ABSTRACT BACKGROUND: We aimed to develop and validate a practical instrument to assess older adults’ satisfaction with their social participation (SP). DESIGN AND SETTING: This methodological validation study was conducted at a public higher education institution. METHODS: A two-phase study was designed, developed, and validated to assess older adults’ satisfaction with their SP. In the first phase, we conceptualized SP and developed an “instrument to assess older adults’ satisfaction with their SP (IAPSI),” as approved by a committee of specialists, pre-tested, and partially validated. Second, we determined the IAPSI’s reproducibility using Cronbach’s alpha to measure internal consistency, Pearson’s and Spearman’s coefficients to measure correlations, the Bland-Altman plot and intraclass correlation coefficient (ICC) to measure reproducibility. We also generated a receiver operating characteristic (ROC) curve. RESULTS: 102 older adults (mean age, 87.29) participated in the first phase. Moderate internal consistency (Cronbach’s alpha 0.7) and significant moderate correlations with quality of life by World Health Organization Quality of Life (WHOQOL)-bref and by WHOQOL-old social domains (Pearson’s coefficients 0.54 and 0.64, respectively; P < 0.001) were found. The ROC curve indicated an IAPSI score of 17 as the threshold for the impact of pain on satisfaction with SP (83.3% sensitivity and 88.9% specificity, P < 0.001). In the second phase, 56 older adults (between 81 and 90 years old) participated. We found adequate intra- and inter-observer reproducibility for the IAPSI (ICC 0.96 and 0.78, respectively). CONCLUSION: We have developed a practical instrument with appropriate psychometric properties to assess older adults’ satisfaction with their SP.

RESUMO Introdução: A co-ocorrência de dor crônica e de distúrbios do sono contribuem para um impacto funcional e social negativo em idosos. Porém, o binômio dor-sono não foi explorado em relação a questionários para idosos, a fim de auxiliar na triagem, no diagnóstico ou no monitoramento da eficácia do tratamento médico. Objetivo: Desenvolver e validar um instrumento breve, prático e abrangente para avaliar a concorrência de condições álgicas crônicas e distúrbios de sono em idosos. Métodos: Estudo descritivo e qualitativo de metodologia de desenvolvimento e validação de instrumento de medida para avaliação de dor e sono em idosos, composto por sete itens. Após a fundamentação teórica, desenvolveram-se os itens do instrumento, seguidos de um estudo quantitativo (validação), em que testamos pacientes idosos com dor crônica. Resultados: Aplicou-se o Instrumento de Avaliação de Sono para Dor em Idosos (IASID) a uma amostra de 100 idosos. Alcançou-se o alfa de Cronbach (0,602) de boa homogeneidade por correlação item-total (≥0,4). Encontramos correlações estatisticamente significativas entre o IASID e a qualidade do sono (PSQI, r=61,5%); a intensidade da dor (NVS, r=30,5%); seus impactos (GPM, r=40,5); depressão (GEAP, r=45,5%); comorbidades (r=27,9) e uso de medicamentos (r=30,4). A curva ROC apontou sensibilidade de 73,2% e especificidade de 79,1% para predição de distúrbios do sono associados à dor crônica em idosos. Conclusões: O IASID apresentou propriedades métricas adequadas e demonstrou ser uma ferramenta simples e prática para a avaliação do impacto da dor no sono em idosos.

Abstract Background: The co-occurrence of chronic pain and sleep disturbance contribute to a significant functional and social impact in older adults. However, there are no validated instruments to measure sleep disturbance and pain in this population that could be used to screen or diagnose individuals or monitor treatment effectiveness. Objective: Our aim was to develop and validate a brief, practical, and comprehensive tool to assess the impact of co-occurring pain and sleep disturbance in older adults. Methods: Development and validation of a measurement tool for assessing pain and sleep in older adults consisting of seven items. Results: We applied the “Sleep Assessment Instrument for Pain in older adults” (SAIOAP) in a sample of 100 older individuals. A Cronbach’s alpha of 0.602 indicated a moderate level of reliability, and item-total correlations of ≥0.4 for all items indicated good homogeneity. There were statistically significant correlations between the SAIOAP and sleep quality (PSQI, r=61.5), pain intensity (VNS, r=30.5), the multidimensional impacts of pain (GPM, r=40.5), depression (GEAP, r=45.5), comorbidity (r=27.9), and medication use (r=30.4). A ROC curve indicated a sensitivity of 73.2% and a specificity of 79.1% in relation to the prediction of sleep disturbances associated with pain in older adults. Conclusions: The SAIOAP presented adequate metric properties and was demonstrated to be a simple and practical tool for the assessment of the impact of pain on sleep in older adults.

ABSTRACT BACKGROUND: Fatigue is a frequent symptom in patients with primary Sjögren’s syndrome (pSS) and can be a cause of or be associated with sleep disorders. OBJECTIVE: To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity. DESIGN AND SETTING: Analytical observational study conducted at an exercise psychobiology laboratory. METHODS: Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics. RESULTS: A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI. CONCLUSION: The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue.

RESUMO Objetivo: O termo síndrome locomotora (SL) designa condições nas quais os idosos apresentam alto risco de incapacidade para deambulação em decorrência de problemas em órgãos locomotores. Para seu rastreio foi criado o 25-Question Geriatric Locomotive Function Scale (GLFS-25). Objetivou-se aqui, traduzir, adaptar transculturalmente para o Brasil e estudar as propriedades psicométricas do GLFS-25. Método: Feitas tradução e adaptação transcultural do GLFS-25 que originaram o GLFS 25-P, cujas propriedades psicométricas foram analisadas numa amostra de 100 idosos. Apurados dados sociodemográficos relativos a dor, queda, autopercepção da saúde e funcionalidades básica e instrumental. O GLFS 25-P foi aplicado em três momentos: num mesmo dia por dois entrevistadores e após 15 dias novamente pelo primeiro entrevistador. Resultado: O GLFS 25-P apresentou alto valor de consistência interna, segundo o coeficiente Alfa de Cronbach (0,942); e reprodutibilidade ótima, segundo a correlação intraclasses: valores de 97,6% e 98,4%, interobservador e intraobservador, respectivamente (p < 0,01). As concordâncias para cada item do instrumento foram consideráveis (entre 0,248 e 0,673), segundo a estatística Kappa. Na validação, segundo o coeficiente de Pearson, foram obtidas correlações regular e boa para as atividades de vida diária básicas (AVDB) e instrumentais (AIVD), respectivamente (p < 0,01). Encontradas associações estatisticamente significantes com dor crônica (p < 0,001), queda (p = 0,02) e autopercepção de saúde (p < 0,001). A análise multivariada evidenciou risco de SL significativamente maior na presença de dor crônica (OR 15,92, IC 95% 3,08-82,27) e pior autopercepção de saúde (OR 0,23, IC 95% 0,07-0,79). Conclusão: O GLFS 25-P demonstrou ser confiável e válido no rastreio da SL em idosos.

ABSTRACT Objective: The term Locomotive Syndrome refers to conditions in which the elderly are at high risk of inability to ambulate due to problems in locomotor system. For Locomotive Syndrome screening, the 25-Question Geriatric Locomotive Function Scale was created. The objective here was to translate, adapt culturally to Brazil, and study the psychometric properties of 25-Question Geriatric Locomotive Function Scale. Method: The translation and cultural adaptation of 25-Question Geriatric Locomotive Function Scale were carried out, thus resulting in GLFS 25-P, whose psychometric properties were analyzed in a sample of 100 elderly subjects. Sociodemographic data on pain, falls, self-perceived health and basic and instrumental functionalities were determined. GLFS 25-P was applied three times: in one same day by two interviewers, and after 15 days, again by the first interviewer. Result: GLFS 25-P showed a high internal consistency value according to Cronbach's alpha coefficient (0.942), and excellent reproducibility, according to intraclass correlation, with interobserver and intraobserver values of 97.6% and 98.4%, respectively (p < 0.01). Agreements for each item of the instrument were considerable (between 0.248 and 0.673), according to Kappa statistic. In its validation, according to the Pearson's coefficient, regular and good correlations were obtained for the basic (BADL) and instrumental (IADL) activities of daily living, respectively (p < 0.01). Statistically significant associations with chronic pain (p < 0.001), falls (p = 0.02) and self-perceived health (p < 0.001) were found. A multivariate analysis showed a significantly higher risk of Locomotive Syndrome in the presence of chronic pain (OR 15.92, 95% CI 3.08–82.27) and with a worse self-perceived health (OR 0.23, 95% CI 0.07–0.79). Conclusion: GLFS 25-P proved to be a reliable and valid tool in Locomotive Syndrome screening for the elderly population.

Resumo Objetivos: avaliar a frequência de transtornos de ansiedade em idosos longevos com dor crônica e verificar as suas associações. Método: estudo descritivo, analítico e de corte transversal do "Projeto Longevos", do qual participam idosos da comunidade com 80 anos de idade ou mais. Selecionados os longevos com dor crônica dos quais se apuraram as características sociodemográficas e os aspectos referentes à dor, principalmente aqueles relacionados às suas multidimensões, segundo o Geriatric Pain Measure-p (GPM-p). Foram realizadas avaliações de funcionalidade e autopercepção de saúde, e os rastreios dos transtornos de depressão e ansiedade, segundo a Escala de Depressão Geriátrica e o Inventário de Ansiedade Traço-Estado, respectivamente. As associações foram analisadas segundo a correlação de Pearson, o teste de Anova e o Teste de comparações múltiplas de Tukey. Resultados: amostra constituída por 41 idosos com média de idade de 85,7 anos, sendo a maioria do sexo feminino, branca, viúva e de baixa escolaridade. Observadas altas prevalências de transtornos de ansiedade, 53,6% e 68,3%, respectivamente, traço e estado de ansiedade. Foi observada correlação significativa, mas não alta, da ansiedade-traço com a dor crônica segundo o GPM-p (r=31,5%; p=0,048) e correlação significativa e alta desse mesmo tipo de ansiedade com a depressão (r=61,3%; p<0,001). Conclusão: os transtornos de ansiedade foram muito prevalentes nos longevos com dor crônica, e esses se correlacionaram significativamente com a dor e a depressão, o que poderia justificar a necessidade de medidas terapêuticas multidisciplinares e diferentes nos quadros álgicos persistentes de idosos.

Abstract Objectives: to evaluate the frequency of anxiety disorders in older elderly persons with chronic pain and identify associated factors. Method: a descriptive, analytical and cross section study of the "Projeto Longevos" ("Long-Lived Elderly Persons Project") was carried out, featuring elderly persons living in the community who were aged 80 or over. Older elderly persons with chronic pain were selected, and data regarding their sociodemographic characteristics and factors related to pain was gathered, especially with regard to the multidimensional nature of pain, according to the "Geriatric Pain Measure-p" (GPM-p). Self-perception of health was also recorded and functionality assessments were carried out, along with the screenings for depression and anxiety disorders, according to the Geriatric Depression Scale and the State-Trait Anxiety Inventory, respectively. Associations were analyzed by Pearson correlation, the ANOVA Test and Tukey multiple comparisons. Results: the sample was composed of 41 elderly persons with a mean age of 85.7 years, most of whom were female, white, widowed and had a low education. A high prevalence of anxiety disorders was observed, being 53.6% and 68.3%, respectively, for trait and state anxiety. A significant, but not high, correlation was found between the anxiety trait and chronic pain according to the GPM-p (r=31.5%; p=0.048), and there was a significant and high correlation between the same type of anxiety and depression (r=61.3%; p<0.001). Conclusion: anxiety disorders were very prevalent in older elderly persons with chronic pain, and these correlated significantly with pain and depression, which could justify the need for varied multidisciplinary therapeutic measures against the persistent pain conditions of the elderly.

Resumo Objetivo: A fim de se introduzir no nosso meio um instrumento que permitisse uma avaliação clínica abrangente da depressão dor-induzida em idosos, propôs-se a tradução, adaptação transcultural para o Brasil e estudo das propriedades psicométricas do “Geriatric Psychosocial Assessment of Pain-induced Depression” (GEAP). Esse instrumento foi desenvolvido especialmente para rastreio da depressão associada à dor em idosos. Método: Foram realizadas tradução e adaptação transcultural do GEAP, cujas propriedades psicométricas foram analisadas em uma amostra de 48 idosos. Foram apurados dados sociodemográficos e relacionados a dor crônica, além de depressão. O GEAP-b foi aplicado em três momentos distintos, em um mesmo dia por dois entrevistadores diferentes (E1 e E2), e após 15 dias por um daqueles entrevistadores (E3). Resultados: O instrumento GEAP-b mostrou-se ser de fácil aplicação e alto valor de consistência interna, de acordo com o coeficiente alfa de Cronbach (0,835). Teve reprodutibilidade ótima, segundo as correlações intraclasses: valores de 98,5 e 92%, interobservador e intraobservador, respectivamente. As concordâncias para cada item do GEAP-b foram “consideráveis“ (entre 0,419 e 1,0), excetuando-se a concordância para o item 19, segundo a estatística kappa. Para a validade de critério do GEAP-b, correlações positivas e estatisticamente significativas foram obtidas para a dor, segundo o GPM-p (r=49,5%; p<0,001), e para a depressão, segundo o GDS (r=59%; p<0,001), com ambos os valores considerados regulares (entre 40 e 60%). Conclusão: O GEAP-b demonstrou ser confiável e válido no rastreio da depressão associada à dor em idosos.

Summary Objective: In order to introduce an instrument within our midst that allows a comprehensive clinical evaluation of pain-induced depression in the elderly, we proposed the translation, cross-cultural adaptation into Brazilian Portuguese, and study of the psychometric properties of the “Geriatric Psychosocial Assessment of Pain-induced Depression” (GEAP) scale. This instrument was especially developed for the screening of depression associated with chronic pain in the elderly. Method: We performed translation and cross-cultural adaptation of the GEAP scale, whose psychometric properties were analyzed in a sample of 48 elderly individuals. Sociodemographic data and information related to chronic pain were ascertained, as well as those related to depression. The GEAP-b scale was applied at three different times on the same day by two different interviewers (I1 and I2), and after 15 days by one of those interviewers (I3). Results: The GEAP-b proved to be an easy-to-apply instrument with a high internal consistency value, according to the Cronbach’s alpha coefficient (0.835). The reproducibility of the instrument was optimal, achieving intraclass correlations of 98.5 and 92% for interobserver and intraobserver, respectively. There was “considerable” agreement (between 0.419 and 1.0) for each GEAP-b item, except for item 19, according to the kappa statistic. As for the validity of the GEAP-b criterion, positive and statistically significant correlations were obtained for pain, according to GPM-p (r=49.5%, p<0.001), and depression, according to GDS (r=59%, p<0.001), both values being considered regular (between 40-60%). Conclusion: The GEAP-b scale has proven to be reliable and valid in the screening of pain-related depression in the elderly.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor crônica diminui consideravelmente a qualidade de vida dos idosos, dando relevância aos estudos que a abordam nesses indivíduos, sobretudo nos longevos. Recentemente, a hipovitaminose D, muito prevalente entre idosos, tem sido relacionada à dor crônica. O objetivo deste estudo foi estimar a prevalência de dor crônica entre os longevos da comunidade com independência funcional, avaliar suas características e correlacionar essa dor com os níveis séricos de vitamina D. MÉTODOS: Estudo transversal do “Projeto Longevos”, com idosos de 80 anos ou mais, de ambos os gêneros, com independência funcional. Foram apurados os dados sócio-demográficos, avaliadas e mensuradas as dores crônicas apresentadas e obtidos os níveis séricos da vitamina D. RESULTADOS: Foram avaliados 330 participantes do “Projeto Longevos”, e encontrada prevalência de 20,9% de dor crônica, sendo essa principalmente do tipo nociceptiva, contínua, de intensidade moderada a intensa, de localização lombar. Dentre os instrumentos de mensuração da intensidade dolorosa, os preferidos foram as escalas de faces e numérica verbal. Observou-se alta prevalência de hipovitaminose D nos longevos com dor crônica (87%); níveis de deficiência e insuficiência em 49 e 38%, respectivamente, porém tais níveis não se correlacionaram significativamente com a presença de dor crônica. CONCLUSÃO: A prevalência de dor crônica entre os longevos foi alta. Intensidade moderada e intensa e localização lombar foram as mais frequentes. Houve alta prevalência de hipovitaminose D entre os longevos estudados, porém não se observou correlação significativa entre baixos níveis séricos de vitamina D e dor crônica.

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain considerably worsens quality of life of the elderly, giving relevance to studies addressing it in such individuals, especially those long-lived. Recently, vitamin D deficiency, very prevalent among the elderly, has been correlated to chronic pain. This study aimed at estimating the prevalence of chronic pain among community long-lived elderly with functional independence, at evaluating its characteristics and at correlating this pain to serum vitamin D levels. METHODS: Cross-sectional study of the “Long-Lived Project”, with elderly aged 80 years or above, of both genders, with functional independence. Socio-demographic data were collected, referred chronic pains were measured and serum vitamin D levels were obtained. RESULTS: We have evaluated 330 participants of the “Long-Lived Project” and pain prevalence was 20.9%, especially nociceptive, continuous, moderate to severe and lumbar pain. Among pain intensity measurement tools, faces and verbal numeric scales were preferred. There has been high prevalence of vitamin D deficiency among long-lived elderly with chronic pain (87%); deficiency and insufficiency levels were 49 and 38%, respectively, however such levels were not significantly correlated to chronic pain. CONCLUSION: There has been high prevalence of chronic pain among the elderly. Moderate to severe and low back pain were the most frequent. There has been high prevalence of vitamin D deficiency among studied long-lived elderly; however there has been no significant correlation between low serum vitamin D levels and chronic pain.

JUSTIFICATIVA E OBJETIVOS: A dor crônica é queixa muito frequente nas consultas, principalmente entre os idosos. Na tentativa de buscar terapêuticas mais eficazes e com menos efeitos adversos, nessa população, especialmente considerando idosos com dor neuropática e musculoesquelética, tem-se observado estudos que vêm relacionando a vitamina D a quadros dolorosos, o que poderia propô-la como uma alternativa analgésica. O objetivo deste estudo foi rever, na literatura, o papel da vitamina D na dor crônica neuromusculoesquelética em idosos. CONTEÚDO: Realizada a revisão bibliográfica na base de dados do Pubmed, Medline, LILACS, Biblioteca Cochrane e Scielo, contemplando os últimos 10 anos, títulos em português e inglês. Os descritores usados na busca inicial foram "vitamina D" e "dor crônica", resultando 220 artigos, dos quais apenas os que se tratavam de dor neuromusculoesquelética em idosos foram utilizados. Destes, somente 10 preenchiam os critérios estabelecidos e foram analisados, resultando: um estudo de revisão sistemática, cinco estudos analíticos transversais, dois estudos retrospectivos do tipo série de casos, um estudo observacional prospectivo e um trial clínico randomizado e controlado. Observou-se em cinco estudos uma relação significativa entre a hipovitaminose D e dor crônica musculoesquelética, em três estudos uma melhora da dor após suplementação com vitamina D, e, em outros dois, não haver melhora da dor com esta suplementação. CONCLUSÃO: Os estudos relacionando a vitamina D e a dor crônica em idosos ainda são escassos e bastante heterogêneos. A avaliação do déficit de vitamina D deveria estar mais presente nas consultas geriátricas, pois este tem sido correlacionado com certas síndromes dolorosas e sua adequação poderia trazer beneficio terapêutico em alguns casos.

BACKGROUND AND OBJECTIVES: Chronic pain is a frequent complaint during medical visits, especially among the elderly. In the attempt to find more effective therapies with less adverse effects in this population, especially considering elderly people with neuropathic and musculoskeletal pain, there are studies relating vitamin D to pain, which could propose it as an analgesic alternative. This study aimed at reviewing in the literature the role of vitamin D in chronic musculoskeletal pain in the elderly. CONTENTS: Pubmed, Medline, LILACS, Cochrane Library and Scielo databases were queried for the last ten years, looking for studies in Portuguese and English. Initial search keywords were "vitamin D" and "chronic pain", resulting in 220 articles, of which only those addressing musculoskeletal pain in the elderly were selected. From those, only ten met established criteria and were analyzed, resulting in: one systematic review, five transversal analytical studies, two case-series retrospective studies, one prospective observational study and one randomized and controlled clinical trial. Five studies have shown significant relationship between vitamin D deficit and chronic musculoskeletal pain; three studies have shown pain improvement after vitamin D supplementation and two have not observed pain improvement with such supplementation. CONCLUSION: Studies relating vitamin D to chronic pain in the elderly are still scarce and highly heterogeneous. The evaluation of vitamin D deficit should be more frequent during geriatric consultations, because this has been correlated to some painful syndromes and its correction could bring therapeutic benefits in some cases.