IVAN APRAHAMIAN
Projetos de Pesquisa
Unidades Organizacionais
LIM/66, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Comparison of 3 Frailty Instruments in a Geriatric Acute Care Setting in a Low-Middle Income Country(2018) LIN, Sumika Mori; ALIBERTI, Marlon Juliano Romero; FORTES-FILHO, Sileno de Queiroz; MELO, Juliana de Araujo; APRAHAMIAN, Ivan; SUEMOTO, Claudia Kimie; JACOB FILHO, WilsonObjective: Comparison of frailty instruments in low-middle income countries, where the prevalence of frailty may be higher, is scarce. In addition, less complex diagnostic tools for frailty are important in these settings, especially in acutely ill patients, because of limited time and economic resources. We aimed to compare the performance of 3 frailty instruments for predicting adverse outcomes after 1 year of followup in older adults with an acute event or a chronic decompensated disease. Design: Prospective cohort study. Setting: Geriatric day hospital (GDH) specializing in acute care. Participants: A total of 534 patients (mean age 79.6 +/- 8.4 years, 63% female, 64% white) admitted to the GDH. Measurements: Frailty was assessed using the Cardiovascular Health Study (CHS) criteria, the Study of Osteoporotic Fracture (SOF) criteria, and the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) questionnaire. Monthly phone contacts were performed over the course of the first year to detect the following outcomes: incident disability, hospitalization, fall, and death. Multivariable Cox proportional hazard regression models were performed to evaluate the association of the outcomes with frailty as defined by the 3 instruments. In addition, we compared the accuracy of these instruments for predicting the outcomes. Results: Prevalence of frailty ranged from 37% (using FRAIL) to 51% (using CHS). After 1 year of follow-up, disability occurred in 33% of the sample, hospitalization in 40%, fall in 44%, and death in 16%. Frailty, as defined by the 3 instruments was associated with all outcomes, whereas prefrailty was associated with disability, using the SOF and FRAIL instruments, and with hospitalization using the CHS and SOF instruments. The accuracy of frailty to predict different outcomes was poor to moderate with area under the curve varying from 0.57 (for fall, with frailty defined by SOF and FRAIL) to 0.69 (for disability, with frailty defined by CHS). Conclusions: In acutely ill patients from a low-middle income country GDH acute care unit, the CHS, SOF, and FRAIL instruments showed similar performance in predicting adverse outcomes. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
bookPart Escalas(2019) SARAIVA, Marcos Daniel; ALIBERTI, Márlon Juliano Romero; SERRANO, Priscila Gonçalves; ONODERA, Eduardo Sho; APOLINARIO, Daniel; MAGALDI, Regina Miksian; FORTES FILHO, Sileno de Queiroz; MELO, Juliana de Araújo; ROTTA, Thereza Cristina Ariza; LIN, Sumika Mori; RANGEL, Luis Fernando; SILVA, Marina Maria Biella; APRAHAMIAN, Ivan; MAUER, Sivan; SIQUEIRA, Alaise Silva Santos de; MORILLO, Lilian Schafirovits; ARAúJO, Juliano Silveira de; STORNIOLO, Luana Vergian- Depression is associated with self-rated frailty in older adults from an outpatient clinic: a prospective study(2019) APRAHAMIAN, Ivan; SUEMOTO, Claudia Kimie; LIN, Sumika Mori; SIQUEIRA, Alaise Silva Santos de; BIELLA, Marina Maria; MELO, Brian Alvarez Ribeiro de; JACOB-FILHO, WilsonObjectives:The aim of the present study was to evaluate the association between depression and SSRI monotherapy and frailty both baseline and prospectively in older adults.Design:Prospective cohort study, 12-month follow-up.Setting:Geriatric outpatient clinic in SAo Paulo, Brazil.Participants:A total of 811 elderly adults aged 60 or older.Measurements:Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities.Results:Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69-4.69) and after 12 months (OR 2.75, 95% CI = 1.84-4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29-3.07) and Health Status (OR 4.64, 95% CI = 2.11-10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04-2.23).Conclusion:It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.
- Frailty and cognitive status evaluation can better predict mortality in older adults?(2018) APRAHAMIAN, Ivan; SUEMOTO, Claudia Kimie; ALIBERTI, Marlon Juliano Romero; FORTES FILHO, Sileno de Queiroz; MELO, Juliana de Araujo; LIN, Sumika Mori; JACOB FILHO, WilsonObjectives: to evaluate the improvement in one-year mortality prediction after adding a 2-min cognitive screening to a simple 1-min frailty detection instrument. Secondary outcomes were new activities of daily living (ADL) disability and falls. Design: Prospective cohort study. Setting: A geriatric day-hospital for intermediate care. Participants: A total of 701 older adults with an acute or decompensated disease (79.5 (8.3) years, 64% female). Measurements: A rapid and simple frailty evaluation was performed using the FRAIL questionnaire. The presence of cognitive impairment was defined by previous diagnosis of dementia or a score of five or less on an education-corrected 10-point cognitive screening tool. Results: Frail participants with normal (hazard risk [HR] 4.0, 95% confidence interval [CI], 1.73-9.25) and impaired cognition had a higher risk of death (HR 4.38, 95% CI, 1.95-9.87) than robust participants. The presence of cognitive impairment increased the risk of death in prefrail (HR 3.60, 95% CI, 1.55-8.34) and robust participants (HR 3.49, 95% CI, 1.22-9.96). Cognitive impairment was associated with an increased risk of incident ADL disability in all frailty categories. The presence of cognitive impairment was associated with a significantly higher risk of fall in robust seniors. The predictive accuracy of the FRAIL scale was lower than expected (between 0.58 and 0.69), and a small improvement was observed after adding the cognitive screening (between 0.61 and 0.72). Conclusion: Despite of significant results in predicting relevant clinical events, the present combination of the FRAIL and 10-CS scales may not be ideal in clinical practice.
- Serotonin receptor inhibitor is associated with falls independent of frailty in older adults(2021) LIN, Sumika M.; BORGES, Marcus K.; SIQUEIRA, Alaise S. S. de; BIELLA, Marina M.; JACOB-FILHO, Wilson; CESARI, Matteo; VOSHAAR, Richard C. Oude; APRAHAMIAN, IvanObjectives: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. Methods: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ? 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. Results: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. Conclusion: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.
- A multidimensional program including standing exercises, health education, and telephone support to reduce sedentary behavior in frail older adults: Randomized clinical trial(2021) TOSI, Fabiana C.; LIN, Sumika M.; GOMES, Gisele C.; APRAHAMIAN, Ivan; NAKAGAWA, Naomi K.; VIVEIRO, Larissa; BACHA, Jessica M. R.; JACOB-FILHO, Wilson; POMPEU, Jose E.Objectives: The primary aim of this study was to evaluate the effect of a multidimensional program including home-based standing exercises, health education, and telephone support for the reduction of sedentary behavior in community-dwelling frail older adults. The secondary aim of this study was to evaluate the safety and adherence of the program. Study design: A single-blind, randomized controlled trial. Methods: A total of 43 frail older adults were randomly assigned to the intervention and control groups. The intervention consisted of combined strategies including home-based standing exercises, health education, and telephone support for 16 weeks for frail older adults. The control group received orientation regarding the harmful effects of a sedentary lifestyle. Sedentary behavior was evaluated by total sedentary time, accumulated sedentary time in bouts of at least 10 min, and by the break in sedentary time, measured by an accelerometer used for at least 600 min/day for 4 days. Safety was assessed by self-reporting of possible adverse events. Adherence was assessed based on the number of days in which standing exercises were performed by the participants. Repeated measures ANOVA and Tukeys post hoc test were used to analyze the collected data. Results: The intervention group reduced the sedentary time by 30 min/day (p= 0.048), but without significant maintenance after 30 days of the program. Of the total number of participants, 82% (n = 14) of the intervention group participants showed more than 70% adherence to the program. The main adverse effects faced by the intervention group participants were tiredness (53%; n = 9) and lower limb pain (47%; n = 8). Conclusions: The multidimensional program reduced sedentary behavior, was safe, and showed satisfactory adherence in frail older adults.
- Association of Cognitive Performance with Frailty in Older Individuals with Cognitive Complaints(2022) LIN, S. M.; APOLINARIO, D.; GOMES, G. C. Vieira; TOSI, F. Cassales; MAGALDI, R. M.; BUSSE, A. L.; GIL, G.; RIBEIRO, E.; SATOMI, E.; APRAHAMIAN, I.; FILHO, W. J.; SUEMOTO, Claudia K.Objectives Frailty is a risk factor for poor cognitive performance in older adults. However, few studies have evaluated the association of cognitive performance with frailty in a low- to middle-income country (LMIC). This study aimed to investigate an association between cognitive performance and frailty in older adults with memory complaints in Brazil. Secondarily, we aim to assess an association of cognitive performance with gait speed and grip strength. Design Cross-sectional study. Setting Outpatient service from a LMIC Participants Older adults with memory complaints reported by the participants, their proxies, or their physicians. Measurements Frailty was evaluated using the Cardiovascular Health Study criteria. A neuropsychological battery evaluated memory, attention, language, visuospatial function, executive function. Linear regression analysis with adjustment for age, sex, and education was used. We also evaluated the interaction of education with frailty, grip strength, and gait speed. Results Prefrailty was associated with poor performance in the memory domain, as well as slower gait speed was associated with worse performance in memory, attention, language, and executive function. Frailty and grip strength were not associated with cognitive performance. Interactions of education with gait speed were significant for global performance, as well as for attention and visuospatial ability. Conclusion In elderly patients with memory complaints, prefrailty was associated with poor memory performance. Slowness was associated with poorer performance in some cognitive domains, mainly in participants with low education.
- Screening for Frailty With the FRAIL Scale: A Comparison With the Phenotype Criteria(2017) APRAHAMIAN, Ivan; CEZAR, Natalia Oiring de Castro; IZBICKI, Rafael; LIN, Sumika Mori; PAULO, Debora Lee Vianna; FATTORI, Andre; BIELLA, Marina Maria; JACOB FILHO, Wilson; YASSUDA, Monica SanchesBackground: Reliable and valid frailty screening instruments are lacking. The aim of the present study was to compare the diagnostic properties of the FRAIL-BR with Fried's frailty phenotype (CHS), which has not been done. Methods: Cross-sectional observational study of 124 older adults aged 60 or older from 2 university-based geriatric outpatient units in the state of Sao Paulo, Brazil. In ROC analyses, we evaluated different cutoff points and AUC areas of the FRAIL-BR compared with the CHS criteria. Also, components of both diagnostic strategies had head-to-head comparisons whenever possible. Results: The sample was composed mostly of overweight (mean BMI = 29.5 kg/m(2)) women (83%) with mean age of 78.6 (+/- 7.1) years. Prevalence of frailty varied according to the FRAIL-BR (23.3%) and the CHS criteria (14.5%) (P = .04). A cutoff of 3 points in the FRAIL-BR presented a sensitivity of 28% and specificity of 90% (P = .049). A cutoff of 2 points resulted in a sensitivity of 54% and specificity of 73% (P = .01). Comparisons of 4 FRAIL-BR items (ie, weight loss, aerobic capacity, fatigue, and physical resistance) to the respective CHS components showed an independent diagnostic property of all measures, with the exception for weight loss. Conclusion: The FRAIL scale can be used as a screening instrument for frailty (time and cost-effective). (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
- 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.