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      Impact of matrix support on older adults in primary care: randomized community trial

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          ABSTRACT

          OBJECTIVE

          To analyze the effect of matrix support on health for older adults in primary care according to the dimensions of frailty measured with the Clinical-Functional Vulnerability Index-20 (IVCF-20).

          METHODS

          This is a randomized controlled community trial, developed in the Northern Minas Gerais state, Brazil, in 2018. Initially, the stratification of clinical and functional vulnerability of older adults supported by six Family Health Strategy teams occurred with the IVCF-20. Subsequently, three teams were drawn to receive matrix support for six months, and the others for control. In this intervention, face-to-face educational activities were developed for health teams. Descriptive statistics were performed, followed by bivariate analysis by Pearson’s chi-square test, to compare the variables of the IVCF-20 between the two moments (before and after the intervention), with a 5% significance level. Relative risks and respective 95% confidence intervals (95%CI) were estimated.

          RESULTS

          The groups were similar before intervention, and the effect of matrix actions was positive for most dimensions measured by IVCF-20 (instrumental daily living activity, cognition, mood, mobility, communication, and multiple comorbidities). At the end of the research, the percentage of frailty in the group assisted by professionals participating in matrix support was lower than that of the control group.

          CONCLUSIONS

          Matrix support actions, such as pedagogical attribution and horizontal care for health teams, have the potential to contribute to the articulation of models of care for older adults.

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          Most cited references40

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          Frailty consensus: a call to action.

          Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
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            The World report on ageing and health: a policy framework for healthy ageing.

            Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.
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              Frailty defined by deficit accumulation and geriatric medicine defined by frailty.

              As nonreplicative cells age, they commonly accumulate subcellular deficits that can compromise function. As people age, they too experience problems that can accumulate. As deficits (symptoms, signs, illnesses, disabilities) accumulate, people become more susceptible to adverse health outcomes, including worse health and even death. This state of increased risk of adverse health outcomes is indistinguishable from the idea of frailty, so deficit accumulation represents another way to define frailty. Counting deficits not only allows grades of frailty to be discerned but also provides insights into the complex problems of older adults. This process is potentially useful to geriatricians who need to be experts in managing complexity. A key to managing complexity is through instruments such as a comprehensive geriatric assessment, which can serve as the basis for routine clinical estimation of an individual's degree of frailty. Understanding people and their needs as deficits accumulate is an exciting challenge for clinical research on frailty and its management by geriatricians. Copyright © 2011 Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Rev Saude Publica
                Rev Saude Publica
                rsp
                Revista de Saúde Pública
                Faculdade de Saúde Pública da Universidade de São Paulo
                0034-8910
                1518-8787
                05 April 2021
                2021
                : 55
                : 10
                Affiliations
                [I ] orgnameUniversidade Estadual de Montes Claros orgdiv1Centro Mais Vida Eny Faria de Oliveira orgdiv2Departamento de Clínica Médica Montes Claros MG Brasil originalUniversidade Estadual de Montes Claros. Centro Mais Vida Eny Faria de Oliveira. Departamento de Clínica Médica. Montes Claros, MG, Brasil
                [II ] orgnameUniversidade Estadual de Montes Claros orgdiv1Centro Mais Vida Eny Faria de Oliveira Montes Claros MG Brasil originalUniversidade Estadual de Montes Claros. Centro Mais Vida Eny Faria de Oliveira. Montes Claros. MG, Brasil
                [III ] orgnameUniversidade Federal de Minas Gerais orgdiv1Instituto Jenny Faria de Oliveira orgdiv2Núcleo de Geriatria e Gerontologia Belo Horizonte MG Brasil originalUniversidade Federal de Minas Gerais. Instituto Jenny Faria de Oliveira. Núcleo de Geriatria e Gerontologia. Belo Horizonte, MG, Brasil
                [IV ] orgnameUniversidade Estadual de Montes Claros orgdiv1Centro de Ciências Biológicas e da Saúde orgdiv2Departamento de Odontologia Montes Claros MG Brasil originalUniversidade Estadual de Montes Claros. Centro de Ciências Biológicas e da Saúde. Departamento de Odontologia. Montes Claros, MG, Brasil
                [V ] orgnameUniversidade Estadual de Montes Claros orgdiv1Centro de Ciências Biológicas e da Saúde orgdiv2Departamento de Saúde da Mulher e da Criança Montes Claros MG Brasil originalUniversidade Estadual de Montes Claros. Centro de Ciências Biológicas e da Saúde. Departamento de Saúde da Mulher e da Criança. Montes Claros, MG, Brasil
                [I ] Brasil originalUniversidade Estadual de Montes Claros. Centro Mais Vida Eny Faria de Oliveira. Departamento de Clínica Médica. Montes Claros, MG, Brasil
                [II ] Brasil originalUniversidade Estadual de Montes Claros. Centro Mais Vida Eny Faria de Oliveira. Montes Claros. MG, Brasil
                [III ] Brasil originalUniversidade Federal de Minas Gerais. Instituto Jenny Faria de Oliveira. Núcleo de Geriatria e Gerontologia. Belo Horizonte, MG, Brasil
                [IV ] Brasil originalUniversidade Estadual de Montes Claros. Centro de Ciências Biológicas e da Saúde. Departamento de Odontologia. Montes Claros, MG, Brasil
                [V ] Brasil originalUniversidade Estadual de Montes Claros. Centro de Ciências Biológicas e da Saúde. Departamento de Saúde da Mulher e da Criança. Montes Claros, MG, Brasil
                Author notes
                Correspondence: Luciana Colares Maia Rua Primeiro Centenário, 101 39401-035 Montes Claros, MG, Brasil E-mail: luciana.colares.maia@ 123456gmail.com

                Authors’ Contribution: Substantial contribution in the design and planning of the study: LCM, SMC, APC. Data collection: LCM. Data analysis and interpretation: LCM, SMC, APC. Writing and review of the manuscript: LCM, TFBC, ENM, SMC, APC. Critical review of the manuscript: LCM, SMC, APC. Approval of the final version of the manuscript: all authors. Public responsibility for the content of this article: LCM.

                Conflict of Interest: The authors declare no conflict of interest.

                Correspondência: Luciana Colares Maia Rua Primeiro Centenário, 101 39401-035 Montes Claros, MG, Brasil E-mail: luciana.colares.maia@gmail.com

                Contribuição dos Autores: Contribuição substancial na concepção e planejamento do estudo: LCM, SMC, APC. Coleta os dados: LCM. Analise e interpretação dos dados: LCM, SMC, APC. Elaboração e revisão do manuscrito: LCM, TFBC, ENM, SMC, APC. Revisão crítica do manuscrito: LCM, SMC, APC. Aprovação da versão final a ser publicada: todos os autores. Responsabilidade pública pelo conteúdo do artigo: LCM.

                Conflito de Interesses: Os autores declaram não haver conflito de interesses.

                Author information
                https://orcid.org/0000-0001-6359-3593
                https://orcid.org/0000-0003-3215-447X
                https://orcid.org/0000-0002-8923-1029
                https://orcid.org/0000-0002-0266-018X
                https://orcid.org/0000-0002-9990-9083
                Article
                00204
                10.11606/s1518-8787.2021055002685
                8023320
                794fee1f-c2b1-445d-a3b4-29f206a0b7cf

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 May 2020
                : 10 July 2020
                Page count
                Figures: 2, Tables: 6, Equations: 0, References: 32
                Funding
                Funded by: Fundação de Amparo à Pesquisa do Estado de Minas Gerais
                Award ID: CDS-BIP00128-02965-17
                Funding: The authors thank the Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) for financial support (CDS-BIP00128-02965-17) and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).
                Categories
                Original Article

                health of the elderly,matrix support,primary health care,public health,clinical trial

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