Rev. Latino-Am. Enfermagem Original Article 2018;26:e3100 DOI: 10.1590/1518-8345.2897.3100 www.eerp.usp.br/rlae Frailty syndrome among elderly and associated factors: comparison of two cities* Rosalina Aparecida Partezani Rodrigues1 Jack Roberto Silva Fhon1 Maria de Lourdes de Farias Pontes2 Antonia Oliveira Silva3 Vanderlei José Haas4 Jair Lício Ferreira Santos5 Objective: to compare the frailty syndrome among elderly people living at home in two Brazilian cities and to identify factors related to sociodemographic and health-related variables. Method: population-based cross-sectional study with 480 elderly individuals from the cities of Ribeirão Preto/SP and João Pessoa/PB, with application of the Mini Mental State Examination instruments and the Edmonton Frailty, Geriatric Depression and Lawton and Brody scales. Descriptive analysis, Chi-square test, Fisher’s test, Student’s t-test, Spermann’s correlation and Logistic regression were used. In all analyzes, the level of significance was set at p≤0.05. Results: in relation to frailty, it was verified that living in Ribeirão Preto, presenting advanced age, low schooling, multiple chronic diseases, reduced cognitive status and functional capacity, besides depressive symptoms, are factors associated with the frailty syndrome, in both cities. Conclusion: we identified that the frailty syndrome in the elderly of both cities has a relation with the place where the elderly person lives, age, schooling, number of diseases, reduction of cognitive status, functional capacity and presence of symptoms depressive. Descriptors: Frailty; Aged; Aging; Geriatric Nursing; Comparative Study; Health of the Elderly. * This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. Supported by Conselho Nacional do Desenvolvimento Científico e Tecnológico (CNPq), Brazil, grant #311030/2011-4. 1 Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. 2 Universidade Federal da Paraíba, Departamento de Enfermagem, João Pessoa, PB, Brazil. 3 Universidade Federal da Paraíba, Instituto Paraibano de Envelhecimento, João Pessoa, PB, Brazil. 4 Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil. 5 Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil. How to cite this article Rodrigues RAP, Fhon JRS, Pontes MLF, Silva AO, Haas VJ, Santos JLF. Frailty syndrome among elderly and associated factors: comparison of two cities. Rev. Latino-Am. Enfermagem. 2018;26:e3100. [Access ___ __ ____]; Available in: ___________________. DOI: http://dx.doi.org/10.1590/1518-8345.2897.3100. month day year URL 2 Rev. Latino-Am. Enfermagem 2018;26:e3100. Introduction the Northeast of Brazil. Both have a similar number of inhabitants: 682,302 and 811,598, respectively(12). In a global context of population aging, in Brazil, The following criteria were defined for participation there has been an accelerated increase in the proportion in the study: being 60 years of age or older, of both of the elderly. In 2010, according to a survey by the sexes, living in the urban area and being able to respond Brazilian Institute of Geography and Statistics (IBGE), to the instruments of data collection. The exclusion there were a total of 23.5 million people aged 60 or over, criteria were elderly with neurological diseases and that and by 2013 this number reached 64.8 million. It is also after the first contact did not attend the researchers in noted an increase in life expectancy, with projections up to three consecutive visits. that reach, by 2041, 80 years(1) . For the identification of the elderly, a sample was The aging process is accompanied by a set of chosen by double-stage conglomerate. In the first, the physiological, psychological and social changes that can sample unit was considered the census sector and, in the trigger multiple syndromes, among them the frailty(2). second, age over 60 years. The sample was calculated in Frailty is a state of multidimensional change each city to guarantee maximum error of 6.3% with 95% in which there is increased vulnerability and loss probability, in situation of maximum variability. To reach of resistance to external stressors, which increases the value of 240 elderly people in each city to compose the chance of certain adverse health events such as the sample, we planned to raffle 20 sectors in both cities decreased strength, endurance and physiological and to ensure the sample self-weighting, for which we function(3). Under these conditions, the risk of fixed the number of 12 elderly people by census sector. dependence and/or death is high(4). Once the sector was chosen, a new lottery of the streets In order to define frailty, the Canadian Initiative and blocks was made to identify the elderly people from on Frailty and Aging (CIF-A) elaborated the concept the starting point, clockwise. based on a holistic approach determined by biological, The data were collected in the two cities by teams psychological and social factors related to the life composed of undergraduate and graduate students trajectory of the elderly(5-6). previously trained by the study coordinator in both cities In a systematic review with 19 articles, the authors to apply the different instruments. The elderly were verified the prevalence of frailty in the elderly between contacted in 2014, in their respective homes, and the 2.3% and 75.0%(7). Research indicates that frailty is interviews occurred in 2015, after previous scheduling, associated with demographic factors, such as female with a duration of approximately 45 minutes each. To sex and old age(7-8), and with clinical conditions, such this end, the following instruments were applied: as decreased functional capacity and cognitive status(9), a) Sociodemographic profile. For the increased number of falls and hospitalizations(10) and characterization of participants, the variables death(11). were: sex (male and female); age (in complete In Brazil, there are few studies on the subject, years); marital status (with and without especially those comparing two cities that can be partner); family arrangement (alone, spouse, influenced by the inequalities present in the different relatives and others); schooling (years of formal Brazilian regions, mainly life expectancy, low schooling, study); income (retirement, other sources monthly income, housing and health conditions of the of income and without retirement) and self- elderly, and conflicting house arrangements, in addition reported morbidities. to suffering difficulties in the attention to healthcare. b) Mini Mental State Examination (MMSE). It is an (13) Thus, in view of the accelerated aging process and instrument translated and validated into the Portuguese language(14) whose score is related the importance of investigating situations that contribute to the educational level of the respondents. The to frailty in the elderly, this study aims to compare the questions are grouped into seven categories and frailty syndrome among elderly people living at home each of them evaluates different and specific in two Brazilian cities and to identify factors related to cognitive functions: orientation on time (5 sociodemographic and health variables. points); orientation on place (5 points); 3-word Method registration (3 points); attention and calculation (5 points); word recall (3 points); language This is an analytical and cross-sectional study (8 points); and visual constructive capacity (1 carried out in the cities of Ribeirão Preto, located in the point). The score can vary from 0 to 30 points, Southeast region, northeast of the state of São Paulo, and the cutoff points are: 13 for illiterate, 18 for and João Pessoa, capital of the Paraíba state, located in low/medium schooling and 26 for high schooling. www.eerp.usp.br/rlae Rodrigues RAP, Fhon JRS, Pontes MLF, Silva AO, Haas VJ, Santos JLF. 3 c) Edmonton Frail Scale (EFS), prepared by For the final analysis, Multiple Linear Regression was the Canadian Initiative on Frailty and Aging used, with frailty as the dependent variable, including (CIF-A)(15) and validated for the Portuguese the cities (Ribeirão Preto and João Pessoa), sex (male language(16-17). The scale evaluates nine domains and female), age, schooling, number of diseases, MMSE represented by 11 items: a) cognitive area with (with and without cognitive deficit), IADL and GDS. In all the clock test (1 item); b) general health status analyzes, the level of significance was set at p ≤ 0.05. (2 items); c) functional independence (1 item); The research was evaluated and approved by d) emotional support (1 item); e) medication the Ethics and Research Committee of the School use (2 items); f) nutrition (1 item); g) mood of Nursing of Ribeirão Preto, University of São Paulo, (1 item); h) continence (1 item); i) functional under the Approval Certificate (CAAE) number performance Time Up and Go for balance and 47155115.3.0000.5393. mobility (1 item). The maximum score is 17 points and represents the highest level of frailty. Results d) Geriatric Depression Scale (GDS), reduced version of the original scale(18) and validated for Of the 480 (100%) elderly, there was a the Portuguese language(19), with dichotomous predominance, in both cities, of elderly women, aged responses. The score ranges from zero (absence of 80 years or more and retirees. In relation to the marital depressive symptoms) to 15 points, with the cutoff status, in Ribeirão Preto, there was prevalence of elderly point> 5 indicating the presence of symptoms. with a partner and, in João Pessoa, without a partner. e) Lawton and Brody scale, which evaluates As for the family arrangement, in Ribeirão Preto, most the Instrumental Activities of Daily Living elderly lived only with their spouses (29.6%) and in (AIVD)(20), adapted to the Brazilian context(21), João Pessoa, with spouse, children and grandchildren and encompasses more complex social (28.0%) (Table 1).