Evaluation of frailty, functional capacity and quality of life of the elderly in geriatric outpatient clinic of a university hospital

Crislainy Vieira Freitas Edilene do Socorro Nascimento Falcão Sarges Karlo Edson Carneiro Santana Moreira Saul Rassy Carneiro About the authors

Abstracts

Objective

To investigate the occurrence of frailty and analyze the functional capacity and quality of life in the elderly in a department of geriatrics and gerontology in Belém-PA.

Method

Cross-sectional, descriptive and analytical study.103 elderly people were assessed as the socio-demographic and clinical aspects, frailty, according to the phenotype of Fried, history of falls, self-perceived health, functional capacity (FC) and quality of life (QOL). The elderly were classified as frail (FR), pre-frail (PF) and non-frail (NF). The groups were compared using the binomial test, Kruskal-Wallis test and ANOVA test, and the relationship between FC and QOL through Pearson correlation.

Results

The mean age was 73.39(±6.42) years; 23.0% of the elderly were FR, 57.0%were PF and 20.0% were NF. The highest criteria of phenotype were muscle weakness and physical inactivity. Was no difference in FC between FR and PF (p<0.01) and FR and NF (p<0.01). The FR elderly had lower QOL and the highest scores were intimacy (15.33±2.26) and death and dying (14.88±3.26). There were correlation between FC and QOL in groups PF (p=0.0273) and NF (p=0.0017). 62.1% of seniors pointed to health as regular and 34.0% had a history of falling.

Conclusion

Muscle weakness and physical inactivity were most striking in the development of frailty, which was associated with worse QOL and FC, despite most seniors be independent. These data are important for early detection of determinants of frailty, since the criteria discussed here are reversible.

Frail Elderly; Quality of Life; Health of the Elderly


Objetivo

Investigar a ocorrência de fragilidade e analisar a capacidade funcional e qualidade de vida nos idosos atendidos em um serviço de geriatria e gerontologia em Belém-PA.

Método

Estudo transversal, descritivo e analítico. Foram avaliados 103 idosos quanto a aspectos sociodemográficos e clínicos, fragilidade de acordo com o fenótipo de Fried, histórico de quedas, autopercepção de saúde, capacidade funcional (CF) e qualidade de vida (QV). Os idosos foram classificados em frágeis (FR), pré-frágeis (PF) e não frágeis (NF), os grupos foram comparados por meio de teste binomial, de Kruskal-Wallis e ANOVA, e a relação entre CF e QV por meio da correlação de Pearson.

Resultados

A média de idade foi 73,39(±6,42) anos; 23,0% dos idosos eram FR, 57,0% PF e 20,0% NF. Os critérios do fenótipo mais pontuados foram fraqueza muscular e inatividade física. Houve diferença na CF entre FR e PF (p<0,01) e FR e NF (p<0,01). Os idosos FR apresentaram menor QV e as facetas mais pontuadas foram intimidade (15,33±2,26) e morte e morrer (14,88±3,26). Houve correlação entre CF e QV nos grupos PF (p=0,0273) e NF (p=0,0017); 62,1% dos idosos apontaram saúde regular e 34,0% tinham histórico de queda.

Conclusão

Fraqueza muscular e inatividade física foram mais marcantes no desenvolvimento da fragilidade, que esteve associada a pior CF e QV, apesar de a maioria dos idosos ser independente. Esses dados são importantes para a detecção precoce de fatores determinantes da fragilidade, já que os critérios abordados são passíveis de reversão.

Idoso Fragilizado; Qualidade de Vida; Saúde do Idoso


INTRODUCTION

Population aging, which is a major phenomenon in Brazil, is related to an increase in chronic diseases and geriatric syndromes, such as the syndrome of frailty.11. Chaimowicz F. Epidemiologia e o Envelhecimento no Brasil. In: Freitas EV, Cançado FA, Doll J, Gorzoni ML, organizadores. Tratado de geriatria e gerontologia. 2ª ed. Rio de Janeiro: Guanabara Koogan; 2006. p. 106-30.,22. Secretaria de Saúde do Estado do Espírito Santo. Diretrizes da saúde da pessoa idosa. 1ª ed. Vitória: Secretaria de Saúde; 2008.. The study of this condition is therefore of major importance, as it can lead to a reduction in the expectancy for a healthy life and the impairment of the autonomy and independence of the elderly, and hence, a deterioration in quality of life (QOL)33. Arantes PMM, Alencar MA, Dias RC, Dias JMD, Pereira LSM. Atuação da fisioterapia na síndrome de fragilidade: revisão sistemática. Rev Bras Fisioter 2009;13(5):365-75..

Functional independence is understood as the capacity to perform essential living activities, including caring for oneself, living independently in a house, and carrying out activities that are important for one's QOL44. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disablity, frailty and comorbidity: implications for improved targeting and care. J Gerontol Ser A Biol Sci Med Sci 2004;59(3):255-63. while QOL in old age means a perception of well-being through an evaluation of to what extent an individual has realized that which is seen as important for a good life and the degree of satisfaction with what has been achieved until that moment.55. Paschoal SMP. Qualidade de vida do idoso: construção de um instrumento de avaliação através de um método de impacto clínico [tese]. São Paulo: Universidade de São Paulo; 2004.

As such, the frailty syndrome has the potential to affect all aspects of life of the elderly. Furthermore, it is an event whose effects extend beyond the elderly themselves, placing a burden on relatives and caregivers, and resulting in high health service costs.33. Arantes PMM, Alencar MA, Dias RC, Dias JMD, Pereira LSM. Atuação da fisioterapia na síndrome de fragilidade: revisão sistemática. Rev Bras Fisioter 2009;13(5):365-75.,66. Brasil. Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Envelhecimento e saúde da pessoa idosa. Brasília, DF: Ministério da Saúde; 2006. (Série Normas e Manuais Técnicos); (Cadernos de Atenção Básica, n. 19).

According to Borges & Menezes,7 7. Borges LL, De Menezes RL. Fragilidade: uma revisão sistemática de definições e marcadores. In: Universidade Católica de Goiás. 4ª Amostra de Produção Científica da Pós-Graduação Latu Sensu [Internet];23 out. 2009 [acesso 10 dez 2013]. Goías: PUC; 2009. Disponível em: http://www.cpgls.ucg.br/ArquivosUpload/1/File/CPGLS/IV%20 MOSTRA/SADE/SAUDE/Fragilidade%20_%20 uma%20Revisosistemtica%20de%20Definies%20 e%20Marcadores%20Frailty%20_%20a%20 Systematic%20Review.pdf.
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some authors consider only physical indicators when defining frailty among the elderly, while others include cognitive, psychological and environmental criteria. Although there is some heterogeneity, currently the most commonly used definition of the frailty syndrome among the scientific community is that proposed by Fried et al.44. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disablity, frailty and comorbidity: implications for improved targeting and care. J Gerontol Ser A Biol Sci Med Sci 2004;59(3):255-63. which considers it to be "a clinical and multifactorial syndrome characterized by a reduction in energy reserves and reduced resistance to stressors, resulting from the cumulative decline of physiological systems".

These authors44. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disablity, frailty and comorbidity: implications for improved targeting and care. J Gerontol Ser A Biol Sci Med Sci 2004;59(3):255-63. proposed a frailty phenotype that involves five factors: weight loss, fatigue, muscle weakness, physical inactivity and slowness of gait. A frail elderly individual is someone who exhibits three or more such components, while individuals with one or two components are classified as pre-frail, and have twice the risk of becoming frail.8 Health professionals should be aware of these aspects, as it is preferable to prevent this syndrome from occurring in the first place than it is to treat a frail elderly person. Early identification of the predictive characteristics that define the syndrome allows the creation of measures that improve the QOL of the elderly person and avoid adverse events, thereby preventing, slowing or stopping the progression of frailty, by improving the care of the elderly.99. Remor CB, Bós AJG, Werlang MC. Características relacionadas ao perfil de fragilidade no idoso. Sci Med 2011;21(3):107-12.

Considering this information, the present study aimed to investigate the occurrence of frailty among elderly persons treated at a geriatric and gerontology department in Belém, in the state of Pará, as well as analyzing the functional capacity and quality of life of this population.

METHOD

An observational, cross-sectional, descriptive and analytical study was performed. It was approved by the Research Ethics Committee of the Hospital Universitário João de Barros Barreto ("the João de Barros Barreto University Hospital") (HUJBB), under registration n° 267149/2013. Sampling was carried out by the convenience method and included elderly men and women aged 60 years or older who attended the geriatric clinic of the HUJBB between June and September 2013. Elderly individuals with cognitive conditions that would make answering questions difficult or impossible were excluded, as determined by scores below the cutoff points established by the Mini-Mental State Examination (MMSE) adjusted for the level of education1010. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(1):189-98.. Those with motor impairments that prevented the assessment of gait and who complained of pain, severe dyspnea or other acute symptoms at the time of evaluation were also excluded from the study. Elderly persons who used walking, visual or hearing aids were not excluded.

After signing a Free and Informed Consent Form (FICF), the elderly persons considered fit for the study responded to an interview containing of sociodemographic (age, gender, education, marital status, and others) and clinical (comorbidity, living habits) data, history of falls and self-perceived health condition; followed by an evaluation of frailty using the phenotype proposed by Fried et al88. Fried LP, Tangen CM, Walston J. Frailty in older adults: evidence of a phenotype. J Gerontol Ser A Biol Sci Med Sci 2001;56(1):146-56. Functional Capacity (FC), using the Functional Independence Measure (FIM) validated for the Brazilian population,1111. Riberto M, Miyazaki MH, Jucá SSH, Sakamoto H, Potiguara P, Pinto N, et al. Validação da versão brasileira da medida de independência funcional. Acta Fisiátrica 2004;11(2):72-6. and QOL, using the World Health Organization WHOQOL-Old scale1212. Power M, Schmidt S. Manual WHOQOL-OLD [Internet]. Genebra: World Health Organization; 1998 [acesso 22 ago. 2012]. Disponível em: http://www.ufrgs.br/psiq/whoqolold%20Manual %20 POrtugues.pdf
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were measured. The assessments were made by a single trained researcher based on the parameters determined by literature.

For frailness testing, unintentional weight loss was considered the self-reporting of weight loss equal to or greater than 4.5kg or 5% of the weight from the year before, without dietary intervention. Muscle strength was measured by grip strength of the dominant hand measured with SaehanTM brand equipment, with which three measures were taken and the arithmetic average used, with a cut-off point adjusted for body mass index (BMI) and gender.1313. Santos EGS. Perfil de fragilidade em idosos comunitários de Belo Horizonte: um estudo transversal [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais; 2008.

Self-reported fatigue was evaluated by agreeing "always" or "mostly" (criteria 3 or 4) to two statements: "I lost interest in my usual activities" and "I could not get going" that make up the scale for assessing depression of the Center for Epidemiological Studies (CES-D) in the USA, validated by Tavares et al.1414. Tavares BS, Neri AL, Cupertino APFB. Validity of the center for epidemiological studies: depression scale (CES-D) among Brazilian elderly. Cad Saúde Pública 2007;41(4):598-605. Gait velocity was measured by the time spent to cover a distance of 4.6m at a comfortable speed, adjusted for gender and stature,88. Fried LP, Tangen CM, Walston J. Frailty in older adults: evidence of a phenotype. J Gerontol Ser A Biol Sci Med Sci 2001;56(1):146-56. with the acceleration and deceleration parts of walking discarded. Finally, level of physical activity was measured by the short version of the International Physical Activity Questionnaire (IPAQ),1515. Marshall A, Buman A. The international physical activity questionnaire: summary report of the reliability & validity studies. DRAFT IPAQ. Geneve: OMS; 2001. adapted for Brazilian elderly individuals,1616. Mazo GZ, Benedetti TRB. Adaptação do questionário internacional de atividade física para idosos. Rev Bras Cineantropom Desempenho Hum 2010;12(6):480-84. with a time of 150 minutes or less per week spent in moderate and intense activities counting towards a definition of frailty.

After the evaluations, the elderly were classified as frail (FR), pre-frail (PF) and not frail (NF) according to the phenotype.88. Fried LP, Tangen CM, Walston J. Frailty in older adults: evidence of a phenotype. J Gerontol Ser A Biol Sci Med Sci 2001;56(1):146-56. The general data was analyzed with descriptive statistics. The binomial test was used to verify age and comorbidities between the groups. The Kruskal-Wallis nonparametric analysis of variance test was used to compare the groups for gender, FC, perception of health and history of falls. For analysis of intergroup QOL, the parametric one-way ANOVA test was applied. The relationship between FC and QOL was analyzed with the Pearson correlation coefficient. In all cases, a significance level of p<0.05 was adopted.

RESULTS

The study consisted of a sample of 103 elderly persons with a mean age of 73.3 (±6.4) years. A total of 73.7% of the group were female; 86.4% came from Belém and metropolitan area; most were married (39.8%) or widowed (36.9%); 88.3% were retired and lived with a mean of 4.0 (±2.0) people in their homes. In terms of educational level, 52.4% were literate.

All the subjects had at least one comorbidity (Table 1), the most common of which were visual disorders (82.5%), systemic arterial hypertension (SAH) (71.8%), insomnia (45.6%) and osteoarthritis (OA) (40.7%).

Table 1.
Number of comorbidities reported by elderly persons treated at the geriatric outpatient clinic of HUJBB, classified according to degree of frailty. Belém-PA, 2013.

In terms of degree of frailty, 23.0% were considered FR; 57.0% were PF and 20.0% were NF. The mean age of the three groups was similar. There were differences regarding gender only between the PF and NF groups and for the presence of comorbidities between the FR and PF groups.

The FR group had on average 3.5 (±0.7) phenotype points and the highest scoring criteria were muscle weakness and physical inactivity, which were also more frequent in the PF group (Table 2).

Table 2.
Domains of phenotype of frailty displayed by elderly persons classified as frail (FR) and pre-frail (PF) treated at the HUJBB outpatient clinic in 2013.

Analysis of FC found that 97.0% of the elderly persons were independent in the performance of activities of daily living (ADLs), and only three individuals had minimum dependency (two in the FR group and one in the PF group). There was a statistically significant difference between the groups FR and PF and between the FR and NF groups in terms of FC (Figure 1).

Figure 1.
Functional capacity of elderly persons treated at the HUJBB geriatric outpatient clinic by frailty group.

Only 95 elderly persons were assessed for QOL, as interviews that were incomplete or where there was intrusion by companions were excluded. The facets with the highest score were intimacy (15.3±2.2) and death and dying (14.8±3.2), and the lowest score was observed for social participation (13.1±2.6). The elderly persons in the FR group had lower scores than those of the other scores (Figure 2).

Figure 2.
Quality of life of elderly persons treated at the HUJBB geriatric outpatient clinic by frailty group.

There was a significant correlation between FC and QOL only in the PF (p=0.0273) and NF (p=0.0017) groups, with this correlation being higher in the NF group. The FR group score was p=0.3990.

In terms of the self-reported health of the elderly, the majority said that they had regular (62.1%), followed by good (18.4%) and bad (16.5%) health. Only 2.9% reported having excellent health and there were no reports of bad health. Among the groups there was a significant difference only between FR and PF (p=0.02), showing that FR individuals have a more negative perception of their health than PF individuals.

A total of 34,0% had a history of falling in the previous year, with most of such histories involving only one fall event (80.0%). There was no significant difference when comparing fall events between the three groups (p=0.06).

DISCUSSION

Numerous studies of frailty have argued that women are more susceptible to the development of comorbidities and frailty itself.88. Fried LP, Tangen CM, Walston J. Frailty in older adults: evidence of a phenotype. J Gerontol Ser A Biol Sci Med Sci 2001;56(1):146-56.,1717. Fhon JRS, Diniz MA, Leonardo KC, Kusumota L, Haas VJ, Rodrigues RAP. Síndrome de fragilidade relacionada à incapacidade funcional no idoso. Acta Paul Enferm [Internet] 2012 [acesso em 20 jun. 2013];25(4):589-94. Disponível em: http://www.scielo.br/pdf/ape/2012nahead/aop1812.
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This was not observed in the elderly individuals from the geriatric outpatient clinic of the HUJBB because, although most of the elderly persons were female, there was no statistically significant difference between the three groups in relation to gender, findings that were similar to those of Montero-Odasso.1818. Montero-Odasso M, Muir SW, Hall M, Doherty TJ, Kloseck M, Beauchet O, et al. Gait variability is associated with frailty in community-dwelling older adults. J Gerontol Ser A Biol Sci Med Sci 2011;66(5):568-76.

Although the presence of comorbidities not mean frailty, it may indicate higher chances for the development of the syndrome by altering the health status of the elderly individudal.99. Remor CB, Bós AJG, Werlang MC. Características relacionadas ao perfil de fragilidade no idoso. Sci Med 2011;21(3):107-12. The elderly persons interviewed in the present study had at least one comorbidity, mainly visual disorders, SAH, insomnia and OA. SAH and OA are among the chronic diseases associated with pain and/or loss of function most commonly involved with the occurrence of frailty,1919. Andrade NA, Fernandes MGM, Da Nóbrega MML, Garcia TL, Costa KNFM. Análise do conceito fragilidade em idosos. Texto Contexto Enferm 2012;21(4):748-56. with heart, kidney and liver failure, cancer, diabetes mellitus, chronic obstructive pulmonary disease, stroke and atherosclerosis,2020. Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ study. Clinics 2013;68(7):979-85. less cited in the present study.

In terms of number of comorbidities, FR elderly persons had more comorbidities than PF individuals, however, there was no significant difference when compared with the NF group, demonstrating that the severity of illness or even treatment aimed at the same may be more associated with frailty than the number of comorbidities only.

The prevalence of frailty identified in the present study was 23.0%, which varies greatly from studies conducted in other states. One study found a prevalence of 20,0% among elderly persons in Paraíba2121. Da Silva SLA, Vieira RA, Arantes P, Dias RC. Avaliação de fragilidade, funcionalidade e medo de cair em idosos atendidos em um serviço ambulatorial de geriatria e gerontologia. Fisioter Pesqui 2009;16(2):120-5., while another identified a prevalence of 31,0% in Rio Grande do Sul99. Remor CB, Bós AJG, Werlang MC. Características relacionadas ao perfil de fragilidade no idoso. Sci Med 2011;21(3):107-12. and another described 9.1% of people having the condition in Rio de Janeiro.2020. Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ study. Clinics 2013;68(7):979-85. This indicates that frailty can vary greatly among the Brazilian population, perhaps due to cultural diversity and living habits, including diet and physical activity, which are important protective factors against frailty.2222. Viana JU, Silva SL, Torres JL, Dias JM, Pereira LS, Dias RC. Influence of sarcopenia and functionality indicators on the frailty profile of communit-dwelling elderly subjects: a cross sectional study. Braz J Phys Ther 2013;17(4):343-81. However, these factors were not the object of this analysis.

When evaluating 100 elderly patients from a geriatric outpatient clinic, Remor et al99. Remor CB, Bós AJG, Werlang MC. Características relacionadas ao perfil de fragilidade no idoso. Sci Med 2011;21(3):107-12. argued that the occurrence of frailty tends to increase with age, unlike in this study, where there was no significant difference in age between the groups analyzed here. However, in the above study99. Remor CB, Bós AJG, Werlang MC. Características relacionadas ao perfil de fragilidade no idoso. Sci Med 2011;21(3):107-12. the average age was higher and caregiver reports were considered, which may have influenced the results and caused them to differ from the present findings.

Among the PF and NF elderly, the highest scoring criteria were muscle weakness and physical inactivity, data ratified by Viana et al.2222. Viana JU, Silva SL, Torres JL, Dias JM, Pereira LS, Dias RC. Influence of sarcopenia and functionality indicators on the frailty profile of communit-dwelling elderly subjects: a cross sectional study. Braz J Phys Ther 2013;17(4):343-81. who reported that these were the most significant factors in the development of the syndrome of frailty. However, unintentional weight loss was less frequent. Despite the practicality of assessing the nutritional status of the elderly, the effectiveness of this item is compromised in cases of overweight frail elderly individuals, which may explain this result.

The level of physical activity measured in minutes/week was equivalent to results from other studies that address this characteristic through weekly caloric expenditure,2323. Tomomitsu MRSV, Lemos ND, Perracini MR. Prevalência e fatores associados à fragilidade em cuidadores idosos. Geriatr Gerontol 2010;4(1):3-12. demonstrating that is an effective evaluation method for this factor, despite its low reliability.1616. Mazo GZ, Benedetti TRB. Adaptação do questionário internacional de atividade física para idosos. Rev Bras Cineantropom Desempenho Hum 2010;12(6):480-84. This evaluation methodology was similar to that of Tribess et al,2424. Tribess S, Virtuoso JS Junior, Oliveira RJ. Atividade física como preditor da ausência de fragilidade em idosos. Rev Assoc Med Bras 2012;58(3):341-7. who judged this method useful due to its simplicity and practicality of use, considering the awareness of the elderly.

As has been described by other scientific studies,2121. Da Silva SLA, Vieira RA, Arantes P, Dias RC. Avaliação de fragilidade, funcionalidade e medo de cair em idosos atendidos em um serviço ambulatorial de geriatria e gerontologia. Fisioter Pesqui 2009;16(2):120-5.,2323. Tomomitsu MRSV, Lemos ND, Perracini MR. Prevalência e fatores associados à fragilidade em cuidadores idosos. Geriatr Gerontol 2010;4(1):3-12. frail elderly persons have a lower FC than non-frail elderly individuals. However, there are differences between the present study and other works2121. Da Silva SLA, Vieira RA, Arantes P, Dias RC. Avaliação de fragilidade, funcionalidade e medo de cair em idosos atendidos em um serviço ambulatorial de geriatria e gerontologia. Fisioter Pesqui 2009;16(2):120-5.,2323. Tomomitsu MRSV, Lemos ND, Perracini MR. Prevalência e fatores associados à fragilidade em cuidadores idosos. Geriatr Gerontol 2010;4(1):3-12. regarding the argument that frail elderly persons display an incapacity for ADL. The results of the present study support the conclusion that elderly persons can remain independent, even when already at risk of developing frailty, or when already considered frail, as only three of 103 elderly persons here presented minimal dependence. Veras et al.,2525. Veras RP, Caldas CP, Coelho FD, Sanchez MA. Promovendo a saúde e prevenindo a dependência: identificando indicadores de fragilidade em idosos independentes. Rev Bras Geriatr Gerontol [Internet] 2007 [acesso em 20 jun. 2013];10(3):355- 70. Disponível em: http://revista.unati.uerj.br/scielo. php?script =sci_arttext&pid=S180998232007000300 008&lng=pt&nrm=iso.
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when investigating predictors of frailty among independent elderly individuals, found that 45,0% of those studied displayed significant indicators for the development of the syndrome. This data reinforces the results of the present study and emphasizes the importance of assessing all elderly persons, even those who are most active in their daily lives, to ensure the early detection or even prevention of the phenomenon of frailty.

Nevertheless, it is important to note that advanced activities of daily living (AADLs), which were not analyzed in this study, are impaired earliest in life, followed by instrumental activities (IADL) and, lastly, basic activities of daily living (BADL)2626. Crego DOC, Batista NA. Funcionalidade, força muscular e depressão em idosos frágeis, pré-frágeis e não-frágeis da região metropolitana de Belo Horizonte [monografia]. Minas Gerais: Universidade Federal de Minas Gerais; 2010. and that the FIM scale used here places greater emphasis on BADL and some IADLs, which in this case are related to getting around and climbing stairs. In general, while the latter domain provided the lowest score among the elderly, these individuals retained their functional independence. Further studies employing specific scales to each of these CF domains to confirm such evidence are suggested.

Although only 95 of the 103 interviewees completed the QOL assessment, it was observed that FR elderly persons had a lower QOL than PF and NF individuals, showing that frailty can affect the QOL of the elderly, a finding which is in agreement with Bilotta et al.,2727. Bilotta C, Bowling A, Casè A, Nicolini P, Mauri S, Castelli M, et al. Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in Italy. Health Qual Life Outcomes [Internet] 2010 [acesso em 4 mar. 2013];8:1-10. Disponível em: http://www.hqlo.com/content/8/1/56
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who advocated the need to consider QOL in frail elderly persons as not only related to physical but also psychosocial aspects. Among the phenotype criteria, slowness of gait is the factor that most affects the physical component of QOL, while fatigue most influences the emotional component.2828. Chang Y, Chen WL, Lin FG, Fang WH, Yen MY, Hsieh CC, et al. Frailty and its impact on health- related quality of life: a cross-sectional study on elder community-dwelling preventive health service users. PLoS ONE [Internet] 2012 [acesso em 20 jun. 2013];7(5):1-5. Disponível em: www.plosone.org/38079.
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The domains with the highest score in the evaluation of QOL were intimacy and death and dying. Intimacy revealed a good ability to deal with feelings of love and companionship and good family relationships,2929. Bajoto AP, Goldim JR. Avaliação da qualidade de vida e tomada de decisão em idosos participantes de grupos socioterápicos da cidade de Arroio do Meio, RS, Brasil. Rev Bras Geriatr Gerontol 2011;14(4):753-61. which could be related to the degree of interaction of elderly persons who have an average of four people in their homes. The domain death and dying displayed a coping capacity in relation to death, and a greater concern about the risk of suffering that precedes it. On the other hand, the lowest score was associated with social participation, similar to the findings of Torres et al.,3030. Torres GV, Dos Reis LA, Dos Reis LA, Fernandes MH. Qualidade de vida e fatores associados em idosos dependentes em uma cidade do interior do Nordeste. J Bras Psiquiatr 2009;58(1):39-44. indicating that these elderly individuals participate little in outdoor activities in the community and are more concerned with family relationships.

An important finding was the similarity of FC and QOL results between PF and NF elderly persons, or in other words those at risk of developing frailty had the same scores as elderly individuals without this risk, indicating that preventive interventions can be extremely effective even among pre-frail elderly persons.

There was a correlation between FC and QOL in the PF and NF groups, showing that being functionally independent is a good determinant of both the physical and mental aspects of quality of life.3030. Torres GV, Dos Reis LA, Dos Reis LA, Fernandes MH. Qualidade de vida e fatores associados em idosos dependentes em uma cidade do interior do Nordeste. J Bras Psiquiatr 2009;58(1):39-44. In addition, the data indicated that this correlation is stronger in NF elderly persons.

A negative perception of health is strongly associated not only with the development of the syndrome of frailty, but also with high rates of morbidity and mortality.1919. Andrade NA, Fernandes MGM, Da Nóbrega MML, Garcia TL, Costa KNFM. Análise do conceito fragilidade em idosos. Texto Contexto Enferm 2012;21(4):748-56.,3131. Souza ACPA. Síndrome da fragilidade e fatores associados em idosos comunitários do município de Santa Cruz -RN [Dissertação]. Rio Grande do Norte: UFRN; 2010. In the present study, most elderly persons considered their health to be regular, and there was no difference among FR and PF individuals. While this finding agreed with the aforementioned studies,1919. Andrade NA, Fernandes MGM, Da Nóbrega MML, Garcia TL, Costa KNFM. Análise do conceito fragilidade em idosos. Texto Contexto Enferm 2012;21(4):748-56.,3131. Souza ACPA. Síndrome da fragilidade e fatores associados em idosos comunitários do município de Santa Cruz -RN [Dissertação]. Rio Grande do Norte: UFRN; 2010. there was no difference between FR and NF and between PF and NF individuals, suggesting that even elderly individuals not at risk of frailty may have a negative opinion of their health, or in other words, in this sample perception of health was not decisive for frailty and vice versa. This is possibly due to the low number of reports of poor (16.5%) or very poor (0.0%) health, categories which, according to Stori et al.,3232. Storti LB, Fabrício-Whebe SCC, Kusumota L, Rodrigues RAP, Marques S. Fragilidade de idosos internados na clínica médica da unidade de emergência de um hospital geral terciário.Texto Contexto Enferm 2013;22(2):452-9. are determinants of frailty.

Although literature has identified a relationship between a history of falls and frailty,3333. Shim EY, Ma SH, Hong SH, Lee YS, Paik WY, Seo DS, et al. Correlation between frailty level and adverse health-related outcomes of community- dwelling elderly: one year retrospective study. Korean J Fam Med 2011;32(4):249-56. this was not observed in this sample, as there was no difference between the F, PF and NF groups. Moreira and Lourenço2020. Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ study. Clinics 2013;68(7):979-85. argued that only a history of three or more falls, which define the elderly individual as a faller, is directly linked to frailty, which may explain the lack of an association here, as in addition to the rate of falls being low, 80% of these elderly individuals had a history of only one fall.

This study was limited by the exclusion of elderly people with cognitive impairment, which is considered a factor for the development of the syndrome of frailty. Instead, the focus was aimed at the reports of the elderly persons themselves in relation to their health and well-being. It is believed that in this way the data becomes more reliable.

The reduced sample size is another limitation that hinders the generalization of the results presented here to other populations, and also meant that it could not be determined whether frailty can cause functional incapacity, or vice versa. In fact, either situation can occur, depending on the context and the life history of the elderly. What is known is that both can affect QOL, and so each case must be assessed individually, considering the lifestyle of each person, to reach correct conclusions, requiring studies with larger sample sizes and longitudinal approaches.

Therefore, the results indicate the need to recognize risks related to frailty even in older people who do not have clear manifestations of the condition, in order to prevent the advance or the emergence of the syndrome, and to ensure a better QOL for as long as possible, as for elderly persons it is more important to live with quality, than simply to live for a long time.3434. Aldwin CM, Gilmer DF. Health, illness, and optimal aging: biological and psychological perspectives.New York: Sage Publications; 2004.

CONCLUSION

Compared to other Brazilian studies, the degree of frailty was relatively high among the elderly population studied. Muscle weakness and physical inactivity proved to be the most significant factors for the development of the syndrome, which was associated with reduced functional capacity and quality of life, although most elderly persons remained independent. Thus, the most important findings of the present study relate to the need to recognize the determinants of frailty, even those that are subclinical, in order to detect the emergence of this syndrome as early as possible, since the biological criteria discussed herein are reversible.

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Publication Dates

  • Publication in this collection
    Jan-Feb 2016

History

  • Received
    08 Jan 2015
  • Reviewed
    26 Oct 2015
  • Accepted
    09 Nov 2015
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