OBJECTIVE:To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS:The Short Assessment of Health Literacy for Portuguesespeaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defi ned as failure to fully understand standard medical prescriptions. RESULTS:Moderate to high correlations were found in the assessment of construct validity (Spearman's coeffi cients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coeffi cient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS:The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy. Health literacy is defi ned as the ability to perform basic reading and numerical tasks required to function in the health care environment.1 There is increasing evidence that health literacy skills are related to important health outcomes, even after adjustments for confounding factors such as education, age, and gender. Inadequate health literacy has been independently associated with lower utilization of preventive services, poor self-management of chronic conditions, low medication adherence, increased hospitalization, and higher death rates. 4 Some population groups are at greater risk for inadequate health literacy including the socioeconomically disadvantaged, immigrants, and older adults. Inadequate health literacy may disproportionately affect the health of older people, not only as a result of generation gap in education, but also because the elderly have more medical conditions, use more health care services, and are more likely to require complex therapeutic regimens. 12Because years of formal schooling alone are not a reliable indicator of health literacy and individuals with lower health literacy skills may try to hide it, it is diffi cult to recognize those patients with inadequate health literacy during routine clinical care.15 Developing RESUMO OBJETIVO: Desenvolver e validar um instrumento breve para avaliação de alfabetismo em saúde na língua portuguesa. MÉTODOS:O instrumento desenvolvido consiste de 50 itens que avaliam a capacidade do indivíduo de pronunciar e compreender termos médicos comuns. As propriedades psicométricas foram avaliadas e...

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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)(8)(9). We also computed a frailty index (0-1; frail >0.25), a well-known frailty measure. We used Cox A complete list of investigators in the COVID HCFMUSP Study Group is provided in Data S1.

ObjectivesTo investigate the relationship between functional health literacy and glycaemic control in a sample of older patients with type 2 diabetes.DesignCross-sectional study.SettingA government-financed outpatient geriatric clinic in São Paulo, Brazil.Participants129 older patients with type 2 diabetes, a mean (SD) age of 75.9 (6.2) years, a mean glycosylated haemoglobin (HbA1c) of 7.2% (1.4), of which 14.7% had no formal education and 82.9% had less than a high-school diploma.MeasuresHbA1c was used as a measure of glycaemic control. Functional health literacy was assessed with the 18-item Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18), a validated instrument to evaluate pronunciation and comprehension of commonly used medical terms. Regression models were controlled for demographic data, depressive symptoms, diabetes duration, treatment regimen, diabetes knowledge and assistance for taking medications.ResultsFunctional health literacy below adequate was encountered in 56.6% of the sample. After controlling for potential confounding factors, patients with inadequate functional health literacy were more likely than patients with adequate functional health literacy to present poor glycaemic control (OR=4.76; 95% CI 1.36 to 16.63). In a fully adjusted linear regression model, lower functional health literacy (β=−0.42; p<0.001), longer diabetes duration (β=0.24; p=0.012) and lack of assistance for taking medications (β=0.23; p=0.014) were associated with higher levels of HbA1c. Contrary to our expectations, illiterate patients did not have poorer outcomes when compared with patients with adequate functional health literacy, raising the hypothesis that illiterate individuals are more likely to have their difficulties recognised and compensated. However, the small subsample of illiterate patients provided limited power to reject differences with small magnitude.ConclusionsPatients with inadequate functional health literacy presented with higher odds of poor glycaemic control. These findings reinforce the importance of addressing limited functional health literacy in clinical practice.

Our results suggest that the intake of Brazil nut restores selenium deficiency and provides preliminary evidence that Brazil nut consumption can have positive effects on some cognitive functions of older adults with MCI.

Based on empirical data, we have developed a brief and easy-to-use screening strategy with higher accuracy and some practical advantages compared with commonly used tools.

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Background: The COVID-19 pandemic has led to abrupt restrictions of life-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.