Síndrome da fragilidade no idoso: importância da fisioterapia

Conteúdo do artigo principal

Camila Macedo
Juliana Maria Gazzola
Myrian Najas

Resumo

A fragilidade é conceituada como uma síndrome clínica, que pode ser identificada por perda de peso involuntária, exaustão, fraqueza, diminuição da velocidade da marcha e do equilíbrio e diminuição da atividade física. Cada uma dessas manifestações clínicas é preditora de uma série de reações adversas (quedas, hospitalização, institucionalização, declínio funcional e morte). O objetivo desta revisão de literatura foi expor os elementos sobre a Síndrome da Fragilidade dos Idosos, em uma revisão narrativa da literatura, dando um panorama geral sobre epidemiologia, tendências atuais, ciclo da fragilidade, sarcopenia, alterações imunológicas, alterações neuroendócrinas, diagnósticos clínico, laboratorial e diferencial e as possibilidades de intervenções fisioterapêuticas. Para esses fins, realizou-se revisão bibliográfica da literatura nacional e internacional sobre o tema. Com o conhecimento de estudos envolvendo idosos frágeis, é possível planejar as estratégias voltadas para a identificação da parcela da população que mais se beneficiaria de ações para postergar, atenuar e, se possível, reverter tais desfechos.

Detalhes do artigo

Seção
Artigos de Revisão

Referências

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Scie Med S 2001;56(3):M146-56.

Woodhouse KW, Wynne H, Baillie S, James OF, Rawlins MD. Who are the frail elderly? Q J Med 1988;68(255):505-6.

Winograd CH, Gerety MB, Chung M, Goldstein MK, Dominguez F Jr, Vallone R et al. Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc 1991;39(8):778-84.

Speechley M, Tinetti M. Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc 1991;39(1):46-52.

Campbell AJ, Buchner DM. Unstable disability and the fluctuations of frailty. Age Aging 1997;26(4):315-8. http://dx.doi.org/10.1093/ageing/26.4.315

Strawbridge WJ, Shelma SJ, Balfour JL, Higby HR, Kaplan GA. Antecedents of frailty over three decades in an older cohort. J Gerontol B Psychol Sci Soc Sci 1998;53(1):9-16. http://dx.doi.org/10.1093/geronb/53B.1.S9

Fried LP, Walston JM. Frailty and failure to thrive. In: Hazard WR, Blass JP, Ettinger WH Jr, Halter JB, Ouslander J (eds). Principles of Geriatric Medicine and Gerontology. 5th ed. New York: McGraw-Hill; 2003.

Hamerman D. Toward an understanding of fraity. Ann Intern Med 1999;130(11):945-50. http://dx.doi.org/10.7326/0003-4819-130-11-199906010-00022

Rockwood K, Hogan DB, MacKnight C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging 2000;17(4):295-302. http://dx.doi.org/10.2165/00002512-200017040-00005

Lipsitz LA. Dynamics of stability: the physiologic basis of functional health and frailty. J Gerontol A Biol Sci Med 2002;57(3):B115-25.

Bortz WM. A conceptual framework of frailty. J Gerontol A Biol Sci Med Sci 2002;57(5):M283-8. http://dx.doi.org/10.1093/gerona/57.5.M283

Espinoza S, Walston JD. Frailty in older adults: insights and interventions. Cleve Clin J Med 2005;72(12):1105-12. http://dx.doi.org/10.3949/ccjm.72.12.1105

Morley JE, Haren MT, Rolland Y, Kim MJ. Frailty. Med Clin North Am 2006;90(5):837-47. http://dx.doi.org/10.1016/j.mcna.2006.05.019

Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB Jr, Walston JD et al. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc 2004:52(4):625-34. http://dx.doi.org/10.1111/j.1532-5415.2004.52174.x

Bergman H, Béland F, Karunananthan S, Hummel S, Hogan D, Wolfson C. Canadian iniciative on frailty and aging. Developing a working framework for understanding frailty. Gérontologie et Société 2004;109:15-29. http://dx.doi.org/10.3917/gs.109.0015

Teixeira INDO, Néri AL. A fragilidade no envelhecimento: fenômeno multidimensional, multideterminado e evolutivo. In: Freitas EV, Py L, Cançado F, Doll J, Gorzoni ML. Tratado de geriatria e geronlogia 2.ed. Rio de Janeiro: Guanabara Koogan: 2006, cap 115, p. 1102-9.

Fried LP, Hadley E, Walston JD, Newman AB, Guralnik JM, Studenski SA et al. From bedside to bench: research agenda for frailty. Sci Aging Knowledge Environ 2005;2005(31):pe24. http://dx.doi.org/10.1126/sageke.2005.31.pe24

Fried LP, Walston W. Approach to the frail eldery patient. In: Kelley's Textbook of Internal Medicine. 4th ed. Lippicontt Willians & Wilkins; 2000.

Walston J, Hadley EC, Ferruci L, Guralnik JM, Newman AB, Studenski SA et al. Research agenda for frailty in older adults: toward a better understasnding of physiology an etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Olders Adults. J Am Geriatr Soc 2006;54(6):991-1001. http://dx.doi.org/10.1111/j.1532-5415.2006.00745.x

Silva TAA, Frisoli Jr A, Pinheiro MM, Szejnfeld VL. Sarcopenia and aging: aspects and therapeutic options. Rev Bras Reumatol 2006;46(6):391-7.

Roubenoff R. Catabolism of aging: is it inflammatory process? Curr Opin Clin Nutr Metab Care 2003:6(3):295-9 http://dx.doi.org/10.1097/01.mco.0000068965.34812.62

Brüünsgaard H, Pedersen BK. Age-related inflammatory cytokines and disease. Immunol Allergy Clin North Am 2003;23(1):15-39. http://dx.doi.org/10.1016/S0889-8561(02)00056-5

Leng SX, Cappola AR, Andersen RE, Blackman MR, Koening K, Blair M et al. Serum levels of insulin-like growth factor-1 (IGF-1) and dehydroepiandrosterone sulfate (DHEA-S), and their relationships with serum interleukin-6, in the geriatric syndrome of frailty. Aging Clin Exp Res 2004;16(2):153-7. http://dx.doi.org/10.1007/BF03324545

Harris TB, Ferruci L, Tracy RP, Corti MC, Wacholder S, Ettinger WH Jr et al. Associations of elevates interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med 1999;106(5):506-12. http://dx.doi.org/10.1016/S0002-9343(99)00066-2

Roubenoff R, Parise H, Payette HA, Abad LW, D'Agostinho R, Jacques PF et al. Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study. Am J Med 2003;115(6):429-35. http://dx.doi.org/10.1016/j.amjmed.2003.05.001

Visser M, Pahor M, Taaffe DR, Goodpaster BH, Simonsick EM, Newman AB et al. Relationship of interleukin-6 and tumor necrosis factor-alpha with muscle mass and muscle strength in elderly men and women: the Health ABC Study. J Gerontol A Biol Sci Med Sci 2002;57(5): M326-32. http://dx.doi.org/10.1093/gerona/57.5.M326

Walston J. Frailty: the search for underlying causes. Sci Aging Knowledge Environ 2004;2004(4):pe4. http://dx.doi.org/10.1126/sageke.2004.4.pe4

Rawson ES, Wehnert ML, Clarkson PM. Effects of 30 days of creatine ingestion in older men. Eur J Appl Physiol Occup Physiol 1999;80(2):139-44. http://dx.doi.org/10.1007/s004210050570

Campbell WW, Joseph LJ, Davey SL, Cyr-Campbell D, Anderson RA, Evans WJ. Effects of resistence training and chromium picolinate on body composition and skeletal muscle in older men. J Appl Physiol 1999;86(1):29-39.

Daley MJ, Spinks WL. Exercise, mobility and aging. Sports Med 2000;29(1):1-12. http://dx.doi.org/10.2165/00007256-200029010-00001

Fiatarone M, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA 1990;263(22):3029-34.

http://dx.doi.org/10.1001/jama.1990.03440220053029

Okuma SS. O idoso e a atividade física: fundamentos e pesquisa. Campinas: Papirus;1998.

Ades PA, Ballor DL, Ashikaga T, Utton JL, Nair KS. Weigth training improves walking endurance in healthy elderly persons. Ann Intern Med 1996;124(6):568-72. http://dx.doi.org/10.7326/0003-4819-124-6-199603150-00005

Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994;330(25):1769-775. http://dx.doi.org/10.1056/NEJM199406233302501

Hasten DL, Pak-Loduca J, Obert KA, Yarasheski KE. Resistance exercise acutely increases MHC and mixed muscle protein synthesis rates in 78-84 and 23-32 yr olds. Am J Physiol Endocrinol Metab 2000;278(4):E620-6.

Tribees S, Virtuoso JS. Prescription of physical exercises for eldery. Rev Saúde Com. 2005:1(12):163-72.

Borst SE. Interventions for sarcopenia and muscle weakness in older people. Age Ageing 2004;33(6):548-55. http://dx.doi.org/10.1093/ageing/afh201

Buchner DM, Beresford SA, Larson EB, LaCroix AZ, Wagner EH. Effects of physical activity on health status in older adults. II. Intervention studies. Annu Rev Public Health 1992;13:469-88.

http://dx.doi.org/10.1146/annurev.pu.13.050192.002345

Lord SR, Sherrington C, Menz HB. Falls in older people: risk factors and strategies for prevention. United Kingdom: Cambridge University; 2001.

Sousa N, Marques U. Prevenção da queda do idoso. As alterações induzidas pelo treino da força no desempenho do Timed Get-Up & Go Test e do Functional Reach Test. Revista Digital - Buenos Aires 2002;53(8). Disponível em:

Judge JO, Underwood M, Gennosa T. Exercise to improve gait velocity in older persons. Arch Phys Med Rehabil 1993;74(4):400-6.