Objectives: The primary aim of this study is to assess the relationship between different aspects of physical activity (PA) and dementia occurrence in older adults from Brazil.

Methods: It is a secondary analysis of the first wave data derived from the ELSI-Brazil study, a longitudinal study of aging in Brazil with a representative sample of Brazilians aged 50 years and older (n = 9,412). We employed two distinct approaches to assess PA. First, participants’ levels of PA were classified in low, moderate and high based on their reported physical exertion over the preceding seven days at the time of interview. Also, PA was classified as sufficient or not sufficient, according to the World Health Organization (WHO) recommendation. Dementia was defined as those who were 60 years and older, had a cognitive performance ≤1.5 z-score compared to a sub- sample defined as control-group, and also had an impairment in instrumental activity of daily living. Logistic regression was used to estimate the association between physical activity and dementia (crude and adjusted for age, gender, schooling, marital status, smoking and alcoholconsumption).

Results: After excluding those younger than 60 years old and had missing data to any of the variables analyzed, our sample was composed by 4,994 individuals (table 1), with a mean age of 69.7 (SD = 7 .5), 4.7 years of schooling (SD = 4.3) and 214 (4.1%) classified as living with dementia. We also found that higher levels of PA were associated with lower occurrences of dementia (table 2) (moderate OR 0.57 95% CI 0.37 –0 .90, p < 0.05; high OR 0.32 95% CI 0.19 –0.56, p < 0.001). Also, practicing the level of PA recommended by WHO had an inverse association with dementia (table 3) (OR 0.49 95% CI 0.30 – 0.79, p < 0.05).

Conclusions: The main limitation of our study is its cross-sectional nature. Therefore, we cannot determine the direction of relationships between variables. Our findings show a significant inverse association between levels of PA and dementia occurrence. Additionally, adherence to the WHO’s recommendation for PA also showed a significant inverse association with dementia occurrence. These results underscore the importance of promoting regular physical activity as a potential preventive measure against dementia among older Brazilian adults.

Objectives: Insomnia, defined by sleep initiation or maintenance difficulties, is linked to fatigue, depression, and chronic diseases. Though non-pharmacological treatment approaches are preferred, drugs like benzodiazepines and Z drugs are commonly prescribed, despite significant risks. Hypnotics, used by 9% of the general population and 11.9% of older women, can lead to severe side effects, especially among the elderly, including falls and increased mortality. This study aims to assess sleep quality, hypnotic use, and their impact on mortality among Brazilian older adults.

Methods: Using data from 8,004 cases from the Brazilian Longitudinal Study of Aging and sleep measures were collected from the first wave (2015–2016), and mortality data from the second wave (2019–2021). A cox hazard model was performed to analyze self-reported sleep quality (Likert scale from very poor to very good, and one yes/no question evaluating whether the individual had restful sleep for the most part of the past week) and sleeping pill use (past month frequency) in relation to mortality risk. Covariates included age, sex, marital status, education, income, comorbidities, smoking, alcohol consumption, and physical activity level.

Results: We found no association between self-reported sleep quality or experiencing restful and mortality risk after 4-6 years. On the other hand, when compared to individuals who did not take sleeping pills during the past month, hazard ratios (HR) for death were, respectively, 1.79 (1.11–2.88, p = 0.016) and 1.31 (1.03–1.65, p = 0.026) for those who took medication 1–2 times a week and those who took medication 3 or more times a week. Taking sleeping pills less than once a week had no association with mortality. While the top 3 mortality causes for individuals who did not use sleeping pills were stroke, myocardial infarction and diabetes, the top 3 causes for heavy users were myocardial infarction, lung cancer and chronic obstructive pulmonarydisease.

Conclusions: Insomnia must be adequately treated, but awareness of medication risks is vital. This study highlights higher mortality risk with frequent sedative-hypnotic use in older adults. Warranting non-drug treatments and careful hypnotic use could enhance health outcomes.

Objectives: Low- and middle-income countries face increasing burden of noncommunicable chronic diseases due to rapid population aging. The Objectives of this study is to estimate the association of co-occurring depression and diabetes with healthcare services utilization in the Brazilian population aged 50 years andolder.

Methods: This is an analysis using baseline data of the ELSI-Brazil study. Measurements used were self-reported previous diagnosis for diabetes and a cut-off point of 4 on the CES-D-8 score for depression. Any medical consultations, specialist consultations and hospitalizations in the previous 12 months were assessed for measuring health services use. Logistic regression was used to estimate the association of having depression, diabetes, or both, compared to having none of the conditions with healthcare services utilization.

Results: In a final sample of 8303 participants, the adjusted odds ratios (95%CI) in the depression only group (27.9%), in the diabetes only group (9.7%), and in the depression and diabetes group (5.8%), for any medical consultations were 1.2 (1.01-1.42), 3.39 (2.4-4.79) and 3.12 (1.82-5.35); for specialist consultations, 1.05 (0.91-1.21), 1.34 (1.07-1.68) and 1.13 (0.86-1.49); and for hospitalizations, 1.42 (1.1-1.84), 1.42 (1.02-1.96) and 3.1 (2.12-4.54), respectively. All models were adjusted for sex, age, education, marital status, insufficient physical activity, current drinking and smoking, obesity and number of other diseases and conditions.

Conclusions: Those with diabetes seemed more likely to have any or specialized medical consultations. However, those with the depression and diabetes comorbidity were more likely than any other group to have been admitted to a hospital in the last year, which is distressing and costly. Screening for depression could be incorporated into diabetes usual care to reduce related complications and hospitalizations.

Funding: This study did not receive any funding. Authors: Ferri and Lima-Costa are recipient of CNPq research productive fellowship.

Background: The aim of the study was to determine the correlation and agreement between the Mini-mental State Examination (MMSE) and Clock Drawing Test (CDT), administered and scored using Shulman's method (2000), in elderly Brazilian adults with very low levels of formal education.

Methods: CDT and MMSE tests, performed by a sample of 1118 elderly subjects from a population-based cohort, were evaluated. Spearman's correlation coefficient was calculated for the total sample and according to gender, age and schooling level. Agreement was assessed using receiver operating characteristic (ROC) analysis.

Results: CDTs with high scores had high corresponding MMSE scores whereas CDTs with low scores had a wide range of corresponding MMSE scores. Correlation was moderate (ρ = 0.64) and no difference was found according to gender, age or schooling level. For CDT cut-off 3/4, the best MMSE cut-off was 27/28 and agreement between tests was 75.1%.

Conclusions: Correlation between tests was moderate. Subjects who performed well on the CDT could be expected to obtain high MMSE scores. Although one test does not substitute for the other, the CDT may be more practical in developing countries where resources are limited and low education is common in the elderly, as well as in situations where time for assessment or screening is limited. Moreover, the CDT may be sensitive to cognitive domains not assessed by the MMSE.

Background: Two-phase diagnostic surveys are popular in psychiatric epidemiology. The Geriatric Depression Scale (GDS) and the General Health Questionnaire (GHQ) are commonly used to screen in older and younger populations, respectively.

Method: In Phase I, in this Brazilian population-based study, we screened 392 participants aged ≥ 75 years. In Phase II, half of those scoring ≥ 11 in the GDS and ≥ 4 in the GHQ and 20% of others were selected for detailed evaluation with ICD-10 diagnoses assessed by the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) (n = 126).

Results: Internal consistencies were good for all scales. At the optimal cut-off points GDS-30 (14/15) yielded 73% sensitivity and 65% specificity, while classical GHQ (4/5), Likert (15/16) and c-GHQ (5/6) yielded 66–75% sensitivity and 57–62% specificity. Receiver operating characteristic (ROC) curve analysis against SCAN indicated only moderate screening potential [area under the ROC curve (AUROC): GDS = 0.76; classical GHQ = 0.74; Likert = 0.76; c-GHQ = 0.73], with no statistically significant differences. All measures were biased by disability and self-reported health.

Conclusions: In this study, neither screen was sufficiently predictive of SCAN ICD-10 diagnosis to recommend their use in two-phase surveys. Despite its theoretical advantages, the GDS-30 performed no better than the GHQ-12, and was biased in similar ways.