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Diss. (sammanfattning) Umeå : Univ., 2006. / Härtill 4 uppsatser.

Diss. Luleå : Luleå tekniska univ., 2008. / Härtill 4 uppsatser.

Introduction: Frailty is characterized by vulnerability to declining health and increased risk for adverse health outcomes. Measuring frailty would be beneficial for developing interventions and assessing healthcare resource needs. No standardized measurement tool for frailty has been established. The objective of this thesis was to evaluate the frailty of participants in the Canadian Longitudinal Study on Aging (CLSA). Methods: A Frailty Index (FI) was constructed for CLSA participants based on the cumulative deficit theory of frailty. Exploratory factor analysis was conducted to study the underlying constructs of frailty and identify key factors. A hypothesized measurement model for frailty was specified. The model was modified and tested using structural equation modelling (SEM) to improve goodness-of-fit. A new frailty measurement tool was created and the construct validity of the new tool and the Frailty Index were evaluated. Results: A FI was calculated for 20,874 CLSA participants (Mean 0.14 SD 0.07). The maximum FI value was 0.68. A model containing all hypothesized variables had good fit of the data, and all variables contributed significantly. A simplified model also showed good fit and included four domains: upper-body strength, lower-body strength, dexterity, and depressive symptoms. These results persisted in an independent dataset. A Simplified Frailty (SF) score was created based on this simplified model. The FI and SF scores showed significant agreement and associations with sociodemographic variables were as predicted. Conclusions: A FI was simple to construct in the CLSA, having good fit of the data and construct validity. These results are consistent with previous research on the cumulative deficit theory of frailty. A simplified frailty model revealed key domains of frailty and resulted in a potentially useful short screening tool. The FI is recommended as a valid and reproducible approach for measuring frailty in the CLSA and similar population datasets. / Thesis / Master of Science (MSc)

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 4 uppsatser.

A síndrome da fragilidade surge no cenário do crescente número de idosos na população mundial, acometendo esses indivíduos, agravando suas condições de vida e saúde. Considerando que essa síndrome é multifatorial e multidimensional, que atinge idosos que vivem em diversas realidades, esta pesquisa buscou verificar a percepção de qualidade de vida de idosos residentes na comunidade e em Instituições de Longa Permanência, diante de sua condição de fragilidade. Por meio de um estudo epidemiológico descritivo do tipo transversal, com abordagem quantitativa, foram entrevistados 136 idosos, sendo metade deles residentes da comunidade, e a outra metade, residentes de Instituições de Longa Permanência para Idosos - ILPIs. Para o cálculo adotou-se nível de significância de 5% e poder do teste de 80% para se demonstrar uma correlação mínima de 0,35 são necessários 68 sujeitos para cada tipo de residência. Utilizou-se a Escala de Fragilidade de Edmonton (EFS) para identificar a presença de fragilidade e os questionários Whoqol Bref e Old para mensurar a percepção de qualidade de vida. Foi observado uma diferença notória entre o número de idosos frágeis moradores da comunidade (16,2%) e os residentes de ILPIs (51,5%), com significância estatística (p<0,001). A percepção de qualidade de vida também é melhor entre os domiciliados nos dois questionários, com destaque para os domínios relações sociais, meio ambiente e morte e morrer. O domínio autonomia apresentou a pior percepção, sobretudo entre os idosos institucionalizados. Entre os idosos frágeis estão as piores percepções de qualidade de vida na maioria dos domínios, para ambos os questionários. Os resultados mostram que a condição de fragilidade piora a qualidade de vida dos idosos e não são apenas os domínios relacionados à saúde física e mental que prejudicam a qualidade de vida. Fatores relacionados à intimidade, autonomia e relações sociais também se mostram associados à piora da percepção de qualidade de vida para as duas realidades, sobretudo para os institucionalizados. Assim, identifica-se que distinguir idosos frágeis de não frágeis é fundamental para a assertiva intervenção de saúde física ou mental. / The fragility syndrome appears in the scenario of the growing number of elderly people in the world population, affecting these individuals, aggravating their living conditions and health. Considering that this syndrome is multifactorial and multidimensional, reaching elderly people living in different realities, this research sought to verify the perception of quality of life of elderly residents in the community and in Long Stay Institutions, given their fragility condition. A descriptive epidemiological study of the transversal type, with a quantitative approach, interviewed 136 elderly people, half of whom were residents of the community; and the other half, residents of Long Stay Institutions for the Elderly (ILPIs). For the calculation, a significance level of 5% and 80% test power were used to demonstrate a minimum correlation of 0.35, 68 subjects were required for each type of residence. The Fragility Scale of Edmonton (EFS) was used to identify the presence of fragility and the Whoqol Bref and Old questionnaires to measure the perception of quality of life. A noticeable difference was observed between the number of fragile elderly in the community (16.2%) and the residents of ILPIs (51.5%), with statistical significance (p <0.001). The perception of quality of life is also better among those domiciled in the two questionnaires, especially in the areas of \"social relations\", \"environment\" and \"death and dying\". The domain \"autonomy\" presented the worst perception, especially among the institutionalized elderly. Among the fragile elderly are the worst perceptions of quality of life in most domains, for both questionnaires. The results show that the fragility condition worsens the quality of life of the elderly and it is not only the domains related to the physical and mental health that impairs the quality of life. Factors related to intimacy, autonomy and social relations are also associated with the deterioration of the perception of quality of life for both realities, especially for the institutionalized ones. Thus, it is identified that distinguishing fragile elderly from non-fragile individuals is fundamental for assertive physical or mental health intervention.

A síndrome da fragilidade surge no cenário do crescente número de idosos na população mundial, acometendo esses indivíduos, agravando suas condições de vida e saúde. Considerando que essa síndrome é multifatorial e multidimensional, que atinge idosos que vivem em diversas realidades, esta pesquisa buscou verificar a percepção de qualidade de vida de idosos residentes na comunidade e em Instituições de Longa Permanência, diante de sua condição de fragilidade. Por meio de um estudo epidemiológico descritivo do tipo transversal, com abordagem quantitativa, foram entrevistados 136 idosos, sendo metade deles residentes da comunidade, e a outra metade, residentes de Instituições de Longa Permanência para Idosos - ILPIs. Para o cálculo adotou-se nível de significância de 5% e poder do teste de 80% para se demonstrar uma correlação mínima de 0,35 são necessários 68 sujeitos para cada tipo de residência. Utilizou-se a Escala de Fragilidade de Edmonton (EFS) para identificar a presença de fragilidade e os questionários Whoqol Bref e Old para mensurar a percepção de qualidade de vida. Foi observado uma diferença notória entre o número de idosos frágeis moradores da comunidade (16,2%) e os residentes de ILPIs (51,5%), com significância estatística (p<0,001). A percepção de qualidade de vida também é melhor entre os domiciliados nos dois questionários, com destaque para os domínios relações sociais, meio ambiente e morte e morrer. O domínio autonomia apresentou a pior percepção, sobretudo entre os idosos institucionalizados. Entre os idosos frágeis estão as piores percepções de qualidade de vida na maioria dos domínios, para ambos os questionários. Os resultados mostram que a condição de fragilidade piora a qualidade de vida dos idosos e não são apenas os domínios relacionados à saúde física e mental que prejudicam a qualidade de vida. Fatores relacionados à intimidade, autonomia e relações sociais também se mostram associados à piora da percepção de qualidade de vida para as duas realidades, sobretudo para os institucionalizados. Assim, identifica-se que distinguir idosos frágeis de não frágeis é fundamental para a assertiva intervenção de saúde física ou mental. / The fragility syndrome appears in the scenario of the growing number of elderly people in the world population, affecting these individuals, aggravating their living conditions and health. Considering that this syndrome is multifactorial and multidimensional, reaching elderly people living in different realities, this research sought to verify the perception of quality of life of elderly residents in the community and in Long Stay Institutions, given their fragility condition. A descriptive epidemiological study of the transversal type, with a quantitative approach, interviewed 136 elderly people, half of whom were residents of the community; and the other half, residents of Long Stay Institutions for the Elderly (ILPIs). For the calculation, a significance level of 5% and 80% test power were used to demonstrate a minimum correlation of 0.35, 68 subjects were required for each type of residence. The Fragility Scale of Edmonton (EFS) was used to identify the presence of fragility and the Whoqol Bref and Old questionnaires to measure the perception of quality of life. A noticeable difference was observed between the number of fragile elderly in the community (16.2%) and the residents of ILPIs (51.5%), with statistical significance (p <0.001). The perception of quality of life is also better among those domiciled in the two questionnaires, especially in the areas of \"social relations\", \"environment\" and \"death and dying\". The domain \"autonomy\" presented the worst perception, especially among the institutionalized elderly. Among the fragile elderly are the worst perceptions of quality of life in most domains, for both questionnaires. The results show that the fragility condition worsens the quality of life of the elderly and it is not only the domains related to the physical and mental health that impairs the quality of life. Factors related to intimacy, autonomy and social relations are also associated with the deterioration of the perception of quality of life for both realities, especially for the institutionalized ones. Thus, it is identified that distinguishing fragile elderly from non-fragile individuals is fundamental for assertive physical or mental health intervention.

OBJECTIVE: To establish baseline data of dental utilization and determine the predictors of receipt of dental procedures by Medicaid-enrolled senior adults who reside in Iowa nursing facilities. METHODS: This was a longitudinal retrospective analysis of Iowa Medicaid claims data for SFY 2007-2014 of senior adults who were 68 years or older upon entry to a nursing facility and continuously enrolled (eligible 58 out of 60 months) in Medicaid for three years prior to and at least two years after admission. RESULTS: Controlling for the subject and nursing facility level variables, the strongest predictor of dental utilization after entry was the receipt of a dental procedure before entry (p< 0.001). Subjects residing in a facility located in an urban area (p< 0.002) or in two regions of Iowa (p=0.035, p=0.019, respectively) also had increased odds of receiving a dental procedure. CONCLUSION: Our results show that approximately 50% of the subjects never received a dental procedure in the 5-year study period. The strongest predictor of receipt of dental procedures in the 2 years after entry was the receipt of dental procedures in the 3 years before entry. It is important for Medicaid-enrolled senior adults to establish a dental home while community-dwelling.

No description available.

Hypothesis. We hypothesized that contrary to "normal aging," frail elderly women would have a heightened resting energy expenditure per kg fat free mass (REE/kg FFM) and thermic effect of food (TEF) response. / Methods. 13 healthy (H) [X +/- SEM: 81.4 +/- 1.1 yr] and 9 frail elderly women (F) [84.7 +/- 1.6 yr], free from acute conditions underwent REE and TEF measurements (liquid standard mixed meal: 720 kcal, 58% carbohydrate, 14% protein, 28% fat) using ventilated hood indirect calorimetry. Anthropometric and body composition measurements, thyroid hormones, cortisol, cytokines and catecholamine concentrations, and physical activity (PASE) and mobility ("time up and go" TUG) scores were related to the results obtained. / Results. H had a faster TUG: 10.2 +/- 1.6 vs. 21.0 +/- 9.3 s (p=0.001), greater PASE score: 179.2 +/- 116.1 vs. 47.1 +/- 26.2 (p=0.003), greater triiodothyronine [T3]: 5.1 +/- 0.6 vs. 4.3 +/- 0.4 rhomol/L (p=0.003) and lower cortisol concentrations: 351.1 +/- 19.9 vs. 474.5 +/- 43.6 nmol/L (p=0.011). In H vs. F: REE/kg FFM was 1044 +/- 20.4, 1021 +/- 23.7 kcal/day (NS) and TEF response as expressed as % of REE was 18.4 +/- 5.6, 19.5 +/- 4.2 (NS). The time course of glucose (p=0.043) and insulin from 90 minutes onwards (P=0.013) suggested insulin resistance in F. REE was positively correlated with FFM, percent body fat and [T3] (r>0.499, p<0.021). / Conclusion. REE/kg FFM and TEF response was not different between H and F and thus the greater prevalence of malnutrition in F, cannot be explained by these parameters.