Transição entre os níveis de fragilidade e intensidade da dor e incapacidade em idosas com dor lombar: dados longitudinais da coorte back complaints in the elders (bace-brasil)

Abstract

Frailty syndrome is frequent in an aging population and to identify elderly that frail or in the process of becoming frail, for an appropriate intervention, has become a great challenge for the geriatric and gerontology professionals and researchers. The Frailty Phenotype as described by Fried et al. is the most commonly used internationally to characterize elderly with this syndrome. The presence or lack thereof of factors that make up the criteria of this phenotype allow that elderly, throughout their lives, transit in between their levels, becoming more or less frail. Several factors of senescence and senility may contribute to this transition, amongst them, pain. Low back pain (LBP), a prevailing and incapacitating condition has been poorly explored in elderly specific studies. This study aimed to evaluate the transition between frailty levels, utilizing the Frailty Phenotype (FRIED et al, 2001) at the baseline and after six and twelve months of follow up of elderly women with LBP and to analyze the association between pain intensity and the difficulties in transitions between frailty levels. This study involved a longitudinal analysis of the Back Complaints in the Elders (BACE) – Brazil (COEP UFMG, ETIC 0100.0.203.000-11) database. Women (≥ 65 years) of the Belo Horizonte community that presented new episodes (acute) of LP. The study excluded the elders with cognitive alterations detected through the Mini-Mental estate examination, according to scholarity, visual, auditory and/or motor deficiencies that prevented the mobility tests. The evaluation of frailty throughout time was made with Generalized Estimated Equations, considering multinomial ordinal outcomes. In the first stage of the modeling only the transition over time was considered, and later, co-variables for incapacity and pain were added, to verify its possible associations with the transition. A significance level of 0,05 was adopted. The sample total included 155 elderly, with mean age of 70,4 (±5,4). The pain intensity mean was of 5,5 (±3,3) and the incapacity was 13,4 (±6,0). It was observed a significant transition between frailty levels according to the criteria proposed by Fried et al. in the follow up periods (p<0,0001). The chance of the frailty profile changing, considering the overall follow up over time, was (OR = 2,833, IC95% 1,987-4,678). After the inclusion of the pain variable (β = -0,73505; p= 0,00148) in the transition model’s baseline, a significant association of the pain intensity with the transition of the elderly through the frailty levels was observed. The same happened when the incapacity variable was added to the model (β= -0,74470; p= 0,00134). The transition between frailty levels in the elderly population was observed in the present study, factors such as pain and incapacity prevalent in these individuals are intimately connected to this phenomenon. This pioneer study also made it possible to fill the gap in the literature regarding the analysis of the transition of the elderly with respect to fragility phenotype items separately and during one year of follow-up, strengthening the importance of individualization of individuals presenting pain and disabilities in the clinical setting.