Velocidade da marcha como marcador funcional da saúde do idoso: fatores associados, relações com desfechos adversos e efeitos da dupla tarefa - análises dos dados da Rede FIBRA

Abstract

Introduction: The usual gait speed (UGS) is used as a measure of physical performance to detect changes in mobility and predict adverse health outcomes in the elderly population. Frailty is also able to predict disability, hospitalization, institutionalization, falls, and death. The UGS can be changed while the gait is performed simultaneously to a second task, featuring dual task (DT). Objective: To identify the determinants factors of UGS in the frailty; understand their associations with adverse health outcomes and identify ways in which the DT affects the UGS in the frailty. Methods: Studies A and B used the data from Rede FIBRA. The 5501 elderlies were allocated into groups: non-frail (NFG), pre-frail (PFG) and frail (FG). Binary regression logic models were plotted, having as dependent variable the UGS and as independent variables clinical, demographic, affective and functional characteristics. In study B, the sample was allocated into slow group (SG) and fast group (FG), and the logistic regression model had the UGS as dependent variable and as independent variables the chronic diseases, hospitalization, polypharmacy, number of criteria of frailty and cognitive function. The sample of the study C consisted by 81 community elders allocated into three groups (GNF, GF and GPF). The gait parameters were measured through GAITRite® mat in two situations: single task (ST) and DT. The gait parameters comparisons were done by ANOVA repeated measures test. Results: the study A identified that the performance of activitiesof daily life (ADL) (NFG: OR=1.36, CI95%=1.22-1.52; PFG: OR=1.13, CI95%=1.03-1,23; FG: OR=0.32, CI95%=0.14-0.75); muscular strength (NFG: OR=1.29, CI95%=1.20-1.39; PFG: OR=1.37, CI95%=1.32-1.42; FG: OR=1.48, CI95%=1.24-1.54) and a sense of self-efficacy (NFG: OR=0.81, CI95%=0.77- 0.86; PFG: OR=0.75, CI95%=0.73-0,78; FG: OR=0.58, CI95%=0.68-0.91) were associated with the UGS in the three levels of frailty. In particular the FG showed a strong association with MEEM scores (OR=1.66, CI95%=1.30-2.09) and GDS (OR=0.71, CI95%=0.52-0.96) and history of falls (OR=2.31, CI95%=2.01-2.99). The B study found that elderly individuals with heart diseases (OR=2.06, CI95%=1.67-2.54); respiratory diseases (OR=3.25, CI95%=2.02-5.29); rheumatic diseases (OR=2.16, CI=1.79-2.52); stroke (OR=2.01, CI95%=1.12-3.60); depression (OR=2.51, CI95%=2.10-3.14); hospitalization in the past year (OR=1.51, CI95%=1.21-1.85); polypharmacy (OR=2.14, CI95%=1.80-2.54); frailty (OR=0.21, CI95%=0.19-0.23) and lower scores on the MEEM (OR=1.57, CI95%=1.52-1.62) showed high odds ratio of walking slowly. The C study identified the effect of DT on the three groups (NFG, PFG and FG), with decrease of UGS (NFG=10%; PFG=13.2% and FG=20%), cadence (NFG=5.5%; PFG=6.4% and FG=8.6%), and step length (NFG=5.3%; PFG=6.1% and FG=8%) and increase of the gait time (NFG=5%; PFG=6.4% e FG=15.2%).Conclusion: The association between UGS, frailty and adverse health outcomes reinforces its primacy as an indicator of functional health of the elder. The performance of ADL, muscle strength, sense of selfefficacy, cognitive ability, depressive symptoms, falls, chronic diseases, stroke, hospitalization in the last year, polypharmacy and frailty were closely related to the UGS. Considering the reversibility potential of most variables, one should consider them in the assessment and treatment of the elderly. The importance of DT in the ADL performance and its strong influence on the UGS demonstrate that this methodology should be part of the rehabilitation of the elderly.