OBJECTIVE:To estimate the prevalence of falls in elderly individuals and to analyze associated factors. METHODS:Cross-sectional study with 420 elderly subjects (aged 60 years or older) living in the city of Juiz de Fora (Southeastern Brazil) in 2010. A household survey was conducted and the occurrence of falls in the 12 previous months was described. For the analysis of factors associated with the outcome, a theoretical determination model with three hierarchical blocks was built. The variables were adjusted among each other within each block; those with level of signifi cance ≤ 0.20 were included in the Poisson regression model and adjusted to the immediately higher level, with 5% signifi cance level. RESULTS:The prevalence of falls among the elderly was 32.1% (95%CI: 27.7; 36.9). Among those who experienced falls, 53% had a single fall and 19% had fractures as a consequence. Most of the falls (59%) occurred at the elderly person's home. The occurrence of falls was associated with old age, female sex, need of help for locomotion and self-reported diagnosis of osteoporosis. CONCLUSIONS:Falls are frequent among the elderly. Knowledge of the factors associated with the occurrence of this event can aid the development of prevention strategies and adequate health services.

BackgroundStudies on health-related quality of life are based on the increasingly evident need for medical care not to be limited to preventing death, but to focus instead on the value of health. ObjectiveThis study aimed to measure the health-related quality of life in hemophilia, using the Hemophilia- Specific Quality of Life (Haem-A-QoL) questionnaire and describe the socioeconomic characteristics and health conditions of these patients. MethodsThe Brazilian version of the Hemophilia-Specific Quality of Life questionnaire was administered to hemophiliac adults, treated in an on-demand regime at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation. The patients were interviewed about demographic and socioeconomic data and their understanding of the questionnaire. Clinical data were collected from medical records. The Mann-Whitney U test was used for statistical analysis. The level of significance was set for p-values < 0.05. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 15.0). ResultsThirty-nine patients were evaluated. The mean age was 36.8 years. 84.6% had hemophilia A; 20.5% of the patients had hemophilia classified as mild, 41% as moderate and 38.5% as severe. The records of 10.5% of the patients registered seropositivity for anti-HIV and 57.9% for anti-HCV. Target joints were detected in 69.2%. The mean total Hemophilia-Specific Quality of Life score was 35.55. 'Sports and leisure'and 'Physical health'were the most impaired dimensions and the dimension 'Relationship and partners'was the least impaired. The Hemophilia-Specific Quality of Life scores showed good discriminant validity for hemophilia severity (p-value = 0.001), HIV-infection (p-value = 0.02), HCV-infection (p-value = 0.01) and the presence of target joints (p-value < 0.001). ConclusionHealth-related quality of life in hemophilia, measured by the Hemophilia-Specific Quality of Life questionnaire, was influenced by the presence of arthropathy and infectious diseases transmitted by blood products. Rehabilitation measures should be encouraged in order to improve the quality of life of these patients.

Background The elderly population is often in continuous use of several medications and is more subject to the "iatrogenic triad" of polypharmacy, potentially inappropriate medication use and drug-drug interactions. However, few studies have investigated these three factors concomitantly. Purpose To assess the prevalence and inter-relationship of potentially inappropriate medication (PIM) use, polypharmacy and drug-drug interactions in older adults, together with their associated factors. Setting city of Juiz de Fora, Brazil. Methods a cross-sectional, observational and door-to-door epidemiologic study in community-dwelling older adults was conducted. Main outcome measure The primary outcomes were polypharmacy, inappropriate medication use (2012 Beers and 2015 STOPP criteria) and drug-drug interactions. Associated factors were also investigated using bivariate and multivariate analyses. Results a total of 368 (92%) older adults were in continuous use of at least one drug. There was a high prevalence of polypharmacy (44.6%), drug-drug interaction (72.3%) and PIMs by Beers (42.1%) and PIMs by STOPP (46.2%). Analysis of the inter-relationship of the criteria (polypharmacy, PIMs STOPP and drug-drug interactions) revealed that 108 (29.3%) of the older adults had all three criteria concomitantly and multivariate analysis showed that frailty and having a caregiver were associated with this "iatrogenic triad". Conclusion A high prevalence of iatrogenic effects from drugs was found in the older adults assessed. One in every three elderly participants of the study had all three iatrogenic criteria concomitantly, highlighting the major public health impact of this problem. The results of this study can serve to inform new preventive and educational strategies for health professionals.

Resumo Introdução As alterações cognitivas advindas com o envelhecimento humano representam condições importantes, pois afetam diretamente a funcionalidade dos indivíduos e os predispõe a quedas. Objetivo Verificar a associação entre capacidade cognitiva e quedas em uma população de idosos e caracterizar o perfil dessa amostra. Metodologia Estudo transversal oriundo do projeto Inquérito de Saúde no Município de Juiz de Fora, MG. A amostra foi composta por 462 idosos (60 anos ou mais), de ambos os sexos e não institucionalizados. As variáveis analisadas foram resultantes da aplicação do Mini-Exame do Estado Mental (MEEM) e de um questionário semiestruturado contendo questões sociodemográficas e ocorrência de quedas. Foram estimadas as frequências absolutas e relativas e utilizado o teste Qui-quadrado (χ2) para averiguar a associação entre capacidade cognitiva apontada pelo MEEM e quedas (nível de significância = 5%). Resultados A média de idade foi 71,03 (dp = 7,79) e de anos de escolaridade, 3,64 (dp = 3,26), 64,8% eram do sexo feminino e 28,14% apresentaram declínio cognitivo. A frequência de quedas encontrada no grupo com comprometimento cognitivo foi de 42%. Verificou-se associação entre comprometimento cognitivo e queda (p = 0,043). Conclusão Idosos com comprometimento cognitivo apresentaram maior frequência de quedas comparados com a população idosa em geral. Esse achado, aliado à associação entre comprometimento cognitivo e queda, reforça a necessidade de ações preventivas e novas práticas de saúde com ênfase no envelhecimento saudável.

Objectives: To investigate the prevalence of fear of falling among a sample of elderly persons in the community, and to analyze its correlation with age, self-perceived health, difficulty walking, use of an assistive device for walking, history of falls, and functional capacity. Method: A cross-sectional study of 314 non-institutionalized elderly individuals, living in the city of Juiz de Fora in the state of Minas Gerais) in 2015, was carried out. A household survey was conducted and fear of falling was assessed using the Falls Efficacy Scale -International -Brazil (FES-I-BR ASIL). The Spearman correlation was used to verify the correlation of the independent variables with the fear of falling. The significance level for the study was 5%. Results: The prevalence of fear of falling among the elderly was 95.2% (95% CI= 92.3; 97.3). Fear of falling was significantly correlated with all the variables analyzed: age (r= 0.199), self-perceived health (r=0.299), difficulty walking (r= -0.480), use of an assistive device for walking (r=0.337), history of falls (r= -0.177), and functional capacity (r = -0.476). Conclusions: A high prevalence of fear of falling was observed, with a significant correlation between the outcome and the variables studied. These findings point to the need for rehabilitation, prevention, and health promotion strategies that enable healthy aging.

Objective: analyze adherence to pharmacotherapy and associated factors among elderly patients using at least one antihypertensive medication. Methods: A cross-sectional, population-based study was performed of elderly patients resident in Juiz de Fora, Minas Gerais, Brazil. Adherence to medication was assessed with the Morisky-Green Test. Socio-demographic variables and variables related to health status, the health service and drug therapy were collected. The Poisson regression model was used to assess crude and adjusted (95% confidence interval) prevalence ratios (PR). The level of significance was tested using the Wald test. Results: The prevalence of adherence to pharmacological therapy was 47% (95% CI: 41%-53%). The sample consisted of 279 elderly persons, the majority of whom were women (69%), described themselves as white (45.5%), and had up to four years of schooling (76.48%). Regarding pharmacological therapy, the subjects took 5.19 (±2.8) medications and 7.1 (±4.4) tablets per day. Conclusion: a significant association was observed between adherence to pharmacological therapy and the variables positive perception of vision, positive perception of hearing and absence of frailty.

The present study found moderate-to-high levels of concordance among the four PIM criteria assessed, pointing to a consensus in this field. However, each criterion showed particular characteristics: the EU(7)-PIM criterion had higher sensitivity, the Taiwan criterion higher specificity, and the Beers and STOPP a more balanced profile. These results highlight that each criterion has its own characteristics, and should be used according to health providers' objectives. Geriatr Gerontol Int 2017; 17: 1628-1635.

OBJECTIVE To analyze if demographic and socioeconomic factors and factors related to health and health services are associated with frailty in community-dwelling older adults.METHODS This is a cross-sectional study with 339 older adults (60 years old or more) living in Juiz de Fora, State of Minas Gerais, Brazil, in 2015. A household survey was carried out and frailty was evaluated using the Edmonton Frail Scale. For the analysis of the factors associated with outcome, a theoretical model of determination was constructed with three hierarchical blocks: block 1 with demographic and socioeconomic characteristics, block 2 with the health of the older adult (divided into three sub-levels: 2.1 self-reported health variables, 2.2 self-perceived health variables, and 2.3 geriatric syndromes), and block 3 with characteristics related to health services. The variables were adjusted in relation to each other within each block; those with significance level ≤ 0.20 were included in the Poisson regression model and adjusted to a higher level, considering a level of significance of 5%.RESULTS The prevalence of frailty among older adults was 35.7% (95%CI 30.7–40.9). Of the total, 42.2% did not present frailty; 22.1% were apparently vulnerable. Among the frail ones, 52.9% presented mild frailty, 32.2% moderate frailty, and 14.9% severe frailty. Frailty was associated with difficulty walking, need for an auxiliary device to walk, presence of caregiver, depressive disorders, and functional dependence to perform instrumental activities of daily living.CONCLUSIONS Frailty is frequent among the older population and it is associated with health variables of the three sub-levels that make up block 2 of the theoretical hierarchical model of determination: self-reported health variables, self-perceived health variables, and geriatric syndromes.