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Introduction: Frailty is a complex geriatric syndrome with a multifaceted etiology. We aimed to identify the best combinations of risk factors that predict the development of frailty using recursive partitioning models. Methods: We analyzed reports from 1,724 community-dwelling men and women aged 65–74 years participating in the International Mobility in Aging Study (IMIAS). Frailty was measured using frailty phenotype scale that included five physical components: unintentional weight loss, weakness, slow gait, exhaustion, and low physical activity. Frailty was defined as presenting three of the above five conditions, having one or two conditions indicated prefrailty and showing none as robust. Socio-demographic, physical, lifestyle, psycho-social, and life-course factors were included in the analysis as potential predictors. Results: 21% of pre-frail and robust participants showed a worse stage of frailty in 2014 compared to 2012. In addition to functioning variables, fear of falling (FOF), income, and research site (Canada vs. Latin America vs. Albania) were significant predictors of the development of frailty. Additional significant predictors after exclusion of functioning factors included education, self-rated health, and BMI. Conclusions: In addition to obvious risk factors for frailty (such as functioning), socio-economic factors and FOFs are also important predictors. Clinical assessment of frailty should include measurement of these factors to identify high-risk individuals.

Some studies have employed machine learning (ML) methods for mobility prediction modeling in older adults. ML methods could be a helpful tool for life-space mobility (LSM) data analysis.This study aimed to evaluate the predictive value of ML algorithms for the restriction of life-space mobility (LSM) among elderly people and to identify the most important risk factors for that prediction model.A 2-year LSM reduction prediction model was developed using the ML-based algorithms decision tree, random forest, and eXtreme gradient boosting (XGBoost), and tested on an independent validation cohort. The data were collected from the International Mobility in Aging Study (IMIAS) from 2012 to 2014, comprising 372 older patients (≥ 65 years of age). LSM was measured by the Life-Space Assessment questionnaire (LSA) with five levels of living space during the month before assessment.According to the XGBoost algorithm, the best model reached a mean absolute error (MAE) of 10.28 and root-mean-square error (RMSE) of 12.91 in the testing portion. The variables frailty (39.4%), mobility disability (25.4%), depression (21.9%), and female sex (13.3%) had the highest importance.The model identified risk factors through ML algorithms that could be used to predict LSM restriction; these risk factors could be used by practitioners to identify older adults with an increased risk of LSM reduction in the future. The XGBoost model offers benefits as a complementary method of traditional statistical approaches to understand the complexity of mobility.

Con un enfoque interdisciplinario, esta obra aborda temas fundamentales sobre el cuidado de las personas mayores y quienes se ocupan de su cuidado. Esta obra busca establecer un diálogo desde las diversas disciplinas que se ocupan de reflexionar sobre este tema de vital importancia en nuestra sociedad, ya que desde 2015, cuando surgió la Convención de los derechos humanos de las personas mayores, a nivel regional interamericano en este tema aún no hay suficiente bibliografía, reflexión e investigación. El libro aporta experiencias no solo interdisciplinarias sino que también articula tres temas fundamentales como el cuidado, personas mayores y sus cuidadores, con experiencias de Colombia, Uruguay y España, las cuales enriquecen la construcción que Colombia está haciendo en este ámbito del sistema de cuidado.

BACKGROUND AND PURPOSE To identify the circumstances of falls and the factors associated with falls among older adults with cardiovascular disease (CVD). METHODS Baseline (2012) data from the International Mobility in Aging Study (IMIAS), a cross-sectional study, were used. Falling was measured by the subjective question, "Have you fallen in the last 12 months?" Several subjective questions were asked to obtain information about the circumstances of falls. Potential clinical factors associated with falling were cognitive status, depressive symptoms, physical performance, grip strength, visual acuity, and fear of falling (FOF). These clinical factors were measured respectively with the Leganes Cognitive Test, the Center for Epidemiological Studies Scales Depressive Symptoms, the Short Physical Performance Battery, a Jamar handgrip dynamometer, the Early Treatment Diabetic Retinopathy Study (ETDRS) tumbling E chart placed at 2 m, and the Falls Efficacy Scale-International. A χ2 test was used to determine whether there were significant differences in fall circumstances among older adults with and without CVD. Two-sample t tests were used to test for any significant differences between older adults with and without CVD. Bonferroni correction was applied to limit type I errors and was corrected to .007. Simple and multiple logistic regressions identified which clinical factors were associated with falling. RESULTS A total of 429 older adults with CVD (mean age 69.5 ± 2.9) and 431 older adults without CVD (69.2 ± 2.9) participated in the study. Approximately 53% of fallers with CVD had 2 or more falls compared with fallers without CVD (39%). The most common location for falling was at home (43%) for fallers with CVD or in the street (50%) for fallers without CVD. Approximately 9% of fallers with CVD needed to be hospitalized while only 3% of fallers without CVD were admitted to the hospital. Approximately 42% of fallers with CVD had some residual sequelae (eg, being unable to walk around the house or do housework) compared with only 27% of fallers without CVD. Fallers with CVD had significantly (P value < .007) more depressive symptoms (mean ± SD, 14.7 ± 12.9) and poorer physical performance (8.4 ± 3.0) compared with fallers without CVD (10.1 ± 9.4 and 9.6 ± 2.5, respectively); however FOF was the only significant clinical factor (P value < .05) associated with falling for older adults with CVD. CONCLUSIONS Falling incidence is higher among older adults with CVD than those without CVD. Circumstances of falls among fallers with CVD differ from those identified among fallers without CVD. Fear of falling was the only predictor of falls among older adults with CVD. The results suggest the merit of considering FOF when designing prevention and intervention programs to reduce falls among older adults with CVD.

Introduction: Potentially inappropriate medication is associated with adverse health and functional outcomes, as well as increased health care costs. Objective: To estimate the prevalence and types of potentially inappropriate medication according to the Beers criteria in community-dwelling older persons and to identify the major clinical and functional consequences of potentially inappropriate medication during two years of following. Materials and methods: We conducted a longitudinal, descriptive, and observational study that included 400 65-year or older community-dwelling people (48% women) selected by simple random sampling in 2012. In 2014, 372 people were re-evaluated and classified into two groups based on the presence or absence of potentially inappropriate medication through the follow-up period. Results: In total, 31% had polypharmacy (5-9 medications) and 1,8% had excessive polypharmacy (10 or more medications). The mean of the number of medications was higher in the potentially inappropriate medication group (3 vs. 5.78; p

Resumen: Introducción: la fragilidad es una condición del paciente anciano, caracterizada por un estado de vulnerabilidad para desenlaces adversos en salud, incluidos los causados por la cirugía cardíaca. Objetivo: establecer la prevalencia de fragilidad en el contexto prequirúrgico del anciano sometido a cirugía cardiaca y establecer el riesgo de desenlaces adversos otorgado por esta condición. Metodología: estudio analítico de cohorte que valoró la fragilidad en 66 pacientes ancianos sometidos a cirugía cardiaca mediante el fenotipo físico de fragilidad de Fried. Se realizó un seguimiento a 30 días, durante el cual se estableció la prevalencia de fragilidad y el riesgo otorgado por esta condición a los desenlaces adversos de la cirugía cardiaca. Resultados: la edad de los pacientes osciló entre los 60 y los 83 años; la mediana fue de 70,5 años. La prevalencia de la fragilidad fue del 31,8%. La fragilidad incrementó los siguientes desenlaces adversos postoperatorios: muerte (p 0,001), ventilación prolongada (p 0,001), uso prolongado de vasoactivos (p 0,001) e infección del sitio operatorio (p 0,004). El riesgo de mortalidad otorgado por la fragilidad fue más alto que el de los puntajes usuales de valoración como el EuroSCORE II (HR 5,49; IC95% 1,0-28,5 vs. HR 1,17 IC95% 1,0-1,29). Conclusión: la fragilidad es una condición frecuente en el paciente anciano sometido a cirugía cardiaca e incrementa el riesgo de eventos adversos, en especial el de mortalidad. Se recomienda incluir la medición de la fragilidad en el protocolo prequirúgico del paciente anciano. Abstract: Introduction: Frailty is a common condition in the elderly patient, and is noted for its vulnerability for adverse outcomes in health, including those caused by cardiac surgery. Objective: To establish the prevalence of frailty in the pre-surgical context of the elderly subjected to cardiac surgery, as well as to establish the risk of adverse outcomes due to this condition. Method: An analytical cohort study was performed in order to evaluate frailty in 66 elderly patients subjected to cardiac surgery, using the physical phenotype of frailty described by Fried. A follow-up was made at 30 days, during which the frailty prevalence was established, as well the risk of adverse outcomes of the cardiac surgery due to this condition. Results: The age of the patients varied between 60 and 83 years, with a median of 70.5 years. The prevalence of frailty was 31.8%. Frailty increased the following post-surgical adverse outcomes: death (P = .001), longer ventilation time (P = .001), prolonged use of vasoactive drugs (P = .001), and infection of the surgical site (P = .004). The mortality risk due to frailty was higher than that of the usual evaluation scores such as Euro SCORE II (HR 5.49; 95% CI; 1.0-28.5 vs. HR 1.17: 95% CI; 1.0-1.29). Conclusion: Frailty is a common condition in the elderly patient subjected to cardiac surgery, and increases the risk of adverse events, particularly, mortality. It is recommended to use measurements of frailty in the pre-surgical protocol of the elderly patient.

Objective: To describe the experiences of older adults around forced displacement due to the Colombian armed conflict. Methods: Interpretive-comprehensive study, with a hermeneutical approach; several types of sampling were carried out. The participants were 12 people aged over 60 years, who reported having being displaced and who participated in the SABE Colombia Survey. The data were encoded using the Atlas.ti software. A process of condensation of central analytical, support and emerging categories was made. Results: The displacement generated by the armed conflict has been decisive in the current life conditions of the participants. They know that they are survivors of someone else's violence; there is dislocation, loss of territory, de-anchoring, lack of protection and insecurity. To the stigma of old age, it is added being displaced and being strangers in a place where they don’t belong. They live the violent uprooting of their lands and the confusion of their identity; they found themselves in a foreign scene where they were the unusual and the strangers; from receiving threats, they passed to be labeled as ‘threatening’. This forced displacement stems from violence, but also from fear, and it marks the trajectory of life for older people who experience a prolonged struggle for survival in often hostile environments, living "permanently" displaced. Conclusion: When there is displacement, older people are not only shed of their land and their home, but also from their cosmos and their vital referents; in addition, it changes their life trajectory and their place in the world. Interventions should be designed based on specific particular and contextual analyses. Resumen Objetivo: Describir las vivencias y experiencias de adultos mayores en torno al desplazamiento forzado por efectos del conflicto armado. Métodos: Estudio interpretativo-comprensivo, con un enfoque hermenéutico. Los participantes fueron 12 personas mayores de 60 años que reportaron haber sido desplazadas y que participaron en de la Encuesta SABE Colombia. Los datos se codificaron utilizando el software Atlas.ti. Se hizo un proceso de condensación de categorías analíticas centrales, de soporte y emergentes. Resultados: El desplazamiento generado por el conflicto armado ha sido decisivo en las actuales condiciones de vida de los participantes. Saben que son sobrevivientes de una violencia ajena, hay desubicación, desterritorializacion, desanclaje, desprotección, inseguridad. Al estigma de la vejez se le suma el ser desplazados y extraños en un lugar donde no tienen lugar. Viven el desarraigo violento de sus tierras, la confusión de su identidad, se encontraron en un escenario ajeno donde ellos eran los raros y los extraños, de recibir amenazas pasaron al señalamiento de ser amenazantes. Este desplazamiento forzado nace de la violencia, pero también del miedo y marca la trayectoria de vida a las personas mayores quienes experimentan una prolongada lucha por la supervivencia en entornos a menudo hostiles, viven desplazados "permanentemente". Conclusión: Cuando hay desplazamiento, las personas mayores no solo se despojan de su tierra, de su casa, sino de su cosmos, de sus referentes vitales y se modifica su trayectoria de vida y su lugar en el mundo. Las intervenciones deben ser diseñadas basadas en análisis particulares y contextuales específicos.

Background We determine the best combination of factors for predicting the risk of developing fear of falling (FOF) in older people via Classification Regression Tree (CaRT) analysis. Methods Community-dwelling older adults living in Canada, Albania, Brazil, and Colombia were from International Mobility in Aging Study (IMIAS). In 2014, 1,725 participants (aged 65–74) were assessed. With a retention rate of 81%, in 2016, 1,409 individuals were reassessed. Risk factors for FOF were entered into the CaRT: age, sex, education, self-rated health, comorbidity, medication, visual impairment, frailty, cognitive deficit, depression, fall history, Short Physical Performance Battery (SPPB), walking aid use, and mobility disability measured by the Nagi questionnaire. Results The classification tree included 12 end groups representing differential risks of FOF with a minimum of two and a maximum of five predictors. The first split in the tree involved impaired physical function (SPPB scores). Respondents with less than 8 in SPPB score and mobility disability had 82% risk of developing FOF at the end of 2-year follow-up. Between 23.2% and 82.3% of the risk of developing FOF in 2 years of follow-up were explained by only five variables: age, sex, self-rated health, functional impairment measured by SPPB, and mobility disability. In those with no functional impairment or mobility disability, levels of education, sex, and self-rated health were important predictors of FOF in the future. Conclusion This classification tree included different groups based on specific combinations of a maximum of five easily measurable predictors with emphasis on impaired physical functioning risk factors for developing FOF.

Older adults with heart disease (HD) are more likely to report a higher prevalence of falls compared to those without HD. A knowledge gap currently exists regarding the factors associated with fear of falling (FOF) among older adults with HD. Therefore, this study aimed to estimate FOF and identify factors associated with FOF among older adults with HD.Data came from a secondary analysis of the International Mobility in Aging Study (IMIAS) baseline (2012) data. FOF was measured using the Falls Efficacy Scale-International (FES-I). Stepwise linear regression was used to identify factors associated with FOF.A total of 429 participants identified themselves as having heart disease diagnosed by their physician (mean age 69.5 ± 2.9). Older adults with HD reported on average (25.6) higher FOF than those without HD. For older adults with HD, FES-I increased significantly by 1.3, 1.0, and 0.6 points, when the Short Physical Performance Battery, the Leganes Cognitive Test, and QOL total scores decreased by one point. FES-I also significantly increased by 3.2 when income was insufficient compared to sufficient or very sufficient income.FOF is multifactorial, and our findings provide a base for developing future management rehabilitation intervention programs aimed at decreasing FOF among older adults with HD.

Background: Frailty is associated with poor outcomes hence identification of risks factors is pivotal. Since the independent role of parathyroid hormone (PTH) in frailty remains unexplored, we aimed to determine this in a population of older individuals with a history of falling. Design: Cross-sectional study. Setting: Falls and Fracture Clinic, Nepean Hospital (Penrith, Australia). Participants: 692 subjects (mean age=79, 65% women) assessed between 2009-2015. Measurements: Assessment included clinical examination, mood, nutrition, grip strength, gait velocity, bone densitometry and posturography. Chemistry included serum PTH, calcium, vitamin D (25(OH)D3), creatinine and albumin. Normocalcemic subjects were divided into 4 groups: (1) Normal: 25(OH)D3 >50nmol/L and PTH between 1.6-6.8pmol/L; (2) PTH responsive: low 25(OH)D3 (6.8pmol/L); (3) PTH unresponsive: low 25(OH)D3 and normal PTH; (4) Hyper PTH (>6.8pmol/L) with normal 25(OH)D3. Frailty was defined using Fried’s criteria. Difference between the groups was assessed using one-way ANOVA and X2 analysis. Multinomial logistic regression evaluated the association between the groups and the number of Fried’s criteria adjusted for age, BMI, renal function, 25(OH)D3 levels, and albumin. Results: 22.6% subjects had high PTH levels (>6.8pmol/L). All subjects in the high PTH groups had significantly lower grip strength, gait velocity, limits of stability, and higher BMI. The PTH responsive group had a higher risk of pre-frailty (β=3.8, 95% CI = 3.42 – 5.22, p< 0.01) and frailty (β=8.26, 95% CI = 2.8-16.1, p

To identify the main factors associated with disability in older adults in Colombia, adjusted according to structural and intermediary determinants of healthy aging.This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built environment, and health care systems. Data analysis employed multivariate logistic regression.The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activities of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low educational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability.Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.Determinar los principales factores asociados con la discapacidad en personas mayores en Colombia, ajustados según determinantes estructurales e intermediarios del envejecimiento saludable.Este estudio empleó datos transversales de 23 694 adultos de más de 60 años provenientes de la encuesta nacional Colombia SABE. Se analizaron los determinantes estructurales como las variables demográficas y de situación socioeconómica. Las variables intermediarias se clasificaron en tres bloques: capacidad intrínseca, entorno físico y construido, y sistemas de atención de salud. El análisis de datos empleó la regresión logística con múltiples variables.La prevalencia de la discapacidad general fue de 21% en la actividad cotidiana, 38% en la actividad cotidiana instrumental y 33% en la discapacidad relacionada con la movilidad. Se asoció la discapacidad con los determinantes estructurales sociodemográficos, como edad avanzada, sexo femenino, residencia en entornos rurales, estar soltero o divorciado, vivir solo, un nivel educativo bajo y tener etnicidad indígena o negra. Con respecto a los determinantes relativos a la situación socioeconómica, la principal influencia en la discapacidad fueron los ingresos netos bajos, la situación socioeconómica baja, una percepción insuficiente de ingresos y un plan de seguro de salud subsidiado. Los determinantes intermediarios de la capacidad intrínseca, como la mala salud informada por la propia persona, la multimorbilidad, la poca fuerza en el puño, un estilo de vida sedentario, las adversidades económicas desde la primera infancia, la carencia de apoyo social y la falta de participación en actividades se asociaron de manera significativa con la discapacidad.Las medidas que tienen un efecto sobre los principales factores asociados con la discapacidad, como la reducción de las inequidades en materia de salud, mediante políticas, estrategias y actividades, pueden contribuir significativamente al bienestar y la calidad de vida de las personas mayores colombianas.Identificar os principais fatores associados à incapacidade em idosos na Colômbia, ajustados de acordo com os determinantes estruturais e intermediários do envelhecimento saudável.Este estudo usou dados transversais de 23.694 adultos com mais de 60 anos de idade que participaram da pesquisa nacionalA prevalência de incapacidade em geral foi de 21% para as atividades da vida diária, 38% para atividades instrumentais da vida diária e 33% para restrição de mobilidade. Constatou-se associação da incapacidade com determinantes estruturais sociodemográficos, como idade avançada, sexo feminino, residência em área rural, estado civil solteiro ou divorciado, viver sozinho, baixa escolaridade e etnia indígena/negra. Com relação aos determinantes da condição socioeconômica, baixa renda líquida, pertencimento ao estrato socioeconômico mais pobre, percepção de renda insuficiente e ter um plano de seguro-saúde subsidiado exerceram grande influência sobre a incapacidade. Determinantes intermediários da capacidade intrínseca, como autopercepção de saúde ruim, multimorbidade, força de preensão reduzida, estilo de vida sedentário, adversidade econômica na primeira infância, ausência de suporte social e não participação em atividades foram significativamente associados à incapacidade.Ações que afetem os principais fatores associados à incapacidade, como a redução das iniquidades em saúde por meio de políticas, estratégias e atividades, podem contribuir significativamente para o bem-estar e a qualidade de vida dos idosos colombianos.

Objective:To examine factors associated with visual impairment (VI) and eye care in the International Mobility in Aging Study (IMIAS). Method: IMIAS data were analyzed ( N = 1,995 with ages 65-74). Outcomes were VI defined as presenting visual acuity worse than 6/18 in the better eye and eye care utilization assessed by annual visits to eye care professionals. The Hurt–Insult–Threaten–Scream (HITS) questionnaire requested information on domestic violence. Results: Among men, VI varied from 24% in Manizales (Colombia) to 0.5% in Kingston (Canada); among women, VI ranged from 20% in Manizales to 1% in Kingston; lifetime exposure to domestic violence was associated with VI (odds ratio [OR] = 1.87; 95% confidence interval [CI] = [1.17, 3.00]). Eye care utilization varied from 72% in Kingston’s men to 25% in Tirana’s men; it was associated with domestic violence (prevalence ratio [PR] = 1.3; 95% CI = [1.1, 1.6]). Discussion: VI is more frequent where eye care utilization is low. Domestic violence may be a risk factor for VI.

Resumen Introducción. La estatura en el anciano no refleja su talla real de adulto joven debido al envejecimiento de su columna vertebral, entre otros aspectos. Objetivo. Proponer ecuaciones para estimar la talla de los ancianos colombianos mediante la altura de la rodilla, según el grupo étnico y el sexo. Materiales y métodos. Se hizo un análisis secundario del estudio transversal SABE 2015, utilizando un diseño muestral probabilístico y multietápico en personas colombianas de 60 o más años. Se seleccionaron aleatoriamente dos grupos de la base de datos del estudio SABE: el grupo para el desarrollo de las ecuaciones y el grupo para su validación. Se hizo un análisis de regresión lineal múltiple para estimar la estatura mediante la altura de la rodilla en los grupos étnicos (indígenas, afrodescendientes y blancos-mestizos) por edad y sexo; los resultados se validaron en cada subgrupo de estudio. Resultados. Se diseñaron seis ecuaciones por sexo (hombres=3.665, mujeres=3.019) y etnia; los coeficientes de determinación ajustados (R2 ) de las ecuaciones en hombres de los tres grupos étnicos oscilaron entre 64 y 75 % y, los errores estándar, entre 3,09 y 3,93 cm. En las mujeres, los R2 de las tres ecuaciones fluctuaron entre 53 y 73 % y los EE, entre 2,96 y 3,90 cm. Conclusión. La ecuación con mejor capacidad para estimar la talla del anciano colombiano fue la obtenida para los afrodescendientes de ambos sexos, en tanto que en la población indígena se presentaron los menores coeficientes de determinación. Abstract Introduction: The height in the elderly does not reflect their real size as young adults due to the aging of their spine, among other aspects. Objective: To estimate the equations to predict the height in Colombian elders according to their ethnic group and sex using the knee height measurement. Materials and methods: We conducted a secondary analysis of the SABE, 2015, crosssectional study using a multistage probabilistic sampling design in people aged 60 years and over in Colombia. We randomly selected two groups from the study’s database: A development group and a validation group of the equations. Age and anthropometric characteristics were similar in both groups. We performed a multiple linear regression analysis to predict the height using knee height measurement in the different ethnic groups (Indigenous, Afro-descendant, and white-mestizo groups) by age and sex; the results were validated in each selected subgroup. Results: We designed six equations by sex (men=3,665; women=3,019) and ethnic group. The adjusted R2 of the equations in men from the three ethnic groups oscillated between 64% and 75% and the standard errors, between 3,09 and 3,93 cm while in women, the R2 s of the three equations ranged between 53% and 73% and the EEs, between 2,96 and 3,90 cm. Conclusion: The equation with the best predictive capacity of the height of Colombian elders was obtained for African descendants of both sexes. The lowest coefficients of determination were obtained for the indigenous population.

The incidence of fear of falling (FOF) is high among people with cancer. However, factors that are associated with FOF in people with cancer has not yet been investigated. Therefore, the objective of this study was to identify the associated factors with FOF in people with cancer.This is a secondary analysis of the International Mobility in Aging Study (IMIAS) study. A total of 175 people self-identified as patients with cancer (mean age: 69.3 years, women: 50.2%) and 177 healthy age-matched group. FOF measured using the Falls Efficacy Scale-International (FES-I) was the primary outcome. Potential variables/factors for consistency known to be associated with FOF (cognitive status, depression, physical performance, the number of falls in the last year, visual acuity and grip strength) were assessed. Simple linear regression was used to identify factors associated with FOF. Variables with p-value0.05 were then included in a multiple linear regression adjusted for the study confounders (study site, sex, and age).For people with cancer, FES-I was significantly associated with the Leganes Cognitive Test, The Short Physical Performance Battery (SPPB) total scores and the number of falls reported in the past 12 months (P-value0.05). For the healthy group, FOF was only associated with depression and SPPEB.FOF is multifactorial in people with cancer and it is associated with cognitive status, physical performance and number of falls in the last year. Healthcare providers for patients with cancer should evaluate all potential factors associated with FOF and manage it.

OBJECTIVE To investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score, FRS) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS). MATERIAL AND METHODS This cross-sectional study used data from the IMIAS, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). A total of 1724 older adults aged 65-74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. The FRS was calculated to estimate the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high-density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Confounders included measures of childhood social and economic adversity, as well as mid-life and adult adversity. RESULTS After adjustment for adversities which occurred during in early, adult or current life, frail individuals presented higher FRS values (β = 3.81, 95 %CI: 0.97-6.65, p-value

Physical activity (PA) among older adults is understudied in middle-income countries. The authors examined the associations of factors across levels of the social ecological model (individual, interpersonal, organizational, and community) with older adults meeting guidelines of 150 min of moderate- to vigorous-intensity PA per week through walking in three middle-income countries: Albania (n = 387), Colombia (n = 404), and Brazil (n = 402). Using 2012 International Mobility in Aging Study data, multivariate logistic regression models identified the following significant associations with meeting PA guidelines through walking (a) individual level: depression (odds ratio [OR] = 0.62, 95% confidence interval, CI [0.45, 0.86]), being female (OR = 0.74, 95% CI [0.56, 0.998]), and high relative education (OR = 1.79, 95% CI [1.33, 2.41]) and (b) interpersonal level: high life partner (OR = 1.38, 95% CI [1.04, 1.83]) and friend social ties (OR = 1.39, 95% CI [1.05, 1.83]). While individual and interpersonal variables were associated with meeting PA guidelines, community-level social and environmental variables were not.

Introduction: The height in the elderly does not reflect their real size as young adults due to the aging of their spine, among other aspects. Objective: To estimate the equations to predict the height in Colombian elders according to their ethnic group and sex using the knee height measurement. Materials and methods: We conducted a secondary analysis of the SABE, 2015, crosssectional study using a multistage probabilistic sampling design in people aged 60 years and over in Colombia. We randomly selected two groups from the study’s database: A development group and a validation group of the equations. Age and anthropometric characteristics were similar in both groups. We performed a multiple linear regression analysis to predict the height using knee height measurement in the different ethnic groups (Indigenous, Afro-descendant, and white-mestizo groups) by age and sex; the results were validated in each selected subgroup. Results: We designed six equations by sex (men=3,665; women=3,019) and ethnic group. The adjusted R2 of the equations in men from the three ethnic groups oscillated between 64% and 75% and the standard errors, between 3,09 and 3,93 cm while in women, the R2s of the three equations ranged between 53% and 73% and the EEs, between 2,96 and 3,90 cm. Conclusion: The equation with the best predictive capacity of the height of Colombian elders was obtained for African descendants of both sexes. The lowest coefficients of determination were obtained for the indigenous population.Introducción. La estatura en el anciano no refleja su talla real de adulto joven debido al envejecimiento de su columna vertebral, entre otros aspectos. Objetivo. Proponer ecuaciones para estimar la talla de los ancianos colombianos mediante la altura de la rodilla, según el grupo étnico y el sexo. Materiales y métodos. Se hizo un análisis secundario del estudio transversal SABE 2015, utilizando un diseño muestral probabilístico y multietápico en personas colombianas de 60 o más años. Se seleccionaron aleatoriamente dos grupos de la base de datos del estudio SABE: el grupo para el desarrollo de las ecuaciones y el grupo para su validación. Se hizo un análisis de regresión lineal múltiple para estimar la estatura mediante la altura de la rodilla en los grupos étnicos (indígenas, afrodescendientes y blancos-mestizos) por edad y sexo; los resultados se validaron en cada subgrupo de estudio. Resultados. Se diseñaron seis ecuaciones por sexo (hombres=3.665, mujeres=3.019) y etnia; los coeficientes de determinación ajustados (R2) de las ecuaciones en hombres de los tres grupos étnicos oscilaron entre 64 y 75 % y, los errores estándar, entre 3,09 y 3,93 cm. En las mujeres, los R2 de las tres ecuaciones fluctuaron entre 53 y 73 % y los EE, entre 2,96 y 3,90 cm. Conclusión. La ecuación con mejor capacidad para estimar la talla del anciano colombiano fue la obtenida para los afrodescendientes de ambos sexos, en tanto que en la población indígena se presentaron los menores coeficientes de determinación.

Objective: The objective of this study is to evaluate the influence of urinary incontinence (UI) on physical performance. Method: In prospective analyses from the International Mobility in Aging Study (IMIAS), 915 women (65-74 years) from Canada, Colombia, Albania, and Brazil were evaluated in relation to self-reported UI (past week) and physical performance (Short Physical Performance Battery [SPPB]), with reevaluation after 2 years. Linear mixed models examined the influence of UI on SPPB, adjusted by covariates (age, study site, education, income sufficiency, body mass index [BMI] and parity). Results: Women reporting some UI presented lower SPPB mean (β = −0.41, p = .009) and a greater reduction (β = −0.53, p = .001) over 2 years than those reporting no UI. Discussion: Compared with no reported UI, some UI was associated with worse and more pronounced declines in physical performance over 2 years. This study highlights the importance of practices to reduce UI to contribute to healthier aging.

Objectives To examine differences in incidence of functional disability between older women and men. Methods 2002 participants (65–74 years) were recruited in 2012 from Canada, Brazil, Colombia, and Albania, and re-assessed in 2016. Three measures of functional disability were used (1) Difficulty in any of five mobility-related Activities of Daily Living (ADL disability); (2) Self-reported difficulty climbing a flight of stairs or walking 400 m (mobility disability); and (3) Poor physical performance. We estimated the adjusted gender-specific incidence risk ratios (IRR) for each outcome in 2016. Results In 2016, 1506 participants (52% women) were re-examined, 80% of the surviving cohort. Among those not disabled in 2012, seventy-four (12.9%) men developed ADL disability, while 105 (19.2%) developed mobility disability, and 97 (16.1%) developed poor physical performance. For women, numbers were higher 120 (21.4%) developed ADL disability, 117 (26.5%) developed mobility disability, and 140 (23.0%) developed poor physical performance. Compared to men, women had a higher adjusted incidence of self-reported ADL disability (IRR 1.4; 95% CI 1.04–1.88) and mobility disability (IRR 1.4; 95% CI 1.06–1.77), but not of poor physical performance (IRR 1.03; 95% CI 0.88–1.32). Conclusions Although women have a higher self-reported incidence of ADL and mobility disability than men, there was no significant difference in poor physical performance. Reasons for this discrepancy between self-reported and performance-based measures require further investigation. Understanding gender differences in functional disabilities can provide the basis for interventions to prevent mobility loss and minimize any gender gap.

The fear of falling has a high prevalence in the community, and intervention programs for this condition are scarce, making it is necessary to strengthen this type of therapy in order to prevent adverse consequences in the elderly population.To establish the effectiveness of three intervention programs in reducing the fear of falling and increasing functionality in elderly people in the city of Manizales.A randomised trial was conducted on ambulatory elderly patients with fear of falling and functional limitation of the city of Manizales. A total of 125 individuals were randomised to one of three interventions: Tai Chi (TCh), cognitive behavioural therapy (CBT), and postural control (CP) exercises. The primary outcomes were: fear of falling (evaluated by the Falls Efficacy Scale [FES-I]), and functionality using the Short Physical Performance Battery (SPPB). The data was collected before initiating the interventions and after the 8 weeks intervention.An intention-to-treat analysis was conducted on 119 elderly patients. The three interventions reduced the fear of falling and increased physical performance, with no significant differences observed between them (P=.13). As regards gait speed, differences were only found between the pre- and post-intervention with CP (P.001).The results suggest that the TCh, CBT and CP interventions helped the elderly to reduce their fear of falling. Only CP demonstrated an improvement in the speed of walking at the end of the eight weeks of intervention (identifier NCT03211429).

espanolEn este texto nos inclinamos sobre una mirada del envejecimiento desde una concepcion filosofica de la conciencia del tiempo ya que es uno de los elementos mas relevantes que no solo ha emergido en el Proyecto de investigacion SABE Colombia (Encuesta Salud, bienestar y Envejecimiento), sino de la estructura misma de la vida; es mas la vejez en si misma, como fenomeno temporal, es la acumulacion de tiempo en un mismo cuerpo; ademas, la nocion de tiempo esta implicita en el estudio del envejecimiento. Este articulo tiene como objetivo revelar el sentido de la conciencia temporal de la vejez o la vejez a la luz de la conciencia temporal, en tanto el tiempo se va desprendiendo de la existencia humana poco a poco hasta agotar su contenido en el cuerpo como revelacion del tiempo, como huella, como rastro en donde se revela la vida misma. Para lograr este objetivo se proponen tres puntos nodales de reflexion, primero, entre la latencia y la presencia de la vejez; segundo, entre vejez y clandestinidad del futuro, y por ultimo, el rostro de la vejez: el desprendimiento de cuerpo a traves de la conciencia temporal del presente. EnglishIn this text we approach the process of aging from the philosophical view-point of the awareness of time. We consider this awareness of paramount importance not only in the course of the research project SABE Colombia (Survey of Health, Well-being and Aging, according to its initials in Spanish), but also because of the very structure of life. Moreover, old age in itself, as a time-related phenomenon, consists of the accumulation of time in a single body: therefore, the notion of time must be implicit in the study of aging. This article aims at revealing the sense of the time consciousness of old age or (in other words) at viewing old age in the light of time consciousness, insofar as time lets human existence come off gradually until its exhaustion reveals life as a time trace, as a time mark in the body. To achieve this goal, we propose three nodal points of reflection: first, between the latency and the presence of old age; second, between old age and the secrecy of future, and finally, the face of old age: the detachment of the body through the time consciousness of the present.

One of the challenges of population aging is to ensure that there are enough trained professionals to meet the changing, specific needs of aging populations. The aim of this study was to describe the number, geographical distribution, and general characteristics of gerontological training programs offered by Latin American universities and to analyze their disciplinary content and the degree of similarity among programs. One hundred undergraduate and postgraduate programs with gerontological content were found to be offered by Latin American universities. Information on the institutional affiliation, academic level, management, length, and content of the programs was analyzed. Descriptive statistics were run and content analysis was performed on the programs’ syllabuses to address the objectives of the study. Results show that despite being a relatively young region of the world, the majority of Latin American universities offer gerontological programs. However, the nature of this course offering seems to be quite diverse across countries. Moreover, the analysis of the programs’ disciplinary content indicates that the program providers take a multidisciplinary approach to gerontology. The great diversity of programs and their multidisciplinary contents suggest a low degree of standardization of gerontological training in Latin America. Fil: Villar Posada, Feliciano. Universidad de Barcelona; España Fil: Giuliani, María Florencia. Universidad Nacional de Mar del Plata. Facultad de Psicología. Instituto de Psicología Básica, Aplicada y Tecnología. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Psicología Básica, Aplicada y Tecnología; Argentina Fil: Serrat Fernández, Rodrigo Andrés. Universidad de Barcelona; España Fil: Curcio, Carmen Lucía. Universidad de Caldas; Colombia Fil: Lopes, Alexandra. Universidad de Porto; Portugal Fil: Maldonado, María de la Luz Martínez. Universidad Nacional Autónoma de México; México Fil: Oliveira, Rita da Cássia. Universidade Estadual de Ponta Grossa; Brasil

ObjectivesTraditionally, the approach to fracture prevention has focused on increasing bone mineral density while typically lacking a combined clinical approach to falls prevention and vice versa. To resolve this gap, we implemented and evaluated a novel combined model of care to the assessment and prevention of osteoporosis and falls in the outpatients setting.SettingFalls and Fractures Clinic (FFC) at Nepean Hospital (Penrith, NSW, Australia).ParticipantsPre-effects and posteffects assessment of 106 community-dwelling older patients referred from the community.Primary and secondary outcome measuresPrevious falls and fractures were recorded. Clinical, functional and paraclinical evaluations were performed. A comprehensive multidisciplinary care plan was then tailored based on the presence of risk factors. Six-month follow-ups were performed assessing the incidence of falls and fractures, change in risk factors for falls and level of risk, with the recommended plan.ResultsWe report that 97% of patients had a fall in the preceding 6 months, 47.6% of whom experienced a fracture from the fall. Furthermore, 64% of patients had a marked risk for falling by Physiological Profile Assessment (PPA), 90% had intermediate–high 10-year probability of fracture according to FRAX and 78% had sarcopenia. At 6-month follow-up, we observed more than an 80% reduction in falls and recurrent falls, and 50% reduction in fractures. In addition, 65% of patients had reduced PPA and a 57% reduction in 10-year fracture probability.ConclusionsIn conclusion, we suggest that a multidisciplinary FFC can provide substantial reductions in falls and fractures for high-risk older people, even over a relatively short 6-month time period. The current model of service provision via traditional falls clinics could be significantly improved by encompassing fracture prevention within the multifactorial approach to interventions.

Background Life course exposure to violence may lead to disability in old age. We examine associations and pathways between life course violence and mobility disability in older participants of the International Mobility in Aging Study (IMIAS). Methods A cross-sectional study using IMIAS 2012 baseline. Men and women aged 65–74 years were recruited at 5 cities (n=1995): Kingston and Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Mobility was assessed by the Short Physical Performance Battery (SPPB) and by 2 questions on difficulty in walking and climbing stairs. Childhood physical abuse history and the HITS instrument were used to gather information on childhood exposure to violence and violence by intimate partners or family members. Multivariate logistic regression and mediation analysis models were constructed to explore the significance of direct and indirect effects of violence on mobility. Interaction effects of gender on violence and on each of the mediators were tested. Results Experiences of physical violence at any point of life were associated with mobility disability (defined as SPPB

Objectives To examine whether the association between emotional support and indicators of health and quality of life differs between Canadian and Latin American older adults. Design Cross-sectional analysis of the International Mobility in Aging Study (IMIAS). Social support from friends, family members, children and partner was measured with a previously validated social network and support scale (IMIAS-SNSS). Low social support was defined as ranking in the lowest site-specific quartile. Prevalence ratios (PR) of good health, depression and good quality of life were estimated with Poisson regression models, adjusting for age, gender, education, income and disability in activities of daily living. Setting Kingston and Saint-Hyacinthe in Canada, Manizales in Colombia and Natal in Brazil. Participants 1600 community-dwelling adults aged 65–74 years, n=400 at each site. Outcome measures Likert scale question on self-rated health, Center for Epidemiological Studies Depression Scale and 10-point analogical quality-of-life (QoL) scale. Results Relationships between social support and study outcomes differed between Canadian and Latin American older adults. Among Canadians, those without a partner had a lower prevalence of good health (PR=0.90; 95% CI 0.82 to 0.98), and those with high support from friends had a higher prevalence of good health (PR=1.09; 95% CI 1.01 to 1.18). Among Latin Americans, depression was lower among those with high levels of support from family (PR=0.63; 95% CI 0.48 to 0.83), children (PR=0.60; 95% CI 0.45 to 0.80) and partner (PR=0.57; 95% CI 0.31 to 0.77); good QoL was associated with high levels of support from children (PR=1.54; 95% CI 1.20 to 1.99) and partner (PR=1.31; 95% CI 1.03 to 1.67). Conclusions Among older adults, different sources of support were relevant to health across societies. Support from friends and having a partner were related to good health in Canada, whereas in Latin America, support from family, children and partner were associated with less depression and better QoL.

Objective: This study aimed to determine the prevalence of successful aging (SA) and identify its predictive factors in a cohort of older people in the Colombian Andes Mountain. Method: Data were drawn from a prospective longitudinal study of community-dwelling elderly people in Manizales. SA encompassed indicators in four domains: physical, cognitive, emotional, and social functioning. Results: The prevalence of SA was 24.4%. The independent predictors were good and very good self-rated health, middle–high/high-income level, absence of chronic conditions, married status, high educational level, and very high spirituality. Discussion: The prevalence of SA was low: One of 10 people older than 65 years showed SA when presence of diseases was included in the criteria, compared with one of four when such an item was excluded. The identification of predictive factors allows distinguishing this population in primary care services and promoting strategies that ensure high functionality levels for as long as possible.

Fear of falling (FoF) is a common health problem among older adults. Although the relationship between FoF and limitation in daily activities has been reported, FoF's relationship to mobility disability, a transitional phase to end-stage disability, is not yet understood. We examined the relationship between FoF and mobility disability among community-dwelling older adults and explored the differences in this relationship among socio-culturally diverse sites.Cross-sectional study.Community.1875 participants (65-74 years) were recruited from five sites and included in the analysis (Kingston, Canada: 394; St-Hyacinthe, Canada: 397; Tirana, Albania: 359; Manizales, Colombia: 341; and Natal, Brazil: 384).FoF was quantified using the Falls Efficacy Scale-International (FES-I, range: 16-64). Mobility disability was defined as difficulty climbing a flight of stairs or walking 400m without assistance.Overall, 21.5% of participants reported high FoF (FES-I27). The average FoF scores were significantly different between the sites (p0.001) and higher in women (p0.001). In general, 36.2% of participants reported mobility disability. The distribution of mobility disability was significantly different at the five study sites (ranged from 19.8% at Kingston, Canada to 50.7% at Tirana, Albania, p0.001). After adjusting for covariates, those with high and moderate FoF had about 3 times (95% CI: 2.59-3.83) and 2.5 times (95% CI: 1.99-2.91) higher risk of mobility disability, respectively, compared to those with no/low FoF.FoF was significantly associated with risk of mobility disability across the sites. The strength of this relationship appears to be different between the five sites.

Según estudios realizados hasta la fecha, pocos tratan la relación espacio de vida y entorno del barrio en adultos mayores en América Latina. El objetivo de este artículo es determinar la asociación entre espacio de vida y entorno del barrio en adultos mayores de 65 a 74 años en el área urbana de Manizales, Colombia. La metodología utilizada fue un estudio cuantitativo (descriptivo, prospectivo y transversal) con una muestra de 398 adultos mayores, distribuidos en 11 comunas y 29 barrios. Se evaluó espacio de vida y entorno del barrio, se realizó un análisis uni-bivariado (p