The complex physiology underpinning the frailty syndrome is responsible for the absence of robust biomarkers that can be used for screening, diagnostic and/or prognostic purposes and has made clinical implementation difficult. Considering socially vulnerable populations, who have poor health status and increased morbidity and mortality, this scenario is even more complex. However, to the best of our knowledge, there are no studies available to investigate frailty biomarkers in socially vulnerable populations. Thus, the aim of this cross-sectional study was to identify potential blood-based biomarkers of frailty in a socially vulnerable population. A sample consisting of 347 community-dwelling older people living in a context of high social vulnerability was divided into non-frail (robust), pre-frail and frail groups, according to modified Fried frailty phenotype criteria. Blood samples were collected and analyzed for basic metabolic parameters and for inflammatory cytokines. Levels of Interleukin-1α (IL-1α) and Tumor Necrosis Factor α (TNF-α) were significantly higher in pre-frail subjects, compared to non-frail ones. Tumor Necrosis Factor β (TNF-β) levels presented higher values in the frail compared to non-frail individuals. Interleukin-6 (IL-6) levels in pre-frail and frail subjects were significantly higher compared to the levels of non-frail subjects. Using an ordinal regression analysis, we observed that socially vulnerable older people at higher risk of developing frailty were subjects above 80 years old (OR: 2.5; 95% CI: 1.1–5.6) and who presented higher levels of TNF-β (≥0.81 pg/mL, OR: 2.53; 95% CI: 1.3–4.9). As vulnerable populations continue to age, it is imperative to have a greater understanding of the frailty condition, identifying novel potential blood-based biomarkers. The results presented here could help to implement preventive healthcare strategies by evaluating frailty and at the same time measuring a set of inflammatory biomarkers, paying special attention to TNF-β plasmatic levels.

This study investigated the relationship between metabolic parameters and low serum 25-hydroxyvitamin D (25(OH)D) levels in older adults (n = 265). They were assessed for anthropometrics and metabolic measurements, including 25(OH)D, insulin, glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and other inflammatory markers. Vitamin D deficiency was defined as a 25(OH)D level below 50 nmol/L. Comparisons between groups were performed using Wilcoxon–Mann–Whitney or Pearson’s Chi-squared test. A multivariate adjusted Poisson regression was used to model the number of metabolic parameters as a function of a set of explanatory variables. Subjects with 25(OH)D deficiency were predominantly females and presented higher body weight, body mass index, waist circumference, triglycerides and Tumor Necrosis Factor-α (TNF-α), and higher insulin resistance. Metabolic syndrome was also more prevalent among 25(OH)D-deficient subjects. In those without metabolic syndrome, 25(OH)D deficiency was related only to obesity and higher insulin resistance. Female sex, hypertension, higher waist circumference and higher levels of hemoglobin A1C (%), HDL-C, and TG were significantly associated with an increased number of metabolic syndrome parameters after adjusting for covariates, but 25(OH)D was not. The fact that serum 25(OH)D concentration was inversely associated with metabolic syndrome and insulin resistance not only reaffirms the relevance to consider serum 25(OH)D concentration as an influencing factor for insulin resistance, but also the need to actively screen for hypovitaminosis D in all patients with this condition.

Objective: To identify factors associated with depressive symptoms in the elderly inserted in a context of high social vulnerability. Methods: A cross-sectional study was carried out with 302 elderly people enrolled in Primary Care. We used a sociodemographic questionnaire, Geriatric Depression Scale, Mini Nutritional Assessment, Shor-form-6D Quality of Life Questionnaire and Medical Outcome Study Scale. For data analysis, a logistic regression was performed considering two groups, with and without depressive symptoms. Results: A good perception of the quality of life (OR: 0.21) and receiving emotional support (OR: 0.98) were presented as protective factors for depression, have risks of malnutrition (OR: 4.87), belong to the female sex OR: 1.88) and living alone (OR: 2.34), indicated a predictor factor for depression. Conclusion: Quality of life and social support were identified as protective factors for depressive symptoms while being at risk of malnutrition, living alone, reporting pain and being female are predictors.

To compare the effects of water-based and land-based physical therapy on postural control of older women with osteoporosis. Thirty-six postmenopausal women with osteoporosis were allocated into two groups: land-based or water-based. Volunteers received 12 weeks of a supervised land-based or water-based physical therapy treatment. The outcome measure was postural control of the body during quiet standing on upright stance (eyes opened and closed), tandem and one-limb stance on a force plate. A two-way ANOVA with a Tukey HSD post-hoc test were used to highlight differences between pre- and post-intervention evaluations. Effect sizes were measured with Cohen d coefficient. For all variables, a level of 5% of significance was adopted. Significant improvements at tandem (p < 0.05, effect sizes from -0.67 to -1.35) and one-limb stance (p < 0.05, effect sizes from -0.76 to -1.03) for women carrying out water-based treatment were observed. Land-based treatment did not present significant improvement. Group-based water-based physical therapy treatment may be more effective than land-based therapy to improve postural control at one-limb stance in women with osteoporosis.

Objective: to identify factors associated with depressive symptoms in elderly caregivers with chronic pain. Method: the study included people 60 years of age or older who reported chronic pain and cared for another elderly person living in the same household (n=186). Statistical analyzes were performed using the Mann-Whitney test, univariate and multiple logistic regression. Results: most participants had no depressive symptoms (70.4%), 24.2% had mild depressive symptoms and 5.4% had severe symptoms. Univariate analysis showed that the variables family income, number of diseases, number of medications in use, pain intensity, overload and perceived stress were associated with depressive symptoms. Multivariate analysis found an association with perceived stress (95% CI 1.101-1207) and number of medications (95% CI 1.139-1.540) in use. Conclusion: factors associated with depressive symptoms in elderly caregivers with chronic pain were stress and the number of medications in use.

Background: Individual case management programs may be particularly effective in reducing fall risk as they can better identify barriers and facilitators to health recommendations. Objective: This paper describes the protocol for a single-blind, parallel-group randomized controlled trial that aims to investigate the effectiveness and cost-effectiveness of a home-based multifactorial program targeting fall risk factors among people aged 60 years and over who have fallen at least twice in the past 12 months (the MAGIC trial). Methods: Older people with a history of at least 2 falls in the last year will be divided into 2 groups. The intervention group will receive case management at home for reducing the risk of falls, including a multidimensional assessment, explanation of fall risk factors, and elaboration and monitoring of an individualized intervention plan based on the identified fall risk factors, personal preferences, and available resources. The control group will be monitored once a month. Assessments (clinical data, fall risk awareness, physical and mental factors, safety at home, feet and shoes, and risk and rate of falls) will be carried out at baseline, after 16 weeks of the intervention, and at the posttrial 6-week and 1-year follow-up. After 16 weeks of the intervention, satisfaction and adherence to the intervention will also be assessed. Economic health will be evaluated for the period up to the posttrial 1-year follow-up. Results: Data collection started in April 2021, and we expected to end recruitment in December 2021. This case management program will address multifactorial assessments using validated tools and the implementation of individualized intervention plans focused on reducing fall risk factors. Conclusions: This trial may provide reliable and valuable information about the effectiveness of case management for increasing fall risk awareness and reducing fall risk in older people. Trial Registration: Brazilian Clinical Trials Registry (ReBec) RBR-3t85fd; https://ensaiosclinicos.gov.br/rg/RBR-3t85fd International Registered Report Identifier (IRRID): DERR1-10.2196/34796