Prevalence of chronic pain and analysis of handgrip strength in institutionalized elderly

Dáfne dos Santos Ribeiro Karina Garbin Matheus Santos Gomes Jorge Marlene Doring Marilene Rodrigues Portella Lia Mara Wibelinger About the authors

ABSTRACT

BACKGROUND AND OBJECTIVES:

Musculoskeletal disorders are accentuated with aging. Among these, chronic pain can influence several functional aspects such as handgrip strength, especially in institutionalized elderly. The objective of this study was to check the prevalence of chronic pain and to analyze the handgrip strength in institutionalized elderly.

METHODS:

A cross-sectional, population-based study was carried out at long-term care facilities in Passo Fundo/RS (2016-2018). The population was composed of 281 residents, evaluated for sociodemographic variables (medical records), handgrip strength (manual dynamometry), and chronic pain (self-report). The statistical analysis used the descriptive statistics and the Student t-test of independent samples (p≤0.05).

RESULTS:

The sample consisted of 173 elderly individuals (80.95±8.94 years). The majority lived in private institutions, were women, widows, with 1 to 8 years of education. The prevalence of chronic pain was 39.3%, and the mean handgrip strength was 7.0±6.42kg (right hand) and 6.24±5.96kg (left hand). The handgrip strength was higher in the groups of elderly men (right and left hands: p=0.000) and non-long-living seniors (right hand: p=0.017; left hand: p=0.002). There was no difference in handgrip strength values between the groups with and without chronic pain (p>0.05).

CONCLUSION:

Institutionalized elderly present an expressive prevalence of chronic pain and handgrip strength values much lower than expected, being influenced by gender and age.

Keywords:
Gender and health; Hand strength; Health profile; Longevity; Long-term care facilities for the elderly; Pain

RESUMO

JUSTIFICATIVA E OBJETIVOS:

Os distúrbios musculoesqueléticos se acentuam com o avanço da idade. Dentre eles, a dor crônica pode influenciar em diversos aspectos funcionais, como a força de preensão manual, especialmente em idosos institucionalizados. O objetivo deste estudo foi verificar a prevalência de dor crônica e analisar a força de preensão manual em idosos institucionalizados.

MÉTODOS:

Estudo transversal de base populacional, realizado em instituições de longa permanência de Passo Fundo/RS (2016-2018). A população foi composta por 281 residentes, avaliados quanto às variáveis sociodemográficas (registros médicos), a força de preensão manual (dinamometria manual) e a dor crônica (autorrelato). A análise estatística utilizou a estatística descritiva e o teste t Student de amostras independentes (p≤0,05).

RESULTADOS:

A amostra foi composta por 173 idosos (80,95±8,94 anos). A maioria residia em instituições privadas, eram mulheres, viúvas e com escolaridade de 1 a 8 anos. A prevalência de dor crônica foi de 39,3% e a força de preensão manual média foi de 7,0±6,42kg (mão direita) e 6,24±5,96kg (mão esquerda). A força de preensão manual foi maior nos grupos dos idosos do sexo masculino (mãos direita e esquerda: p=0,000) e dos idosos não longevos (mão direita p=0,017; mão esquerda p=0,002). Não houve diferença nos valores de força de preensão manual entre os grupos com e sem dor crônica (p>0,05).

CONCLUSÃO:

Idosos institucionalizados apresentam uma expressiva prevalência de dor crônica e valores de força de preensão manual muito abaixo do esperado, sendo influenciada pelo sexo e pela idade.

Descritores:
Dor; Força da mão; Sexo e saúde; Instituição de longa permanência para idosos; Longevidade; Perfil de saúde

INTRODUCTION

Individuals aged 65 and over in developed countries and over 60 in underdeveloped or developing countries are considered elderly11 Ponciano Netto M. O Estudo da Velhice: Histórico, Definição do Campo e Termos Básicos. In: Freitas EV, Py L, editores. Tratado de Geriatria e Gerontologia. 4ª ed. Rio de Janeiro: Guanabara Koogan; 2016. 62-75p.. In Brazil, estimates indicate that by 2025, the elderly population could reach 32 million people22 Instituto Brasileiro de Geografia e Estatística - IBGE. Perfil dos idosos responsáveis pelos domicílios. Brasília: 2010. [Acesso em: 22 de setembro de 2014]. Disponível em: URL: https://ww2.ibge.gov.br/home/presidencia/noticias/25072002pidoso.shtm.
https://ww2.ibge.gov.br/home/presidencia...
. With human aging, a series of physiological insufficiencies and changes in cellular, tissue, and systemic activity occur. Thus, the elderly has changes in the neuromuscular system, reduced muscle mass, and strength, flexibility, resistance, joint mobility, coordination, and balance33 Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. J Pain. 2012;13(8):773-83..

The elderly is the group of individuals who suffer major consequences from chronic musculoskeletal pain, a condition that affects 100 million people worldwide. Pain is one of the main factors that impact the quality of life (QoL), productivity44 Kayser B, Miotto C, Molin VD, Kummer J, Klein SR, Wibelinger LM. Influence of chronic pain on functional capacity of the elderly. Rev Dor. 2014;15(1):48-50. and functionality, especially in the elderly55 Miotto C, Kayser B, Molin VD, Kummer JA, Wibelinger LM. Physiotherapeutic treatment of arthralgias. Rev Dor. 2013;14(3):216-8..

Such complications resulting from the senescence process are significant and interfere with the functionality and performance of activities of daily living66 Garrido R, Menezes PR. Brazil is aging: good and bad news from an epidemiological perspective. Rev Bras Psiquiatr. 2002;24(Suppl 1):3-6.. In this sense, the hands, which are complex structures with particular functions, such as the handgrip strength (HGS), and fundamental to effectively perform activities of daily living (ADL)77 Jorge MS, Knob B, Ribeiro D dos S, Zanin C, Wibelinger LM. Effects of rehabilitation physiotherapeutic in the hands of individuals with rheumatic diseases: systematic review. Rev Inspirar. 2017;14(3):39-47., physiologically present growth in their values of grip strength until the third decade of life, which after that has declined88 Jorge MS, Ribeiro DS, Garbin K, Moreira I, Rodigheri PV, Lima WG, et al. Values of handgrip strength in a population of different age groups. Lect Educ Física y Deport. 2019;23(249):56-69.. In addition, individuals with pathological conditions that cause pain present even more impaired values77 Jorge MS, Knob B, Ribeiro D dos S, Zanin C, Wibelinger LM. Effects of rehabilitation physiotherapeutic in the hands of individuals with rheumatic diseases: systematic review. Rev Inspirar. 2017;14(3):39-47.,99 Jorge MS, Lima WG, Vieira PR, Siiss LA, Zanin C, Vogelmann SC, et al. Effects of kinesiotherapy on palmar grip strength in individuals with rheumatic diseases. RIES. 2018;7(1):374-87.. In this sense, it can be assumed that institutionalized elderly, who may have decreased HGS due to pain, are more susceptible to falls, difficulty performing ADL, impact on their functionality and mobility, and even the higher risk of mortality.

The literature has already presented the values of the HGS and its relationship with chronic pain in community elderly1010 Wagner PR, Ascenço S, Wibelinger LM. Hand grip strength in the elderly with upper limbs pain. Rev Dor. 2014;15(3):182-5.. However, few studies explore this relationship in institutionalized elderly, which becomes a problem, as this population has worse physical and cognitive conditions than their peers in the community, which may interfere with their health status1111 Lini EV, Portella MR, Doring M. Factors associated with the institutionalization of the elderly: a case-control study. Rev Bras Geriatr Gerontol. 2016;19(6):1004-14.. Knowing the prevalence of chronic pain and HGS values in residents of long-term care facilities for the elderly (LTCF) is fundamental for understanding the health profile of this population, as well as for outlining health promotion strategies and QoL in this context, and contribute to the implementation of public policies in the care of these elderly. Thus, this study aimed to verify the prevalence of chronic pain and to analyze the HGS in institutionalized elderly.

METHODS

A population-based, descriptive and exploratory cross-sectional study that is part of a project entitled “Patterns of Aging and Longevity: Biological, Educational and Psychosocial Aspects of Institutionalized Elderly” (PROCAD) developed by the Graduate Program in Human Aging from the University of Passo Fundo. The study was conducted in Passo Fundo/RS, one of the most populated cities in the state, characterized as an important regional health and education hub. In addition, the municipality has 24 LTCF that house about 450 elderly people1212 Zanin C, Candido JB, Jorge MS, Wibelinger LM, Doring M, Portella MR. Sarcopenia and chronic pain in institutionalized elderly women. BrJP. 2018;1(4):288-92..

The sample calculation was performed using the formula “n=Z22 Instituto Brasileiro de Geografia e Estatística - IBGE. Perfil dos idosos responsáveis pelos domicílios. Brasília: 2010. [Acesso em: 22 de setembro de 2014]. Disponível em: URL: https://ww2.ibge.gov.br/home/presidencia/noticias/25072002pidoso.shtm.
https://ww2.ibge.gov.br/home/presidencia...
.p.(1-p)/e22 Instituto Brasileiro de Geografia e Estatística - IBGE. Perfil dos idosos responsáveis pelos domicílios. Brasília: 2010. [Acesso em: 22 de setembro de 2014]. Disponível em: URL: https://ww2.ibge.gov.br/home/presidencia/noticias/25072002pidoso.shtm.
https://ww2.ibge.gov.br/home/presidencia...
”, where the letter “n” corresponds to the desired sample size; the letter “Z” corresponds to the deviation of the acceptable average value to reach the desired confidence level (adopting the most commonly used value for this type of calculation: 1.96), the letter “p” corresponds to the expected proportion (adopted the value of 58.1%, taking into consideration the findings of Barbosa et al.1313 Barbosa MH, Bolina AF, Tavares JL, Cordeiro AL, Luiz RB, de Oliveira KF. Sociodemographic and health factors associated with chronic pain in institutionalized elderly. Rev Lat Am Enfermagem. 2014;22(6):1009-16. English, Portuguese, Spanish. and the letter “e” corresponds to the admitted margin of error (adopting the most commonly used value for this type of calculation: 0.05). Thus, the sample size needed to meet the aim of this study would be approximately 374 individuals.

Inclusion criteria were individuals of both genders, aged 60 years old and over, who lived in LTCF in the city of Passo Fundo/RS full time. Exclusion criteria were individuals unable to walk, verbalize or perform the manual dynamometry test (restricted to bed), who were hospitalized on the day of the meeting with the research team, with upper limb neuromotor sequelae, with amputation of one of the upper limbs, or in acute condition of degenerative diseases. Losses were considered to be eligible individuals who refused to participate or who did not sign the Free and Informed Consent Term (FICT). Study participants signed the FICT.

The data collection period was between December 2016, and July 2018. The data collection procedure and the elaboration of the data collection instrument has already been described1212 Zanin C, Candido JB, Jorge MS, Wibelinger LM, Doring M, Portella MR. Sarcopenia and chronic pain in institutionalized elderly women. BrJP. 2018;1(4):288-92.. Sociodemographic and health data were included in a questionnaire prepared by the authors themselves, which recorded the type of LTCF, gender, age, marital status, education, and the presence of chronic pain.

The MPF was assessed by manual dynamometry using a Kratos® device. This instrument measures the handgrip strength produced through an isometric contraction recorded in kilograms(kg)88 Jorge MS, Ribeiro DS, Garbin K, Moreira I, Rodigheri PV, Lima WG, et al. Values of handgrip strength in a population of different age groups. Lect Educ Física y Deport. 2019;23(249):56-69.. In this study, the recommendations of the American Society of Hand Therapists were used, where the individual should be seated, with the shoulder adducted, elbow flexed at 90º, neutral forearm and wrist with 30º extension. Three attempts were made, and then the arithmetic mean calculated1414 MacDermid J, Solomon G, Valdes K. Clinical Assessment Recommendations. 3rd ed. MacDermid J, Solomon G, Valdes K, editors. American Society of Hand Therapists; 2015. 80p..

This study was approved by the UPF Human Research Ethics Committee under opinion number 2.097.278. The study is in accordance with the guidelines of National Health Council Resolution 466/2012, which deals with regulatory standards and ethical aspects of research involving human beings, and the Declaration of Helsinki.

Statistical analysis

Data were coded and stored in a database using statistical software. The descriptive statistics was used to characterize the sample, and to verify the relationship between quantitative and qualitative variables, the analysis was performed by Student’s t-test of independent samples. The significance level adopted was p≤0.05.

RESULTS

The study population consisted of 281 elderly residents in LTCF in the city of Passo Fundo/RS. Based on the inclusion and exclusion criteria, the sample involved 173 institutionalized elderly, with a mean age of 80.95±8.94 years old (60-100). 108 institutionalized elderly (16 elderly did not answer about the presence or absence of chronic pain, and 92 elderly could not perform the manual dynamometry test) were excluded, totaling a sample loss of approximately 38%. Table 1 presents the data regarding the characterization of the sample studied.

Table 1
Characterization of the sample. Passo Fundo/RS, 2019

Most of the elderly lived in private LTCF, were long-lived, widows with education from 1 to 8 years of study. The prevalence of chronic pain was 39.3%, and the mean HGS was 7.0±6.42 (0-30.0) kg in the right hand and 6.24±5.96 (0-27.0) kg in the left hand. Table 2 presents the relationship between the HGS and the dependent variables chronic pain, gender, and age group of institutionalized elderly.

Table 2
Relationship between handgrip strength, chronic pain, gender, and age group in institutionalized elderly. Passo Fundo/RS, 2019

There was no relationship between HGS and chronic pain in institutionalized elderly. However, men and non-long-lived elderly had higher HGS values in both hands compared to women and long-lived elderly.

DISCUSSION

The institutionalized elderly presented very low HGS values compared to the reference values for this age group, which are 30.0kg for men and 20.0kg for women1515 Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-23.. The prevalence of chronic pain was also low in the study sample compared to other studies conducted in the same context1313 Barbosa MH, Bolina AF, Tavares JL, Cordeiro AL, Luiz RB, de Oliveira KF. Sociodemographic and health factors associated with chronic pain in institutionalized elderly. Rev Lat Am Enfermagem. 2014;22(6):1009-16. English, Portuguese, Spanish.,1616 Reis LA, Torres GV. Influência da dor crônica na capacidade funcional de idosos institucionalizados. Rev Bras Enferm. 2011;64(2):274-80.. Still, there was no relationship between the HGS and chronic pain, but between the HGS and the factors gender and age.

In this study, it was found that the profile of the institutionalized elderly consisted predominantly of private residents of LTCF, women, long-lived, widows and with education from 1 to 8 years1212 Zanin C, Candido JB, Jorge MS, Wibelinger LM, Doring M, Portella MR. Sarcopenia and chronic pain in institutionalized elderly women. BrJP. 2018;1(4):288-92. and that are in agreement with other studies1111 Lini EV, Portella MR, Doring M. Factors associated with the institutionalization of the elderly: a case-control study. Rev Bras Geriatr Gerontol. 2016;19(6):1004-14.,1717 Damo CC, Doring M, Alves AL, Portella MR. Risk of malnutrition and associated factors in institutionalized elderly persons. Rev Bras Geriatr Gerontol. 2018;21(6):735-42.,1818 Ferreira E, Portella MR, Doring M. Changes to the feet of institutionalized elderly persons. Rev Bras Geriatr Gerontol. 2018;21(3):352-9..

With the considerable increase in the number of elderly people in recent times, musculoskeletal disorders, especially chronic pain, have been one of the main complaints among this population1919 Jorge MS, Zanin C, Knob B, Wibelinger LM. Physiotherapeutic intervention on chronic lumbar pain impact in the elderly. Rev Dor. 2015;16(4):302-5., and in up to 80% of cases, these symptoms persist for at least two years until the search for treatment2020 Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. Portuguese.. Thus, chronic pain can be a compromising factor for dislocation and functional activities of daily living, implying disability and loss of QoL of the elderly2121 Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. English, Portuguese, Spanish..

The prevalence of chronic pain in the elderly is constantly explored, and these values are widely variable, permeating around 50% of the elderly in the community2121 Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. English, Portuguese, Spanish.,2222 Dellaroza MS, Pimenta CA, Matsuo T. [Prevalence and characterization of chronic pain among the elderly living in the community]. Cad Saude Publica. 2007;23(5):1151-60. Portuguese.. In institutionalized elderly, this number may vary between 40 and 78%2323 Pereira LV, Pereira Gde A, Moura LA, Fernandes RR. [Pain intensity among institutionalized elderly: a comparison between numerical scales and verbal descriptors]. Rev Esc Enferm USP. 2015;49(5):804-10. Portuguese.. In this study, a prevalence of chronic pain in institutionalized elderly was found corresponding to what the literature reports.

Decreased HGS in the elderly is related to impairments in performing manual tasks and functional limitations in gait and balance, such as the increased risk of falls and loss of functional independence2424 Pereira R, Cardoso BS, Itaborahy AS, Machado M. Análise da força de preensão de mulheres idosas: estudo comparativo entre faixas etárias. Acta Med Port. 2011;24(1):521-6.. Thus, assessing it is essential to determine the risk of accelerated health decline in the elderly2525 Taekema DG, Gussekloo J, Maier AB, Westendorp RG, de Craen AJ. Handgrip strength as a predictor of functional, psychological and social health. A prospective population-based study among the oldest old. Age Ageing. 2010;39(3):331-7.. A previous study analyzed the HGS of 112 community elderly in the municipality of Passo Fundo/RS, considering age, disease presence, and gender. The HGS values were 24.4kg (right hand) and 13.8kg (left hand) in the men’s group, and 15.0kg (right hand) and 15.6kg (left hand) in the women group. In addition, 40.2% of the elderly had some type of joint disease that causes pain2626 Dresch DR, Tauchert V, Wibelinger LM. Handgrip strength of elderly. Lect Educ Física y Deport. 2014;19(194):1-1.. Although the prevalence of chronic pain is similar to the current study, the values of HGS are much higher than those of institutionalized elderly, demonstrating the need to pay attention to the assessment of HGS in this population and the design of public policies for this population.

The results presented in this study on the relationship between HGS and gender (higher in men) and the relationship between HGS and age (higher in non-long-lived elderly), corroborate a recent study with 114 individuals in different age groups, which showed HGS was higher in males, and the peak was in the 30-39 age group, with decline thereafter. In addition, the prevalence of chronic pain and chronic diseases was higher among the elderly compared to the younger ones88 Jorge MS, Ribeiro DS, Garbin K, Moreira I, Rodigheri PV, Lima WG, et al. Values of handgrip strength in a population of different age groups. Lect Educ Física y Deport. 2019;23(249):56-69., reinforcing the importance of investigating the relationship between HGS with variables that may influence it, such as chronic pain.

Among the various factors that may influence the values of HGS, chronic pain can be cited88 Jorge MS, Ribeiro DS, Garbin K, Moreira I, Rodigheri PV, Lima WG, et al. Values of handgrip strength in a population of different age groups. Lect Educ Física y Deport. 2019;23(249):56-69., because, during static contraction, the activity of the aching muscle decreases and other muscles are used in a compensated way to perform the desired movements, increasing the individual’s pain2727 Falla D, Farina D, Dahl MK, Graven-Nielsen T. Muscle pain induces task-dependent changes in cervical agonist/antagonist activity. J Appl Physiol. 2007;102(2):601-9.,2828 Ervilha UF, Arendt-Nielsen L, Duarte M, Graven-Nielsen T. Effect of load level and muscle pain intensity on the motor control of elbow-flexion movements. Eur J Appl Physiol. 2004;92(1-2):168-75.. Thus, it is believed that the loss of muscle strength, including the hands, may be related to this cycle. However, to confirm this hypothesis, further studies with this aim are needed.

In this sense, a study analyzed the HGS of the elderly with and without chronic upper limb pain. The authors assessed 119 elderly from the community and found that the overall HGS was 16.6kg (right hand) and 15.2kg (left hand). When comparing the groups, they found that the right hand HGS was 14.7kg (group with chronic pain) and 15.2kg (group without chronic pain), and the left hand was 14.0kg (group with chronic pain) and 13.5kg (group without chronic pain)1010 Wagner PR, Ascenço S, Wibelinger LM. Hand grip strength in the elderly with upper limbs pain. Rev Dor. 2014;15(3):182-5.. Such values are much higher than those found in this research.

This work showed that, regardless of having chronic pain or not, older men presented higher HGS than women in all measurements, except in the left-hand HGS, and only in the left-hand measurement of the women group there was a significant difference in the values of HGS among individuals with and without chronic pain1010 Wagner PR, Ascenço S, Wibelinger LM. Hand grip strength in the elderly with upper limbs pain. Rev Dor. 2014;15(3):182-5.. These findings corroborate the current study, as it was found that men had higher HGS values than women, and there was no relationship between HGS and chronic pain in institutionalized elderly.

The institutionalized elderly has worse health conditions than their peers in the community, especially cognitive and functional1111 Lini EV, Portella MR, Doring M. Factors associated with the institutionalization of the elderly: a case-control study. Rev Bras Geriatr Gerontol. 2016;19(6):1004-14.. This may justify the reason why the institutionalized elderly presented very low HGS values compared to other studies already presented, performed with community elderly1010 Wagner PR, Ascenço S, Wibelinger LM. Hand grip strength in the elderly with upper limbs pain. Rev Dor. 2014;15(3):182-5.,2626 Dresch DR, Tauchert V, Wibelinger LM. Handgrip strength of elderly. Lect Educ Física y Deport. 2014;19(194):1-1.. This finding is reinforced by another study that assessed 71 elderly (42 community residents and 29 residents in LTCF) and showed that the institutionalized elderly had lower HGS values than the community elderly2929 Gonzalez CS, Aroca JP. Handgrip strength measurement in institutionalized and not institutionalized elderly people in Cascavel - PR. Rev FIEP Bull. 2008;78(2):116-8..

This study is not free to present limitations. As this was a large research, a large team was needed to perform data collection, and several interviewers were required to apply the sociodemographic questionnaire and the manual dynamometry test. To minimize possible biases, they were previously trained and oriented, as explained in the “methods” section in another published study1212 Zanin C, Candido JB, Jorge MS, Wibelinger LM, Doring M, Portella MR. Sarcopenia and chronic pain in institutionalized elderly women. BrJP. 2018;1(4):288-92.. In addition, the lower than expected number for the sample size and the non-differentiation of individuals by diseases or causes of chronic pain were factors that could influence the results obtained, but do not prevent data generation, encouraging future research on this subject.

CONCLUSION

Institutionalized elderly had a significant prevalence of chronic pain and HGS values much lower than expected. Still, the HGS is influenced by factors such as gender and age but was not related to chronic pain.

REFERENCES

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    Ponciano Netto M. O Estudo da Velhice: Histórico, Definição do Campo e Termos Básicos. In: Freitas EV, Py L, editores. Tratado de Geriatria e Gerontologia. 4ª ed. Rio de Janeiro: Guanabara Koogan; 2016. 62-75p.
  • 2
    Instituto Brasileiro de Geografia e Estatística - IBGE. Perfil dos idosos responsáveis pelos domicílios. Brasília: 2010. [Acesso em: 22 de setembro de 2014]. Disponível em: URL: https://ww2.ibge.gov.br/home/presidencia/noticias/25072002pidoso.shtm
    » https://ww2.ibge.gov.br/home/presidencia/noticias/25072002pidoso.shtm
  • 3
    Azevedo LF, Costa-Pereira A, Mendonça L, Dias CC, Castro-Lopes JM. Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal. J Pain. 2012;13(8):773-83.
  • 4
    Kayser B, Miotto C, Molin VD, Kummer J, Klein SR, Wibelinger LM. Influence of chronic pain on functional capacity of the elderly. Rev Dor. 2014;15(1):48-50.
  • 5
    Miotto C, Kayser B, Molin VD, Kummer JA, Wibelinger LM. Physiotherapeutic treatment of arthralgias. Rev Dor. 2013;14(3):216-8.
  • 6
    Garrido R, Menezes PR. Brazil is aging: good and bad news from an epidemiological perspective. Rev Bras Psiquiatr. 2002;24(Suppl 1):3-6.
  • 7
    Jorge MS, Knob B, Ribeiro D dos S, Zanin C, Wibelinger LM. Effects of rehabilitation physiotherapeutic in the hands of individuals with rheumatic diseases: systematic review. Rev Inspirar. 2017;14(3):39-47.
  • 8
    Jorge MS, Ribeiro DS, Garbin K, Moreira I, Rodigheri PV, Lima WG, et al. Values of handgrip strength in a population of different age groups. Lect Educ Física y Deport. 2019;23(249):56-69.
  • 9
    Jorge MS, Lima WG, Vieira PR, Siiss LA, Zanin C, Vogelmann SC, et al. Effects of kinesiotherapy on palmar grip strength in individuals with rheumatic diseases. RIES. 2018;7(1):374-87.
  • 10
    Wagner PR, Ascenço S, Wibelinger LM. Hand grip strength in the elderly with upper limbs pain. Rev Dor. 2014;15(3):182-5.
  • 11
    Lini EV, Portella MR, Doring M. Factors associated with the institutionalization of the elderly: a case-control study. Rev Bras Geriatr Gerontol. 2016;19(6):1004-14.
  • 12
    Zanin C, Candido JB, Jorge MS, Wibelinger LM, Doring M, Portella MR. Sarcopenia and chronic pain in institutionalized elderly women. BrJP. 2018;1(4):288-92.
  • 13
    Barbosa MH, Bolina AF, Tavares JL, Cordeiro AL, Luiz RB, de Oliveira KF. Sociodemographic and health factors associated with chronic pain in institutionalized elderly. Rev Lat Am Enfermagem. 2014;22(6):1009-16. English, Portuguese, Spanish.
  • 14
    MacDermid J, Solomon G, Valdes K. Clinical Assessment Recommendations. 3rd ed. MacDermid J, Solomon G, Valdes K, editors. American Society of Hand Therapists; 2015. 80p.
  • 15
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-23.
  • 16
    Reis LA, Torres GV. Influência da dor crônica na capacidade funcional de idosos institucionalizados. Rev Bras Enferm. 2011;64(2):274-80.
  • 17
    Damo CC, Doring M, Alves AL, Portella MR. Risk of malnutrition and associated factors in institutionalized elderly persons. Rev Bras Geriatr Gerontol. 2018;21(6):735-42.
  • 18
    Ferreira E, Portella MR, Doring M. Changes to the feet of institutionalized elderly persons. Rev Bras Geriatr Gerontol. 2018;21(3):352-9.
  • 19
    Jorge MS, Zanin C, Knob B, Wibelinger LM. Physiotherapeutic intervention on chronic lumbar pain impact in the elderly. Rev Dor. 2015;16(4):302-5.
  • 20
    Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. Portuguese.
  • 21
    Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. English, Portuguese, Spanish.
  • 22
    Dellaroza MS, Pimenta CA, Matsuo T. [Prevalence and characterization of chronic pain among the elderly living in the community]. Cad Saude Publica. 2007;23(5):1151-60. Portuguese.
  • 23
    Pereira LV, Pereira Gde A, Moura LA, Fernandes RR. [Pain intensity among institutionalized elderly: a comparison between numerical scales and verbal descriptors]. Rev Esc Enferm USP. 2015;49(5):804-10. Portuguese.
  • 24
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Publication Dates

  • Publication in this collection
    23 Sept 2019
  • Date of issue
    Jul-Sep 2019

History

  • Received
    04 Mar 2019
  • Accepted
    21 May 2019
Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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