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      Diagnóstico de fragilidad en adultos mayores de una comunidad urbana Translated title: Diagnosis of frailty in urban community-dwelling older adults

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          Abstract

          Objetivos Diagnosticar la población de adultos mayores frágiles en una zona urbana atendida por el Grupo Básico de Trabajo "Palatino" del área de salud "Antonio Maceo"del municipio Cerro en La Habana, Cuba. Métodos Se realizó un estudio observacional, descriptivo, de índole transversal en la población de mayor 60 años durante el 2005. Se trabajó con el universo de los adultos mayores constituido por 699 personas. Se estudiaron 541 que cumplían con los criterios de inclusión. Para estimar la prevalencia de fragilidad se aplicó la Escala Geriátrica de Evaluación Funcional a todos los adultos mayores incluidos en el estudio y se clasificaron en frágiles y no frágiles según los criterios cubanos de fragilidad. Con la información recopilada se confeccionó una base de datos para su análisis por medio, fundamentalmente, de distribuciones de frecuencias. Resultados El 51,4 % de los estudiados se identificó como frágil. Se encontró que el criterio de fragilidad prevalente era la polifarmacia (35,5 %) y que un adulto mayor del sexo femenino tiene un riesgo relativo de ser frágil de 1,33 con respecto a uno del sexo masculino, de ahí que la condición de fragilidad se asoció al sexo femenino. Conclusiones La fragilidad en el adulto mayor es una condición de alta prevalencia en la población del Consejo Popular "Palatino", en cuya expresión incide de manera considerable la polifarmacia.

          Translated abstract

          Objectives To make a diagnosis of frailty in an older adult population living in an urban area cared for by the Basis Working Group "Palatino" in the health area "Antonio Maceo", Cerro Municipality, City of Havana, Cuba. Methods An observational, descriptive and cross-sectional study was conducted in a population aged over 60 years in 2005. The universe of older people was made up of 699 persons but only 541 were studied because they fulfilled the inclusion criteria. For estimating the fragility prevalence, the Geriatric Scale of Functional Assessment was applied to all the elderly included in the study and they were then classified as frail and non-frail according to the present Cuban criteria. The collected information served to make a database for the analysis through frequency distributions basically. Results Of the studied older people, 51.4% were identified as frail. It was found that the prevailing frailty criterion was consumption of many drugs (35,5%) and that the relative risk of frailty in female elder is 1,33 higher than the male older person, that is to say, the frailty condition was associated to the feminine sex. Conclusions Frailty in older people is a highly prevalent condition in the "Palatino" People´s Council population, in which the consumption of many drugs has great incidence.

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          Frailty in older adults: evidence for a phenotype

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            Preventing frail health.

            Frailty is a state of reduced physiologic reserve associated with increased susceptibility to disability. Reduced physiologic capacity in neurologic control, mechanical performance, and energy metabolism are the major components of frailty. Although disease is an important cause of frailty, there is sufficient epidemiologic and experimental evidence to conclude that frailty is also due to the additive effects of low-grade physiologic loss resulting from a sedentary lifestyle and more rapid loss due to acute insults (illness, injuries, major life events) that result in periods of limited activity and bedrest. The pathogenesis of frailty involves a complicated interaction of factors that block recovery from rapid physiologic loss. To some extent, frailty is preventable. Approaches to prevention include (1) the periodic monitoring of key physiologic indicators of frailty, (2) the prevention of physiologic loss and acute and subacute episodes of physiologic loss, (3) the prediction of episodes of physiologic loss and the reduction of frailty prior to the loss, and (4) the removal of obstacles to recovery once physiologic loss has occurred.
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              Associations of subclinical cardiovascular disease with frailty.

              Frail health in old age has been conceptualized as a loss of physiologic reserve associated with loss of lean mass, neuroendocrine dysregulation, and immune dysfunction. Little work has been done to define frailty and describe the underlying pathophysiology. Frailty status was defined in participants of the Cardiovascular Health Study (CHS), a cohort of 5,201 community-dwelling older adults, based on the presence of three out of five clinical criteria. The five criteria included self-reported weight loss, low grip strength, low energy, slow gait speed, and low physical activity. We examined the spectrum of clinical and subclinical cardiovascular disease in those who were frail (3/5 criteria) or of intermediate frailty status (1 or 2/5 criteria), compared to those who were not frail (0/5). We hypothesized that the severity of frailty would be related to a higher prevalence of reported cardiovascular disease (CVD), as well as to a greater extent of CVD, measured by noninvasive testing. Of 4,735 eligible participants, 2,289 (48%) were not frail, 299 (6%) were frail, and 2.147 (45%) were of intermediate frailty status. Those who were frail were older (77.2 yrs) compared to those who were not frail (71.5 yrs) or intermediate (73.4 yrs) (p 75% (adjusted OR = 3.41), ankle-arm index <0.8 (adjusted OR = 3.17) or 0.8-0.9 (adjusted OR = 2.01), major electrocardiography (ECG) abnormalities (adjusted OR = 1.58), greater left ventricular (LV) mass by echocardiography (adjusted OR = 1.16), and higher degree of infarct-like lesions in the brain (adjusted OR = 1.71), were more likely to be frail compared to those who were not frail. The overall associations of each of these noninvasive measures of CVD with frailty level were significant (all p < .05). Cardiovascular disease was associated with an increased likelihood of frail health. In those with no history of CVD, the extent of underlying cardiovascular disease measured by carotid ultrasound and ankle-arm index, LV hypertrophy by ECG and echocardiography, was related to frailty. Infarct-like lesions in the brain on magnet resonance imaging were related to frailty as well.
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                Author and article information

                Journal
                rcsp
                Revista Cubana de Salud Pública
                Rev. cub. salud pública
                Centro Nacional de Información de Ciencias Médicas (La Habana, La Habana, Cuba )
                0864-3466
                1561-3127
                June 2009
                : 35
                : 2
                Affiliations
                [01] La Habana orgnameInstituto Nacional de Higiene Epidemiología y Microbiología. Cuba
                [03] La Habana orgnameInstituto Superior de Ciencias Médicas de La Habana. Cuba
                [02] orgnameHospital Clínico Quirúrgico Dr. Salvador Allende.
                Article
                S0864-34662009000200016 S0864-3466(09)03500216
                10.1590/s0864-34662009000200016
                0bc52600-af70-422a-a7e7-3786ee89a913

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 28 April 2008
                : 24 September 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 38, Pages: 0
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                SciELO Cuba

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Investigación

                family medicine,adulto mayor,Fragilidad,comunidad,atención primaria de salud,anciano frágil,adulto mayor frágil,envejecimiento,medicina familiar,Frailty,older adult,community,primary health care,frail elderly,aging,frail older adult

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