Browsing by Author "Fernandes, Lia"
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- Determinants of frailty: the added value of assessing medicationPublication . Coelho, Tiago; Paúl, Constança; Gobbens, Robbert JJ; Fernandes, LiaThis study aims to analyze which determinants predict frailty in general and each frailty domain (physical, psychological, and social), considering the integral conceptual model of frailty, and particularly to examine the contribution of medication in this prediction. A cross-sectional study was designed using a non-probabilistic sample of 252 community-dwelling elderly from three Portuguese cities. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator. The amount and type of different daily-consumed medication were also examined. Hierarchical regression analysis were conducted. The mean age of the participants was 79.2 years (±7.3), and most of them were women (75.8%), widowed (55.6%) and with a low educational level (0–4 years: 63.9%). In this study, determinants explained 46% of the variance of total frailty, and 39.8, 25.3, and 27.7% of physical, psychological, and social frailty respectively. Age, gender, income, death of a loved one in the past year, lifestyle, satisfaction with living environment and self-reported comorbidity predicted total frailty, while each frailty domain was associated with a different set of determinants. The number of daily-consumed drugs was independently associated with physical frailty, and the consumption of medication for the cardiovascular system and for the blood and blood-forming organs explained part of the variance of total and physical frailty. The adverse effects of polymedication and its direct link with the level of comorbidities could explain the independent contribution of the amount of prescribed drugs to frailty prediction. On the other hand, findings in regard to medication type provide further evidence of the association of frailty with cardiovascular risk. In the present study, a significant part of frailty was predicted, and the different contributions of each determinant to frailty domains highlight the relevance of the integral model of frailty. The added value of a simple assessment of medication was considerable, and it should be taken into account for effective identification of frailty.
- Frailty as a predictor of short-term adverse outcomesPublication . Coelho, Tiago; Paúl, Constança; Gobbens, Robbert JJ; Fernandes, LiaThe objectives of this study were to compare how different frailty measures (Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes. Secondarily, adopting a multidimensional approach to frailty (integral conceptual model–TFI), this study aims to compare how physical, psychological and social frailty predict the outcomes. A longitudinal study was carried out with 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty, and adverse outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL). Ten months later the outcomes were assessed again. Frailty was associated with specific healthcare utilization indicators: the FP with a greater utilization of informal care; GFI with an increased contact with healthcare professionals; and TFI with a higher amount of contacts with a general practitioner. After controlling for the effect of life-course determinants, comorbidity and adverse outcome at baseline, GFI predicted IADL disability and TFI predicted quality of life. The effect of the FP on the outcomes was not significant, when compared with the other measures. However, when comparing TFI’s domains, the physical domain was the most significant predictor of the outcomes, even explaining part of the variance of ADL disability. Frailty at baseline was associated with adverse outcomes at follow-up. However, the relationship of each frailty measure (FP, GFI and TFI) with the outcomes was different. In spite of the role of psychological frailty, TFI’s physical domain was the determinant factor for predicting disability and most of the quality of life.
- Multidimensional Frailty and Pain in Community Dwelling ElderlyPublication . Coelho, Tiago; Paúl, Constança; Gobbens, Robbert JJ; Fernandes, LiaObjective_To examine the relationship between frailty and pain, particularly to analyze whether pain predicts physical, psychological and social frailty, after controlling for the effects of life-course determinants and comorbidity. Design: Cross-sectional. Methods: A nonprobabilistic sample of 252 community dwelling elderly was recruited. Frailty and determinants of frailty were assessed with the Tilburg Frailty Indicator and pain was measured with the Pain Impact Questionnaire. Hierarchical and logistic regression analyses were conducted. Results: In this study, 52.4% of the participants were aged 80 years and over, and 75.8% were women. Pain and frailty were higher in women, and physical frailty was higher in those aged ≥80 years. After controlling for the effects of the determinants and comorbidity, pain predicted 5.8% of the variance of frailty, 5.9% of the variance of physical frailty, and 4.0% of the variance of psychological frailty, while the prediction of social frailty was nonsignificant. Overall, a greater pain impact score was associated with the presence of frailty (odds ratio 1.06; 95% CI 1.03–1.10; P < 0.001). Conclusion: Frailty was independently predicted by pain, emphasizing the importance of its treatment, potentially contributing to the prevention of vulnerability, dependency, and mortality. Nonetheless, longitudinal studies are required to better understand the possible association between pain and frailty.
- Portuguese version of the Tilburg Frailty Indicator: Transcultural adaptation and psychometric validationPublication . Coelho, Tiago; Santos, Rubim; Paúl, Constança; Gobbens, Robbert JJ; Fernandes, LiaTo present the translation and validation process of the Portuguese version of the Tilburg Frailty Indicator (TFI). A cross-sectional study was designed using a non-probability sample of 252 community-dwelling older adults. Preliminary studies were carried out for face and content validity assessment. Internal consistency, test–retest reliability, construct (convergent/divergent) and criterion validity were subsequently analyzed. The sample was mainly women (75.8%), with a mean age of 79.2 ± 7.3 years. TFI internal consistency was good (KR-20 = 0.78). Test–retest reliability for the total was also good (r = 0.91), with kappa coefficients showing substantial agreement for most items. TFI physical and social domains correlated as expected with concurrent measures, whereas the TFI psychological domain showed similar correlations with other psychological and physical measures. The TFI showed a good to excellent discrimination ability in regard to frailty criteria, and fair to good ability to predict adverse outcomes. The psychometric properties of the TFI seem to be consistently good. These findings provide initial evidence that the Portuguese version is a valid and reliable measure for assessing frailty in the elderly.
- Quality of standing balance in community-dwelling elderly: Age-related differences in single and dual task conditionsPublication . Coelho, Tiago; Fernandes, Ângela; Santos, Rubim; Paúl, Constança; Fernandes, LiaAim To examine the relationship between age and quality of standing balance in single and dual task conditions. Methods A cross-sectional study was conducted using a sample of 243 community-dwellers aged ≥65 years. Quality of standing balance was assessed by measuring the center of pressure (COP) sway with a pressure platform. Measurements were performed under single task (orthostatic position) and dual task (orthostatic position while performing a verbal fluency task) conditions. Results The mean age of the participants was 79.1(±7.3) years and 76.1% were women. Older age was associated with an increased COP sway, mainly in the medial/lateral (ML) direction. Most COP sway parameters were higher under dual task conditions than under single task. After controlling for the effect of the number of words enunciated in dual task conditions, only the differences in COP sway parameters in the ML direction remained significant. There was no significant interaction between age group (65–79; ≥80 years) and condition, which indicates that differences in COP sway caused by performing a secondary task were similar for younger and for older participants. Conclusion Age did not seem to influence significantly the decline in the quality of standing balance triggered by performing a concurrent cognitive task. However, older age was consistently associated with poorer standing balance, both in single and in dual task conditions. Therefore, performing a secondary task may lead older individuals to reach their postural stability limits and, consequently, to fall.
- Standing balance in individuals with Parkinson's disease during single and dual-task conditionsPublication . Fernandes, Ângela; Coelho, Tiago; Vitória, Ana; Ferreira, Augusto; Santos, Rubim; Rocha, Nuno; Fernandes, Lia; Tavares, João Manuel R.S.This study aimed to examine the differences in standing balance between individuals with Parkinson's disease (PD) and subjects without PD (control group), under single and dual-task conditions. A cross-sectional study was designed using a non-probabilistic sample of 110 individuals (50 participants with PD and 60 controls) aged 50 years old and over. The individuals with PD were in the early or middle stages of the disease (characterized by Hoehn and Yahr as stages 1-3). The standing balance was assessed by measuring the centre of pressure (CoP) displacement in single-task (eyes-open/eyes-closed) and dual-task (while performing two different verbal fluency tasks). No significant differences were found between the groups regarding sociodemographic variables. In general, the standing balance of the individuals with PD was worse than the controls, as the CoP displacement across tasks was significantly higher for the individuals with PD (p<0.01), both in anteroposterior and mediolateral directions. Moreover, there were significant differences in the CoP displacement based parameters between the conditions, mainly between the eyes-open condition and the remaining conditions. However, there was no significant interaction found between group and condition, which suggests that changes in the CoP displacement between tasks were not influenced by having PD. In conclusion, this study shows that, although individuals with PD had a worse overall standing balance than individuals without the disease, the impact of performing an additional task on the CoP displacement is similar for both groups.
- Tilburg Frailty Indicator/TFI: validação da versão portuguesaPublication . Coelho, Tiago; Santos, Rubim; Paúl, Constança; Gobbens, Robert J. J.; Fernandes, LiaA identificação de fragilidade e a sua prevenção, assim como de outcomes adversos, assume hoje grande relevância clínica e social, dado o crescente aumento da população idosa.