% (n=18) presented a risk of sarcopenia and 60.5% had a prescription of more than three drugs. There was a statistically significant correlation between polypharmacy and malnutrition, (r=0,046). Discussion/Conclusion: The nutritional assessment, presence of sarcopenia and current medication use are extremely relevant at hospital admission. This assessment allows patients to be signaled that they need early nutritional intervention to prevent deteriorating during hospitalization.
- Functional respiratory capacity in the elderly after COVID-19: a pilot studyPublication . Pereira, Filipe Alexandre; Tomás, Maria TeresaBackground: The pandemic spread of SARS-CoV-2 has led to an unprecedented outbreak of viral pneumonia. Despite the current focus of worldwide research being the characterization of post-COVID-19 sequelae, the level of functional impact that this disease causes in the elderly who have presented moderate, severe, or critical manifestations is still unknown. Objective: To identify the main consequences/sequelae on functional respiratory capacity in the elderly after CoViD-19. Methodology: A cross-sectional study was carried out in the community. Functional aerobic capacity (2min step test), dyspnea perception (modified Medical Research Council Dyspnea Questionnaire), respiratory and peripheral muscle strength (maximum inspiratory and expiratory pressure, grip strength), and the Frailty Index (Clinical Fragility Scale) were assessed in 25 community-dwelling individuals aged ≥65 years, who have had a diagnosis of CoViD-19 for up to 6 months, and in an equal number of elderly people with the same characteristics without a known diagnosis of CoViD-19. Results: The elderly with a diagnosis of CoViD-19 up to 6 months presented a decrease in the values of maximum inspiratory pressure (p=0.001) and maximum expiratory pressure (p=0.015), in aerobic capacity (p<0.001) with a significant presence of desaturation on exertion (p<0.001), and increased values of dyspnea perception (p=0.001) and Frailty Index (p=0.026). Conclusion: Significant changes were found in the functional respiratory capacity of elderly patients diagnosed with CoViD-19 for up to 6 months when compared with elderly individuals without a known diagnosis of CoViD-19. It is not possible to extrapolate the results obtained to the Portuguese population, however, these results may be an important indicator in the characterization of sequelae in the elderly after infection by SARS-CoV-2.
- Body composition changes over three years in older adults: a descriptive longitudinal analysisPublication . Tomás, Maria Teresa; Galán-Mercant, Alejandro; Fernandes, BeatrizIntroduction: Many studies analyze body composition changes in older adults. However, few studies analyze body composition in elderly people with functional measures. Studies using Double X-Ray analysis (DXA) or Bioimpedance analysis proved to be reliable but expensive or only possible in a laboratory environment. The purpose of our study was to analyze changes in body composition over three years using anthropometric measures in a sample of elderly people in order to perceive functional changes. Methods: Forty-three participants (12 men; 31 women) aged 60 years and over and independent in activities of daily life were assessed using anthropometric measures in the first moment and past three years. Weight, height, waist and hip circumference were measured, and body mass index (BMI) and waist-to-hip ratio (WHR) were also calculated. Skeletal muscle mass (SMM) was also calculated using Al-Gindan et al. (2014) equations and normalized for height to found skeletal muscle index (SMI) in order to analyze cut-off points associated with physical disability according to Janssen et al (2004). Results: A significant difference was found over three years in SMM (p = 0.007), SMI (p = 0.027), BMI (p = 0.041) and WHR (p = 0.003). The majority of the participants has decreased SMM, SMI, and BMI and increased WHR, which favors a worst prognostic for comorbidities associated with these variables, and a tendency for sarcopenic obesity seems to be present although more studies are needed. Also, we found that using cut-off points for disability risk 83.3% of the men and 38.7% of the women of our sample were at moderate or high risk of disability. Three years later this percentage has increased but only for women to 54.8%. Conclusions: Although men are at risk of disability, women quickly lose their functional capacity, making necessary a rapid intervention to reduce the risk of disability in this population.
- Instrumented 6-minutes walk test, an approach to improve the traditional testPublication . Galán-Mercant, Alejandro; Tomás, Maria Teresa; Fernandes, BeatrizIntroduction: Exercise testing is frequently used to assist clinicians in assessing prognosis and evaluating response to treatment. The 6-min walk test is a standardized test of functional exercise capacity. Objectives: The aim of the present study was to identify and describe the anthropometric characteristics, gait velocity and instrumented 6-min walk test with kinematics parameters from the inertial sensor during the test in a Portuguese population of subjects over 65 years. Methods: They were measured variables related to anthropometrics, the 6-min walk test and kinematic variables in the 6-min walk test related to accelerations and angular velocity. Results: The results were; six minutes walk (359,26 ± 107.49 meters), initial heart rate (72,95 ± 7,74BPM), final initial heart rate (80,58 ± 13,86 BPM), initial systolic blood pressure (148,42 ± 21,25 mmHg), final systolic blood pressure (164,26 ± 24,49 mmHg), initial diastolic blood pressure (75,63 ± 11,04 mmHg), final diastolic blood pressure (77,00 ± 9,52 mmHg), gait velocity (1,04 ± 0,37 m/s), max rotation rate X (1,05 ± 0,36 rad/s), min rotation rate X (−0,82 ± 0,33 rad/s), max rotation rate Y (2,63 ± 0,96 rad/s), min rotation rate Y (−1,69 ± 0,81 rad/s), max rotation rate Z (1,03 ± 0,33 rad/s), min rotation rate Z (−1,12 ± 0,38 rad/s), max acceleration X (0,77 ± 0,37 m/s2), min acceleration X (−0,91 ± 0,44 m/s2), max acceleration Y (0,53 ± 0,23 m/s2), min acceleration Y (−1,25 ± 0,70 m/s2), max acceleration Z (0,49 ± 0,14 m/s2), min acceleration Z (−0,96 ± 0,34 m/s2). Conclusions: The only one outcome in 6-min walk the test (total distance in meters), could be complemented with inertial sensor information. This new complement could be interesting in order to understand other dimensions in the 6-min walk or identify changes in function and results in the test after a program to improve physical fitness.
- Risk of falling, fear of falling and functionality in community-dwelling older adultsPublication . Fernandes, Beatriz; Tomás, Maria Teresa; Quirino, DiogoAgeing among Portuguese population is leading to an increase in the proportion of elderly people. Age-related changes are responsible for high levels of disability, balance problems and high risk of falls, Physiotherapy can identify elderly in risk of falling and provide strategies to prevent falls in this population contributing to maintain functionality. The purpose of this study was to characterise the risk of falling in a sample of community-dwelling older adults and investigate the associations between functionality and balance. Objective: To identify the risk of failing in community-dwelling older adults and ifs relations with fear of falling and functional capacity.
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