Componentes do fenótipo de fragilidade como preditores de mortalidade entre idosos após quatro anos de alta hospitalar
DOI:
https://doi.org/10.33448/rsd-v11i15.37534Palavras-chave:
Idoso fragilizado; Estudos longitudinais; Alta do paciente; Mortalidade.Resumo
Objetivo: verificar a associação entre comprometimento dos componentes do fenótipo de fragilidade como preditores de mortalidade entre idosos após quatro anos de alta hospitalar. Metodologia: Investigação prospectiva e longitudinal, realizada com idosos internados, no baseline, e acompanhados após a alta hospitalar. Dos 163 idosos incluídos no estudo, 43 foram a óbito ao longo do seguimento e 92 completaram o follow-up de quatro anos. Foram utilizados como instrumentos: Mini Exame do Estado Mental, formulário para caracterização dos dados sociodemográficos, econômicos e de saúde; e o fenótipo de fragilidade de Fried. Procedeu-se à análise de sobrevivência pelo método de Kaplan-Meier e regressão de Cox para estimar a razão de risco (Hazard Ratio) de mortalidade entre idosos com comprometimento em cada componente do fenótipo, considerando p<0,05. Resultados: O comprometimento nos componentes do fenótipo de fragilidade lentidão na velocidade de marcha (HR: 3,27; IC95%: 1,655-6,475; p<0,001); diminuição da força muscular (HR:3,09; IC95%: 1,605-5,959; p=0,001); autorrelato de exaustão e/ou fadiga (HR:2,97; IC95%: 1,508-5,853; p=0,002) e baixo nível de atividade física (HR: 3,22; IC95%: 1,693-6,138; p<0,001) permaneceram como preditores de mortalidade, após o ajuste; e representaram menor probabilidade de sobrevida. Conclusão: O comprometimento nos componentes velocidade de marcha, força muscular, exaustão e/ou fadiga e atividade física no baseline representaram maior risco para mortalidade entre idosos no follow-up. Assim, há possibilidade de direcionamento de intervenções nos grupos de risco para melhora da condição de fragilidade e, consequentemente, aumento da sobrevida.
Referências
Abe, T., Kitamura, A., Taniguchi, Y., Amano, H., Seino, S., Yokoyama, Y., Nishi, M., Narita, M., Ikeuchi, T., Fujiwara, Y., & Shinkai, S. (2019). Pathway from gait speed to incidence of disability and mortality in older adults: A mediating role of physical activity. Maturitas, 123, 32–36. https://doi.org/10.1016/j.maturitas.2019.02.002
Alencar, M. A., Dias, J. M. D., Figueiredo, L. C., & Dias, R. C. (2015). Transitions in Frailty Status in Community-Dwelling Older Adults. Topics in Geriatric Rehabilitation, 31(2),105-112. https://doi.org/10.1097/TGR.0000000000000055
Azzolino, D., Arosio, B., Marzetti, E., Calvani, R., & Cesari, M. (2020). Nutritional Status as a Mediator of Fatigue and Its Underlying Mechanisms in Older People. Nutrients, 12(2), 444. https://doi.org/10.3390/nu12020444
Bae, E. J., Park, N. J., Sohn, H. S., & Kim, Y. H. (2019). Handgrip Strength and All-Cause Mortality in Middle-Aged and Older Koreans. International journal of environmental research and public health, 16(5), 740. https://doi.org/10.3390/ijerph16050740
Baldwin, M. R., Reid, M. C., Westlake, A. A., Rowe, J. W., Granieri, E. C., Wunsch, H., Dam, T. T., Rabinowitz, D., Goldstein, N. E., Maurer, M. S., & Lederer, D. J. (2014). The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors. Journal of critical care, 29(3), 401–408. https://doi.org/10.1016/j.jcrc.2013.12.019
Basu, N., Yang, X., Luben, R. N., Whibley, D., Macfarlane, G. J., Wareham, N. J., Khaw, K. T., & Myint, P. K. (2016). Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study. BMC medicine, 14(1), 122. https://doi.org/10.1186/s12916-016-0662-y
Batistoni, S. S., Neri, A. L., & Cupertino, A. P. (2007). Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly. Revista de saude publica, 41(4), 598–605. https://doi.org/10.1590/s0034-89102007000400014
Benedetti. T. B., Mazo, G. Z., & de Barros, M. V. (2004). Application of the International Physical Activity Questionnaire (IPAQ) for evaluation of elderly women: concurrent validity and test-retest reproducibility. Revista Brasileira de ciência e movimento, 12(1), 25-34. https://doi.org/10.18511/rbcm.v12i1.538
Bertolucci, P. H., Brucki, S. M., Campacci, S. R., & Juliano, Y. (1994). O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arquivos de Neuro-psiquiatria, 52(1),1-7. https://doi.org/10.1590/S0004-282X1994000100001
Bielemann, R. M., LaCroix, A. Z., Bertoldi, A. D., Tomasi, E., Demarco, F. F., Gonzalez, M. C., Crespo da Silva, P. A., Wendt, A., Mohnsam da Silva, I. C., Brage, S., Ekelund, U., & Pratt, M. (2020). Objectively Measured Physical Activity Reduces the Risk of Mortality among Brazilian Older Adults. Journal of the American Geriatrics Society, 68(1), 137–146. https://doi.org/10.1111/jgs.16180
Bowden Davies, K. A., Pickles, S., Sprung, V. S., Kemp, G. J., Alam, U., Moore, D. R., Tahrani, A. A., & Cuthbertson, D. J. (2019). Reduced physical activity in young and older adults: metabolic and musculoskeletal implications. Therapeutic advances in endocrinology and metabolism, 10, 1-15. https://doi.org/10.1177/2042018819888824
Brazil. Ministério da Saúde. (2012). Conselho Nacional da Saúde. Resolução 466 de 12 de dezembro de 2012. Diário Oficial da União, Brasília, DF, 13 jun. 2013.
Brazil. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. (2007). Envelhecimento e saúde da pessoa idosa. Ministério da Saúde, Brasília: Ministério da Saúde. Série A. Normas e Manuais Técnicos. Cadernos de Atenção Básica, 19, 192. Accessed from: https://bvsms.saude.gov.br/bvs/publicacoes/evelhecimento_saude_pessoa_idosa.pdf
Chang, S. F., & Lin, P. L. (2015). Frail phenotype and mortality prediction: a systematic review and meta-analysis of prospective cohort studies. International journal of nursing studies, 52(8), 1362–1374. https://doi.org/10.1016/j.ijnurstu.2015.04.005
Cheung, A., Haas, B., Ringer, T. J., McFarlan, A., & Wong, C. L. (2017). Canadian study of health and aging clinical frailty scale: does it predict adverse outcomes among geriatric trauma patients? Journal of the American College of Surgeons, 225(5), 658–665. https://doi.org/10.1016/j.jamcollsurg.2017.08.008
Cunningham, C., O' Sullivan, R., Caserotti, P., & Tully, M. A. (2020). Consequences of physical inactivity in older adults: A systematic review of reviews and meta-analyses. Scandinavian journal of medicine & science in sports, 30(5), 816–827. https://doi.org/10.1111/sms.13616
Diniz, M. A., Rodrigues, R. A. P., Fhon, J. R. S., Hass, V. J., Fabrício-Wehbe, S. C. C., Giacomini, S. B. L., & Almeida, V. C. (2018). Frailty and its relationship to mortality among older adults from a Brazilian community: A cohort study. Journal of Clinical Gerontology & Geriatrics, 9(1), 27-33. https://doi.org/10.24816/jcgg.2018.v9i1.06
Duan-Porter, W., Vo, T. N., Ullman, K., Langsetmo, L., Strotmeyer, E. S., Taylor, B. C., Santanasto, A. J., Cawthon, P. M., Newman, A. B., Simonsick, E. M., Waters, T. M., & Ensrud, K. E. (2019). Hospitalization-Associated Change in Gait Speed and Risk of Functional Limitations for Older Adults. The journals of gerontology. Series A, Biological sciences and medical sciences, 74(10), 1657–1663. https://doi.org/10.1093/gerona/glz027
Dudzińska-Griszek, J., Szuster, K., & Szewieczek, J. (2017). Grip strength as a frailty diagnostic component in geriatric inpatients. Clinical interventions in aging, 12, 1151–1157. https://doi.org/10.2147/CIA.S140192
Ferrucci, L., & Fabbri, E. (2018). Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nature reviews. Cardiology, 15(9), 505–522. https://doi.org/10.1038/s41569-018-0064-2
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., McBurnie, M. A., & Cardiovascular Health Study Collaborative Research Group. (2001). Frailty in older adults: evidence for a phenotype. The journals of gerontology. Series A, Biological sciences and medical sciences, 56(3), 146–156. https://doi.org/10.1093/gerona/56.3.m146
Fritz, S., & Lusardi, M. (2009). White paper: "walking speed: the sixth vital sign". Journal of geriatric physical therapy (2001), 32(2), 46–49.
Gardner, A. W., Montgomery, P. S., Casanegra, A. I., Silva-Palacios, F., Ungvari, Z., & Csiszar, A. (2016). Association between gait characteristics and endothelial oxidative stress and inflammation in patients with symptomatic peripheral artery disease. Age (Dordrecht, Netherlands), 38(3), 64. https://doi.org/10.1007/s11357-016-9925-y
Green, P., Woglom, A. E., Genereux, P., Daneault, B., Paradis, J. M., Schnell, S., Hawkey, M., Maurer, M. S., Kirtane, A. J., Kodali, S., Moses, J. W., Leon, M. B., Smith, C. R., & Williams, M. (2012). The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC. Cardiovascular interventions, 5(9), 974–981. https://doi.org/10.1016/j.jcin.2012.06.011
Han, B., Li, Q., & Chen, X. (2019). Effects of the frailty phenotype on post-operative complications in older surgical patients: a systematic review and meta-analysis. BMC geriatrics, 19(1), 141. https://doi.org/10.1186/s12877-019-1153-8
Hao, Q., Zhou, L., Dong, B., Yang, M., Dong, B., & Weil, Y. (2019). The role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective study. Scientific reports, 9(1), 1207. https://doi.org/10.1038/s41598-018-38072-7
Heppenstall, C. P., Chiang, A., & Hanger, H. C. (2018). Readmissions to hospital in a frail older cohort receiving a community-based transitional care service. The New Zealand medical journal, 131(1484), 38–45.
Jochem, C., Leitzmann, M., Volaklis, K., Aune, D., & Strasser, B. (2019). Association Between Muscular Strength and Mortality in Clinical Populations: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 20(10), 1213–1223. https://doi.org/10.1016/j.jamda.2019.05.015
Khandelwal, D., Goel, A., Kumar, U., Gulati, V., Narang, R., & Dey, A. B. (2012). Frailty is associated with longer hospital stay and increased mortality in hospitalized older patients. The journal of nutrition, health & aging, 16(8), 732–735. https://doi.org/10.1007/s12603-012-0369-5
Lee, J. S., Auyeung, T. W., Leung, J., Kwok, T., & Woo, J. (2014). Transitions in frailty states among community-living older adults and their associated factors. Journal of the American Medical Directors Association, 15(4), 281–286. https://doi.org/10.1016/j.jamda.2013.12.002
Leme, D. E. D. C., Thomaz, R. P., Borim, F. S. A., Brenelli, S. L., Oliveira, D. V., & Fattori, A. (2019). Estudo do impacto da fragilidade, multimorbidade e incapacidade funcional na sobrevida de idosos ambulatoriais. Cien Saude Colet, 24(1), 137-146. https://doi.org/10.1590/1413-81232018241.04952017
Lin, H. S., Watts, J. N., Peel, N. M., & Hubbard, R. E. (2016). Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC geriatrics, 16(1), 157. https://doi.org/10.1186/s12877-016-0329-8
Liu, B., Hu, X., Zhang, Q., Fan, Y., Li, J., Zou, R., Zhang, M., Wang, X., & Wang, J. (2016). Usual walking speed and all-cause mortality risk in older people: A systematic review and meta-analysis. Gait & posture, 44, 172–177. https://doi.org/10.1016/j.gaitpost.2015.12.008
Moreh, E., Jacobs, J. M., & Stessman, J. (2010). Fatigue, function, and mortality in older adults. The journals of gerontology. Series A, Biological sciences and medical sciences, 65(8), 887–895. https://doi.org/10.1093/gerona/glq064
Morley, J. E., Vellas, B., van Kan, G. A., Anker, S. D., Bauer, J. M., Bernabei, R., Cesari, M., Chumlea, W. C., Doehner, W., Evans, J., Fried, L. P., Guralnik, J. M., Katz, P. R., Malmstrom, T. K., McCarter, R. J., Gutierrez Robledo, L. M., Rockwood, K., von Haehling, S., Vandewoude, M. F., & Walston, J. (2013). Frailty consensus: a call to action. Journal of the American Medical Directors Association, 14(6), 392–397. https://doi.org/10.1016/j.jamda.2013.03.022
Nguyen, T. N., Cumming, R. G., & Hilmer, S. N. (2016). The Impact of Frailty on Mortality, Length of Stay and Re-hospitalisation in Older Patients with Atrial Fibrillation. Heart, lung & circulation, 25(6), 551–557. https://doi.org/10.1016/j.hlc.2015.12.002
Papachristou, E., Wannamethee, S. G., Lennon, L. T., Papacosta, O., Whincup, P. H., Iliffe, S., & Ramsay, S. E. (2017). Ability of Self-Reported Frailty Components to Predict Incident Disability, Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men. Journal of the American Medical Directors Association, 18(2), 152–157. https://doi.org/10.1016/j.jamda.2016.08.020
Pate, R. R., Pratt, M., Blair, S. N., Haskell, W. L., Macera, C. A., Bouchard, C., Buchner, D., Ettinger, W., Heath, G. W., & King, A. C. (1995). Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA, 273(5), 402–407. https://doi.org/10.1001/jama.273.5.402
Peel, N. M., Kuys, S. S., & Klein, K. (2013). Gait speed as a measure in geriatric assessment in clinical settings: a systematic review. The journals of gerontology. Series A, Biological sciences and medical sciences, 68(1), 39–46. https://doi.org/10.1093/gerona/gls174
Pereira, A. A., Borim, F., & Neri, A. L. (2017). Absence of association between frailty index and survival in elderly Brazilians: the FIBRA Study. Cadernos de saude publica, 33(5), e00194115. https://doi.org/10.1590/0102-311X00194115
Piasecki, M., Ireland, A., Jones, D. A., & McPhee, J. S. (2016). Age-dependent motor unit remodelling in human limb muscles. Biogerontology, 17(3), 485–496. https://doi.org/10.1007/s10522-015-9627-3
Purser, J. L., Kuchibhatla, M. N., Fillenbaum, G. G., Harding, T., Peterson, E. D., & Alexander, K. P. (2006). Identifying frailty in hospitalized older adults with significant coronary artery disease. Journal of the American Geriatrics Society, 54(11), 1674–1681. https://doi.org/10.1111/j.1532-5415.2006.00914.x
Puthucheary, Z. A., Astin, R., Mcphail, M., Saeed, S., Pasha, Y., Bear, D. E., Constantin, D., Velloso, C., Manning, S., Calvert, L., Singer, M., Batterham, R. L., Gomez-Romero, M., Holmes, E., Steiner, M. C., Atherton, P. J., Greenhaff, P., Edwards, L. M., Smith, K., Harridge, S. D., & Montgomery, H. E. (2018). Metabolic phenotype of skeletal muscle in early critical illness. Thorax, 73(10), 926–935. https://doi.org/10.1136/thoraxjnl-2017-211073
Romero-Ortuno, R., Wallis, S., Biram, R., & Keevil, V. (2016). Clinical frailty adds to acute illness severity in predicting mortality in hospitalized older adults: An observational study. European journal of internal medicine, 35, 24–34. https://doi.org/10.1016/j.ejim.2016.08.033
Sourdet, S., Lafont, C., Rolland, Y., Nourhashemi, F., Andrieu, S., & Vellas, B. (2015). Preventable Iatrogenic Disability in Elderly Patients During Hospitalization. Journal of the American Medical Directors Association, 16(8), 674–681. https://doi.org/10.1016/j.jamda.2015.03.011
Stessman, J., Rottenberg, Y., Fischer, M., Hammerman-Rozenberg, A., & Jacobs, J. M. (2017). Handgrip Strength in Old and Very Old Adults: Mood, Cognition, Function, and Mortality. Journal of the American Geriatrics Society, 65(3), 526–532. https://doi.org/10.1111/jgs.14509
Syddall, H. E., Westbury, L. D., Dodds, R., Dennison, E., Cooper, C., & Sayer, A. A. (2017). Mortality in the Hertfordshire Ageing Study: association with level and loss of hand grip strength in later life. Age and ageing, 46(3), 407–412. https://doi.org/10.1093/ageing/afw222
Theou, O., Squires, E., Mallery, K., Lee, J. S., Fay, S., Goldstein, J., Armstrong, J. J., & Rockwood, K. (2018). What do we know about frailty in the acute care setting? A scoping review. BMC geriatrics, 18(1), 139. https://doi.org/10.1186/s12877-018-0823-2
Wang, M. C., Li, T. C., Li, C. I., Liu, C. S., Lin, W. Y., Lin, C. H., Yang, C. W., Yang, S. Y., & Lin, C. C. (2019). Frailty, transition in frailty status and all-cause mortality in older adults of a Taichung community-based population. BMC geriatrics, 19(1), 26. https://doi.org/10.1186/s12877-019-1039-9
WHO, W. (2011). Global recommendations on physical activity for health. Geneva World Heal Organ, 60.
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