MARCOS DANIEL CABRAL SARAIVA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults During the COVID-19 Pandemic(2021) SARAIVA, M. D.; APOLINARIO, D.; AVELINO-SILVA, T. J.; TAVARES, C. De Assis Moura; GATTAS-VERNAGLIA, I. F.; FERNANDES, C. Marques; RABELO, L. M.; YAMAGUTI, S. Tavares Fernandes; KARNAKIS, T.; KALIL-FILHO, R.; JACOB-FILHO, W.; ALIBERTI, Marlon Juliano RomeroBackground The COVID-19 pandemic has led to abrupt restrictions of lile-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. Objective To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. Design Multicenter prospective cohort study based on structured telephone interviews. Setting Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. Participants 557 community-dwelling adults aged 60 years and older. Measurements The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of >= 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question << How is the COVID-19 pandemic affecting your QoL?>>, to which participants could respond << not at all >>, << to some extent >>, or << to a great extent >>. We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. Results Participants were on average 80 +/- 8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). Conclusion Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.
- Impact of the COVID-19 pandemic on the life-space mobility of older adults with cancer(2021) GATTAS-VERNAGLIA, Isabella Figaro; RAMOS, Paola Teruya; PERINI, Maria Laura Lazaretti; HIGA, Camila Suemi; APOLINARIO, Daniel; ALIBERTI, Marlon Juliano Romero; KANAJI, Ana Lumi; ADRIAZOLA, Izabela Ono; SARAIVA, Marcos Daniel; AVELINO-SILVA, Thiago Junqueira; TAVARES, Caio de Assis Moura; JACOB-FILHO, Wilson; KARNAKIS, Theodora
- COVID-19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients(2021) ALIBERTI, Marlon Juliano Romero; SZLEJF, Claudia; AVELINO-SILVA, Vivian I.; SUEMOTO, Claudia Kimie; APOLINARIO, Daniel; DIAS, Murilo Bacchini; GARCEZ, Flavia Barreto; TRINDADE, Carolina B.; AMARAL, Jose Renato das Gracas; MELO, Leonardo Rabelo de; AGUIAR, Renata Cunha de; COELHO, Paulo Henrique Lazzaris; HOJAIJ, Naira Hossepian Salles de Lima; SARAIVA, Marcos Daniel; SILVA, Natalia Oliveira Trajano da; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.Background Frailty screening using the Clinical Frailty Scale (CFS) has been proposed to guide resource allocation in acute care settings during the pandemic. However, the association between frailty and coronavirus disease 2019 (COVID-19) prognosis remains unclear. Objectives To investigate the association between frailty and mortality over 6 months in middle-aged and older patients hospitalized with COVID-19 and the association between acute morbidity severity and mortality across frailty strata. Design Observational cohort study. Setting Large academic medical center in Brazil. Participants A total of 1830 patients aged >= 50 years hospitalized with COVID-19 (March-July 2020). Measurements We screened baseline frailty using the CFS (1-9) and classified patients as fit to managing well (1-3), vulnerable (4), mildly (5), moderately (6), or severely frail to terminally ill (7-9). We also computed a frailty index (0-1; frail >0.25), a well-known frailty measure. We used Cox proportional hazards models to estimate the association between frailty and time to death within 30 days and 6 months of admission. We also examined whether frailty identified different mortality risk levels within strata of similar age and acute morbidity as measured by the Sequential Organ Failure Assessment (SOFA) score. Results Median age was 66 years, 58% were male, and 27% were frail to some degree. Compared with fit-to-managing-well patients, the adjusted hazard ratios (95% confidence interval [CI]) for 30-day and 6-month mortality were, respectively, 1.4 (1.1-1.7) and 1.4 (1.1-1.7) for vulnerable patients; 1.5 (1.1-1.9) and 1.5 (1.1-1.8) for mild frailty; 1.8 (1.4-2.3) and 1.9 (1.5-2.4) for moderate frailty; and 2.1 (1.6-2.7) and 2.3 (1.8-2.9) for severe frailty to terminally ill. The CFS achieved outstanding accuracy to identify frailty compared with the Frailty Index (area under the curve = 0.94; 95% CI = 0.93-0.95) and predicted different mortality risks within age and acute morbidity groups. Conclusions Our results encourage the use of frailty, alongside measures of acute morbidity, to guide clinicians in prognostication and resource allocation in hospitalized patients with COVID-19.
- Prospective GERiatric Observational (ProGERO) study: cohort design and preliminary results(2020) SARAIVA, Marcos Daniel; RANGEL, Luis Fernando; CUNHA, Julia Lusis Lassance; ROTTA, Thereza Cristina Ariza; DOURADINHO, Christian; KHAZAAL, Eugenia Jatene Bou; ALIBERTI, Marlon Juliano Romero; AVELINO-SILVA, Thiago Junqueira; APOLINARIO, Daniel; SUEMOTO, Claudia Kimie; JACOB-FILHO, WilsonBackgroundThe demographic changes in Brazil as a result of population aging is one of the fastest in the world. The far-reaching new challenges that come with a large older population are particularly disquieting in low- and middle-income countries (LMICs). Longitudinal studies must be completed in LMICs to investigate the social and biological determinants of aging and the consequences of such demographic changes in their context. Therefore, we designed the Prospective GERiatric Observational (ProGERO) study, a longitudinal study of outpatient older adults in SAo Paulo, Brazil, to collect data both on aging and chronic diseases, and investigate characteristics associated with adverse outcomes in this population.MethodsThe ProGERO study takes place in a geriatric outpatient clinic in the largest academic medical center in Latin America. We performed baseline health examinations in 2017 and will complete subsequent in-person visits every 3 years when new participants will also be recruited. We will use periodic telephone interviews to collect information on the outcomes of interest between in-person visits. The baseline evaluation included data on demographics, medical history, physical examination, and comprehensive geriatric assessment (CGA; including multimorbidity, medications, social support, functional status, cognition, depressive symptoms, nutritional status, pain assessment, frailty, gait speed, handgrip strength, and chair-stands test). We used a previously validated CGA-based model to rank participants according to mortality risk (low, medium, high). Our selected outcomes were falls, disability, health services utilization (emergency room visits and hospital admissions), institutionalization, and death. We will follow participants for at least 10 years.ResultsWe included 1336 participants with a mean age of 828years old. Overall, 70% were women, 31% were frail, and 43% had a Charlson comorbidity index score >= 3. According to our CGA-based model, the incidence of death in 1 year varied significantly across categories (low-risk=0.6%; medium-risk=7.4%; high-risk=17.5%; P<0.001).Conclusion The ProGERO study will provide detailed clinical data and explore the late-life trajectories of outpatient older patients during a follow-up period of at least 10years. Moreover, the study will substantially contribute to new information on the predictors of aging, senescence, and senility, particularly in frail and pre-frail outpatients from an LMIC city.