Velocidad de marcha del adulto mayor funcionalmente saludable

Aldo Sgaravatti: Departamento de Geriatría, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Uruguay.-- Darío Santos: Departamento Rehabilitación y Medicina Física, Facultad de Medicina, Universidad de la República, Uruguay.-- Gustavo Bermúdez: Instituto Universitario Asociación Cristiana de Jóvenes, Uruguay.-- Ana Barboza: Departamento de Geriatría, Facultad de Medicina, Universidad de la República, Uruguay.-- Contacto: Ana Barboza. [email protected] proceso de envejecimiento conlleva trastornos conocidos como síndromes geriátricos, los cuales pueden afectar la reserva funcional e incidir en la velocidad de la marcha, la que es un indicador que puede predecir eventos adversos y reflejar alteraciones fisiopatológicas subyacentes. Se realizó un estudio descriptivo, observacional y transversal con el objetivo de medir la velocidad de la marcha en adultos mayores saludables, y su correlación con variables clínicas y demográficas. Se calculó la velocidad de la marcha mediante análisis observacional en video, midiendo parámetros espacio-temporales (longitud y tiempo del ciclo de marcha). Se evaluó una muestra de 60 individuos mayores de 65 años, la edad media fue de 76 años. La velocidad de la marcha media fue 1,10 m/s (Rango 0, 60-1,47 m/s). Para el grupo de menos de 75 años fue de 1,20 m/s, entre los mayores de 80 fue de 1,0 m/s. Se vio un comportamiento similar al encontrado en estudios internacionales. Se evidenció que la velocidad de la marcha del adulto mayor funcionalmente saludable disminuye con la edad. Este estudio es el primero realizado en la población anciana uruguaya.The aging process involves disorder s known as geriatric syndromes, which can aff ect the functional reserve and the gait speed, which is an indicator that can predict adverse events and refl ect underlying pathophysiological changes. A descriptive, observational and cross-sectional study was carried out with the aim of measuring the gait speed in healthy elderly adults, and its relation with clinical and demographic characteristics. Gait speed was calculated by means of observational video analysis, measuring space-time parame ters (length and time of the walking cycle). A sample of 60 individuals older than 65 years was evaluated, the average age was 76 years. The average gait speed was 1.10 m/s (range 0.60-1.47 m/s). For the group of less than 75 years it was 1.20 m/s, among those over 80 it was 1.0 m/s. These fi ndings are similar to that found in international studies. It was evidenced that the gait speed of the functionally healthy older individuals decreases with age. This study is the fi rst performed in the Uruguayan elderly population.O processo de envelhecimento envolve distúrbios conhecidos como síndromes geriátricas, que podem afetar a reserva funcional e a velocidade da marcha, que é um indicador que pode prever eventos adversos e refletir alterações fisiopatológicas subjacentes. Foi realizado um estudo descritivo, observacional e transversal, com o objetivo de medir a velocidade da marcha em idosos saudáveis e sua correlação com variáveis clínicas e demográficas. A velocidade da marcha foi calculada por meio de análise de vídeo observacional, medindo os parâmetros espaço-tempo (duração e tempo do ciclo da marcha). Uma amostra de 60 indivíduos com mais de 65 anos foi avaliada, a idade média foi de 76 anos. A velocidade da marcha média foi de 1,10 m/s (Faixa 0,60-1,47 m/s). Para o grupo de menos de 75 anos, foi de 1,20 m/s, entre aqueles com mais de 80 anos foi de 1,0 m/s. Houve um comportamento semelhante ao encontrado em estudos internacionais. Evidenciou-se que a velocidade de marcha do idoso funcionalmente saudável diminui com a idade. Este estudo é o primeiro realizado na população idosa do Uruguai

Sarcopenia and post-hospital outcomes in older adults: a longitudinal study

Introduction Sarcopenia poses a significant problem for older adults, yet very little is known about this medical condition in the hospital setting. The aims of this hospital-based study were to determine: (i) the prevalence of sarcopenia; (ii) factors associated with sarcopenia; and (iii) the association of sarcopenia with adverse clinical outcomes post-hospitalisation. Methods This is a longitudinal analysis of consecutive patients aged ≥70 years admitted to a Geriatric Management and Evaluation Unit (GEMU) ward. Sarcopenia was classified using the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm, which included: handgrip strength, gait speed, and muscle mass using Bioelectrical Impedance Analysis (BIA). Outcomes were assessed at 12-months post-hospital discharge, and included both mortality and admission to a hospital Emergency Department (ED). Kaplan-Meier methods were used to estimate survival, with Cox proportion hazard models then applied. All regression analyses controlled for age, sex, and co-morbidity. Results 172 patients (72% female) with a mean (SD) age of 85.2 (6.4) years were included. Sarcopenia was present in 69 (40.1%) of patients. Patients with sarcopenia were twice as likely to die in the 12-months post-hospitalisation (HR, 95% CI = 2.23, 1.15–4.34), but did not have an increased likelihood of ED admission. Conclusions Sarcopenia showed an independent association with 12-month post-hospital mortality in older adults. With the new recognition of sarcopenia as a medical condition with its own unique ICD-10-CM code, awareness and diagnosis of sarcopenia in clinical settings is paramount

Gait Speed in Functionally and Healthy Elder People

El proceso de envejecimiento conlleva trastornos conocidos como síndromes geriátricos, los cuales pueden afectar la reserva funcional e incidir en la velocidad de la marcha, la que es un indicador que puede predecir eventos adversos y reflejar alteraciones fisiopatológicas subyacentes.El objetivo del estudio fue medir la velocidad de la marcha en adultos mayores saludables.Se realizó un estudio descriptivo, observacional y transversal. Se calculó velocidad de la marcha mediante análisis observacional en video, midiendo parámetros espacio-temporales (longitud y tiempo del ciclo de marcha).Se evaluó una muestra de 60 individuos mayores de 65 años, la edad media fue de 76 años (Rango 65-95). La velocidad media de marcha fue 1,1 m/s (Rango 0. 60-1,47 m/s). Para el grupo de menos de 75 años fue de 1,2 m/s, entre los mayores de 80 fue de 1 m/s.Este estudio es el primero realizado en la población anciana uruguaya. Muestra un comportamiento similar al encontrado en estudios internacionales. Se evidenció que la velocidad de la marcha del adulto mayor funcionalmente saludable disminuye con la edad.UY-MoUC

Inter-University Network for Healthy Aging, Latin America and the Caribbean (RIES-LAC): a university contribution to the Decade of Healthy Aging

La población mundial está envejeciendo1-3, y la región de América Latina y el Caribe (ALC) no es una excepción.4-6 Actualmente, el 8% de la población de ALC tiene más de 65 años, y se estima que esta cifra aumentará al 30%. para 2050,7 Se sabe que el proceso de envejecimiento implica cambios moleculares, fisiológicos, funcionales, psicosociales y sociales.8 Todos envejecemos; La cuestión es envejecer sanamente. Como este no es siempre el caso, la Organización Mundial de la Salud (OMS) declaró el período de 2021 a 2030 como la Década del Envejecimiento Saludable.9 La Década es una colaboración global que involucra a diversos sectores y partes interesadas (gobiernos, sociedad civil, organizaciones internacionales). organizaciones, profesionales, instituciones académicas, los medios de comunicación y el sector privado) para mejorar las vidas de las personas mayores, sus familias y comunidades. La colaboración se centra en cuatro pilares de acción estrechamente interconectados: cambiar la forma en que pensamos, sentimos y actuamos ante la edad y el envejecimiento; garantizar que las comunidades fomenten las capacidades de las personas mayores; proporcionar atención integrada centrada en la persona y servicios primarios de salud que respondan a las personas mayores; y brindar acceso a atención a largo plazo a las personas mayores que la necesiten.9,10 Ante esta situación, ¿qué pueden hacer los académicos de las universidades de ALC? Si nos organizamos y unimos esfuerzos podemos contribuir al Decenio del Envejecimiento Saludable y, en consecuencia, influir en la calidad de vida de las personas mayores. Por lo tanto, a propuesta del Dr. Robinson Cuadros, Presidente del Comité LAC (COMLAT) de la Asociación Internacional de Gerontología y Geriatría (IAGG), el Profesor Iván Palomo, Director del Centro Interuniversitario para el Envejecimiento Saludable de las universidades públicas de Chile , propone ante COMLAT la creación de una Red Interuniversitaria para el Envejecimiento Saludable en ALC (RIES-LAC).The world’s population is aging1-3, and the Latin America and the Caribbean (LAC) region is no exception.4-6 Currently, 8% of the LAC population is over 65 years old, and this number is estimated to increase to 30% by 2050.7 The aging process is known to involve molecular, physiological, functional, psy-chosocial, and social changes.8 We all age; the point is to age healthily. As this is not always the case, the World Health Organization (WHO) declared the period from 2021 to 2030 as the Decade of Healthy Aging.9 The Decade is a global col-laboration involving diverse sectors and stakeholders (governments, civil society, international organizations, professionals, academic institutions, the media, and the private sector) to improve the lives of older people, their families, and com-munities. The collaboration is centered on four closely interconnected pillars of action: changing how we think, feel, and act towards age and aging; ensuring that communities foster the abilities of older people; providing person-centered inte-grated care and primary health services responsive to older people; and providing access to long-term care for older people who need it.9,10 In light of this situation, what can academics from universities in LAC do? If we organize ourselves and unite efforts, we can contribute to the Decade of Healthy Aging and, consequently, influence the quality of life of older people. Therefore, following the proposal of Dr. Robinson Cuadros, President of the LAC Committee (COMLAT) of the International Association of Gerontology and Geriatrics (IAGG), Professor Iván Palomo, Director of the Inter-University Center for Healthy Aging of public universities in Chile, proposes the creation of an Inter-University Network for Healthy Aging in LAC (RIES-LAC) before COMLAT.https://orcid.org/0000-0002-8584-3191https://scholar.google.com/citations?user=ns-9aAgAAAAJ&hl=es&oi=aohttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001337521Revista Internacional - IndexadaS

Protocol for a systematic review and meta-analysis assessing the effectiveness of deprescribing in falls prevention in older people

Introduction One of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge.Methods and analysis This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses.Ethics and dissemination Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines.PROSPERO registration number CRD42020218231

Medication reviews and deprescribing as a single intervention in falls prevention : a systematic review and meta-analysis

Background: our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods: Design: systematic review and meta-analysis. Data sources: Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria: randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome. Study records: title/abstract and full-text screening by two reviewers. Risk of bias: Cochrane Collaboration revised tool. Data synthesis: results reported separately for different settings and sufficiently comparable studies meta-analysed. Results forty-nine heterogeneous studies were included. Community: meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69–1.14, I2 = 0%, 2 s) for injurious falls. Hospital: meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74–1.28, I2 = 15%, 2 s) and in an RR = 0.50 (0.07–3.50, I2 = 72% %, 2 s) for number of fallers after and during admission, respectively. Long-term care: meta-analyses investigating medication reviews or deprescribing plans resulted in an RR = 0.86 (0.72–1.02, I2 = 0%, 5 s) for number of fallers and in an RaR = 0.93 (0.64–1.35, I2 = 92%, 7 s) for number of falls. Conclusions: the heterogeneity of the interventions precluded us to estimate the exact effect of medication review and deprescribing as a single intervention. For future studies, more comparability is warranted. These interventions should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies due to the multifactorial nature of falls. PROSPERO registration number: CRD4202021823

Evaluation of clinical practice guidelines on fall prevention and management for older adults : a systematic review

IMPORTANCE With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. OBJECTIVES To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. EVIDENCE REVIEW A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. FINDINGS Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. CONCLUSIONS AND RELEVANCE This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders