No abstract

Introduction: Frailty associated to core dimensions of psychological well-being (PwB) has appeared as a possible new frailty phenotype named psychological frailty, implying a parallel to physical frailty (PF). Very little is known about the associations between mental well-being, especially emotional, mood, and self-perception dimensions, and the frailty syndrome in institutionalized older populations. The present study aims to examine the interlink between the PF phenotype and the core dimensions of PwB in Portuguese institution-dwelling older women. Methods: Cross-sectional data were collected. A total of 358 older women, aged 75 years or more, were recruited from four nursing homes within the city of Coimbra and asked to complete a sociodemographic and a general health assessment survey. The main PwB dimensions were assessed in all participants: (i) global cognitive status was assessed using The Montreal Cognitive Assessment (MoCA) Neuropsychology Test, (ii) self-perception was screened using the General Self-Efficacy Scale (GSES) and Global Self-Esteem Scale, (iii) CES-D of depression and Perceived Stress Scale (PSS) were used to screen mood states, and (iv) subjective happiness, satisfaction with life, and attitudes to aging psychometric rating scales were used to screen for emotional well-being. The syndrome of PF was assessed using Fried's PF phenotype that includes weight loss, weakness, slowness, exhaustion, and low physical activity (PA) level assessments. Results: Frail older women had a poor score in all PwB outcomes, except for global selfesteem and satisfaction with life. A hierarchical regression model analysis showed that global cognitive status and emotional well-being of subjective happiness and attitude to aging showed a significant negative relationship with PF in both unadjusted and adjusted models (explaining 34 and 40% of variance, respectively).

Exercise-based interventions emerged as the best alternative for treating frailty syndrome (FS). Recognized as a complex phenotype, the FS is a multifaceted aging expression determined by biologic, environment, and behaviors factors. The biological theories of human development perceive aging process as an accumulation of harmful biochemical changes, whose occurrence attends the course of life. The progressive losses of functional reserves that occur in the body systems are a hallmark of this negative process. Despite the biological effects of physical and cognitive decline, more contemporary studies have identified that the environmental and behavior factors such as malnutrition and negative psychological adjustment across the life span also contribute to the early appearance of FS. Notwithstanding the latest findings that consistently demonstrate an overall positive benefit of long-term-based exercise in the decrease and/or reversal of the FS with a substantial impact on their correlated outcomes, the focus of this chapter is to present strategies for designing exercise programs for this type of population, taking into account their practical application in the field.

This chapter presents an exploratory review on the evaluation, assessment, and monitoring in health and fall risk by common and the most used assessment tools. The main discussion of this chapter of evaluation in health and fall risk is divided into six categories—global health assessment, specific physical (and fitness) assessment, cognitive and psychological assessment, pharmacological assessment, fall risk specific assessment, and some complementary assessment—which show information and how to access. Whereas health evaluative experiences and practices are essential to drive a better and specific intervention, revealing its importance and necessity was also highlighted.

Increasing life expectancy and the growing number of elderly people have also increased the number of comorbidities common in this population in the same proportion, where the risk of falling is highlighted and has been increasing in a worrying and negative way. However, the practice of physical exercise can improve the prevention and reduction of falls. In this context, this chapter addresses the theme with the objective of identifying how, which, and when physical exercise can contribute in relation to the risk of falling in the elderly. Through analysis of articles and recent reviews, the chapter addresses the influence of strength, power, aerobic, and multicomponent exercises in their various components and possible influences on the risk of falling. There is also a proposal for a specific program for the risk of falling in the elderly, with adjustments in volume and intensity according to the needs of the target audience, based and improved by worldwide guidelines.