DANIEL APOLINARIO
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- Predictors of Enteral Tube Feeding in Hospitalized Older Adults(2017) CRENITTE, Milton Roberto Furst; AVELINO-SILVA, Thiago Junqueira; APOLINARIO, Daniel; CURIATI, Jose Antonio Esper; CAMPORA, Flavia; JACOB-FILHO, WilsonBackground: Despite general recognition that enteral tube feeding (ETF) is frequently employed in long-term care facilities and patients with dementia, remarkably little research has determined which factors are associated with its use in acutely ill older adults. In this study, we aimed to investigate determinants of ETF introduction in hospitalized older adults. Methods: We examined a retrospective cohort of acutely ill patients, aged 60 years and older, admitted to a university hospital's geriatric ward from 2014-2015, in SAo Paulo, Brazil. The main outcome was the introduction of ETF during hospitalization. Predictors of interest included age, sex, referring unit, comorbidity burden, functional status, malnutrition, depression, dementia severity, and delirium. Multivariate analysis was performed using backward stepwise logistic regression. Results: A total of 214 cases were included. Mean age was 81 years, and 63% were women. Malnutrition was detected in 47% of the cases, dementia in 46%, and delirium in 36%. ETF was initiated in 44 (21%) admissions. Independent predictors of ETF were delirium (odds ratio [OR], 4.83; 95% CI, 2.12-11.01; P < .001) and total functional dependency (OR, 8.95; 95% CI, 2.87-27.88; P < .001). Malnutrition was not independently associated with ETF. Conclusion: One in five acutely ill older adults used ETF while hospitalized. Delirium and functional dependency were independent predictors of its introduction. Risks and benefits of enteral nutrition in this particular context need to be further explored.
- Feasibility and Factor Structure of the FRAIL Scale in Older Adults(2017) APRAHAMIAN, Ivan; LIN, Sumika Mori; SUEMOTO, Claudia Kimie; APOLINARIO, Daniel; CEZAR, Natalia Oiring de Castro; ELMADJIAN, Serpui Marie; JACOB FILHO, Wilson; YASSUDA, Monica SanchesObjectives: The aim of the present study was to (1) evaluate a geriatric outpatient sample with the FRAIL scale; (2) investigate the psychometric properties of the scale; and (3) characterize different associations of the subdimensions of the scale with demographic and clinical data. Design: Cross-sectional observational study. Setting: Geriatric outpatient center a university-based hospital in Sao Paulo, Brazil. Participants: A total of 811 men and women aged 60 years or older evaluated between March 2015 and September 2015. Measurements: A translated version of the FRAIL scale was used to evaluate frailty. A review of socio-demographic data, medical records, medication, and laboratory data was conducted. A multivariate ordinal logistic regression model was used to investigate the association between frailty categories and clinical variables. Exploratory factor analysis and 2-parameter logistic item response theory was used to evaluate the psychometric properties of the FRAIL scale. Results: The sample was distributed as 13.6% robust, 48.7% prefrail, and 37.7% frail older adults. Most participants reported fatigue (72.3%). Frailty was associated with older age (P = .02), depression (P = .02), dementia (P < .001), and number of medications taken (P < .001). A 2-factor model of the FRAIL scale (""ambulation"" and ""resistance"" namely physical performance; ""fatigue,"" "" weight loss,"" and ""illnesses"" namely health status) provided independent classifications of frailty status. Physical performance (ambulation and resistance) was strongly associated with higher age and dementia, whereas health status (fatigue, weight loss, and illnesses) was more associated with female sex and depression. Conclusions: Our results suggest the existence of 2 subdimensions of the scale, suggesting different pathways to frailty. Frailty was associated with older age, depression, dementia, and number of medications in this outpatient sample. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.