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Silva Godínez JC, Minisha F, Russo Hortencio TD, Innocenzi A, Dos Santos Kasai CC, Povoa-Correa M, Fregni F, Pacheco-Barrios K. Impact of disabilities in activities of daily living on opioid use for chronic pain in older adults: an exploratory secondary analysis from ELSI-Brazil. Public Health 2024; 235:102-110. [PMID: 39089092 DOI: 10.1016/j.puhe.2024.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/06/2024] [Accepted: 06/27/2024] [Indexed: 08/03/2024]
Abstract
OBJECTIVES Problematic use of opioids by older adults is associated with adverse effects and has become a public health crisis worldwide. Ageing-related disabilities in activities of daily living (ADL) could promote unnecessary use of opioids in this population. This study evaluates the association between ADL disability and opioid consumption in Brazilian older adults. STUDY DESIGN Study design- cross-sectional secondary data analysis of the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil). METHODS Data from the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil) were used. Older adults with chronic pain were included. ADL disability was measured using the Katz Index. The primary outcome was opioid consumption for chronic pain. The primary association was explored using logistic regression models adjusting for predetermined confounders. Sensitivity analyses evaluating model performance were done by calibrating and validating the model using randomly split equal sets. RESULTS In those who reported presence of chronic pain (n = 2865), the prevalence of opioid use was 29% (95% CI:23.1%-35.6%). In adjusted models, participants with moderate and severe ADL disability had 1.6 (95% CI:1.13-2.32; P = 0.009) and 3.8 (95% CI: 1.80-7.90; P < 0.001) times higher odds of opioid consumption compared to no disability, respectively. Being female, alcohol consumption, higher pain intensity, history of dementia, fractures, and presence of ≥2 comorbidities were significantly associated with increased opioid use (P < 0.05). CONCLUSION Nearly one-third of the Brazilian elderly population experiencing chronic pain reported using opioids. The functional decline during the process of ageing appears to be a risk factor for pain intolerance and opioid use. Multidisciplinary approaches to detect early ADL disabilities and improve mobility and access to assistive technologies need to be established to prevent opioid overuse and addiction in elderly populations.
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Affiliation(s)
- J C Silva Godínez
- Harvard T. H. Chan School of Public Health, ECPE Department-PPCR Program Boston, MA, USA; Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - F Minisha
- Harvard T. H. Chan School of Public Health, ECPE Department-PPCR Program Boston, MA, USA; Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - T D Russo Hortencio
- Harvard T. H. Chan School of Public Health, ECPE Department-PPCR Program Boston, MA, USA; Faculdade São Leopoldo Mandic, Instituto de Pesquisa São Leopoldo Mandic, Campinas, Brazil
| | - A Innocenzi
- Harvard T. H. Chan School of Public Health, ECPE Department-PPCR Program Boston, MA, USA; Federal University of Rio de Janeiro, Macaé, RJ, Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - C C Dos Santos Kasai
- Harvard T. H. Chan School of Public Health, ECPE Department-PPCR Program Boston, MA, USA; Pontifícia Universidade Católica do Paraná- Campus Londrina, Londrina, Brazil
| | - M Povoa-Correa
- Harvard T. H. Chan School of Public Health, ECPE Department-PPCR Program Boston, MA, USA; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Federal Institute of Cardiology (INC), Rio de Janeiro, RJ, Brazil
| | - F Fregni
- Harvard T. H. Chan School of Public Health, ECPE Department-PPCR Program Boston, MA, USA; Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - K Pacheco-Barrios
- Harvard T. H. Chan School of Public Health, ECPE Department-PPCR Program Boston, MA, USA; Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
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Reis Júnior WM, Ferreira LN, Molina-Bastos CG, Bispo Júnior JP, Reis HFT, Goulart BNG. Prevalence of functional dependence and chronic diseases in the community-dwelling Brazilian older adults: an analysis by dependence severity and multimorbidity pattern. BMC Public Health 2024; 24:140. [PMID: 38200484 PMCID: PMC10777626 DOI: 10.1186/s12889-023-17564-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Despite the advancements in knowledge about health care for older adults, essential gaps persist regarding the effects of chronic diseases as epidemiological markers of the state of functional dependence. This study aimed to identify the prevalence of moderate and severe functional dependence in Brazilian older adults and its association with chronic diseases and verify the multimorbidity patterns by dependence status. METHODS This cross-sectional analytical study used data from 11,177 community-dwelling Brazilian older adults from the 2013 National Health Survey conducted in Brazil. The dependent variables were moderate and severe functional dependence in basic activities of daily living (BADLs) and instrumental ADLs (IADLs). The independent variables were defined based on the questions applied to measure each morbidity in a self-reported manner and asked, "Has a doctor ever diagnosed you as having (each disease)? Multimorbidity was simultaneously considered present for older adults with ≥ 2 chronic morbidities. The association between functional dependence on BADLs and IADLs separately by severity and the independent variables was verified from crude and adjusted estimates of the point prevalence ratios and their 95% confidence intervals using the regression model Poisson with robust variance. To group diseases into patterns, exploratory factor analysis was used. RESULTS The prevalences of moderate and severe BADL dependence were 10.2% (95% CI, 9.6-10.7) and 4.8% (95% CI, 4.4-5.2), respectively. Moderate and severe IADL dependence prevalences were 13.8% (95% CI, 13.1-14.4) and 15.6% (95% CI, 14.9%-16.2), respectively. When changing the condition from moderate to severe dependence in BADLs, in the presence of other mental illnesses and stroke, the probability of dependence increased more than four times in the case of other mental illnesses and more than five times for stroke. There was a linear trend for dependence severity, both moderate and severe, whereas, for severe dependence on IADLs, this same factor maintained a linear trend toward an increase in probability as the number of diseases simultaneously increased. CONCLUSIONS Chronic diseases are associated with functional dependence, with greater emphasis on mental illnesses and stroke in severe disability, considering their acute adverse effects.
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Affiliation(s)
| | | | | | | | | | - Bárbara Niegia Garcia Goulart
- Department of Health 1, State University of Southwest Bahia, Jequié, Bahia, Brazil.
- Federal University of Rio Grande Do Sul, Rio Grande Do Sul. Rua Ramiro Barcelos, 2777 Room 307, Porto Alegre, RS, CEP 90035-003, Brazil.
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Makofane K, Berkman LF, Bassett MT, Tchetgen Tchetgen EJ. The Effect of Family Wealth on Physical Function Among Older Adults in Mpumalanga, South Africa: A Causal Network Analysis. Int J Public Health 2023; 68:1606072. [PMID: 38024215 PMCID: PMC10630774 DOI: 10.3389/ijph.2023.1606072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives: The aging of the South African population could have profound implications for the independence and overall quality of life of older adults as life expectancy increases. While there is evidence that lifetime socio-economic status shapes risks for later function and disability, it is unclear whether, and how, the wealth of family members shapes these outcomes. We investigated the relationship between outcomes activities of daily living (ADL), grip strength, and gait speed, and the household wealth of non-coresident family members. Methods: Using data from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) and the Agincourt Health and Demographic Surveillance System (AHDSS), we examined the relationship between physical function and household and family wealth in the 13 preceding years. HAALSI is a cohort of 5,059 adults who were 40 years or older at baseline in 2014. Using auto-g-computation-a recently proposed statistical approach to quantify causal effects in the context of a network of interconnected units-we estimated the effect of own and family wealth on the outcomes of interest. Results: We found no evidence of effects of family wealth on physical function and disability. Conclusion: Further research is needed to assess the effect of family wealth in early life on physical function and disability outcomes.
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Affiliation(s)
- Keletso Makofane
- Center for Causal Inference, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Lisa F. Berkman
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, United States
| | - Mary T. Bassett
- FXB Center for Health and Human Rights, Harvard University, Boston, MA, United States
| | - Eric J. Tchetgen Tchetgen
- Center for Causal Inference, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
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Chu WM, Tsan YT, Chen PY, Chen CY, Hao ML, Chan WC, Chen HM, Hsu PS, Lin SY, Yang CT. A model for predicting physical function upon discharge of hospitalized older adults in Taiwan-a machine learning approach based on both electronic health records and comprehensive geriatric assessment. Front Med (Lausanne) 2023; 10:1160013. [PMID: 37547611 PMCID: PMC10400801 DOI: 10.3389/fmed.2023.1160013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background Predicting physical function upon discharge among hospitalized older adults is important. This study has aimed to develop a prediction model of physical function upon discharge through use of a machine learning algorithm using electronic health records (EHRs) and comprehensive geriatrics assessments (CGAs) among hospitalized older adults in Taiwan. Methods Data was retrieved from the clinical database of a tertiary medical center in central Taiwan. Older adults admitted to the acute geriatric unit during the period from January 2012 to December 2018 were included for analysis, while those with missing data were excluded. From data of the EHRs and CGAs, a total of 52 clinical features were input for model building. We used 3 different machine learning algorithms, XGBoost, random forest and logistic regression. Results In total, 1,755 older adults were included in final analysis, with a mean age of 80.68 years. For linear models on physical function upon discharge, the accuracy of prediction was 87% for XGBoost, 85% for random forest, and 32% for logistic regression. For classification models on physical function upon discharge, the accuracy for random forest, logistic regression and XGBoost were 94, 92 and 92%, respectively. The auROC reached 98% for XGBoost and random forest, while logistic regression had an auROC of 97%. The top 3 features of importance were activity of daily living (ADL) at baseline, ADL during admission, and mini nutritional status (MNA) during admission. Conclusion The results showed that physical function upon discharge among hospitalized older adults can be predicted accurately during admission through use of a machine learning model with data taken from EHRs and CGAs.
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Affiliation(s)
- Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Education and Innovation Center for Geriatrics and Gerontology, National Center for Geriatrics and Gerontology, Ōbu, Japan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Tse Tsan
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pei-Yu Chen
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Yu Chen
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Man-Ling Hao
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Wei-Chan Chan
- Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hong-Ming Chen
- Department of Applied Mathematics, Tunghai University, Taichung, Taiwan
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Yi Lin
- Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Tung Yang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
- Research Center for Smart Sustainable Circular Economy, Tunghai University, Taichung, Taiwan
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Torres JL, Vaz CT, Pinheiro LC, Braga LS, Moreira BS, Oliveira C, Lima-Costa MF. The relationship between loneliness and healthy aging indicators in Brazil (ELSI-Brazil) and England (ELSA): sex differences. Public Health 2023; 216:33-38. [PMID: 36791648 PMCID: PMC9992154 DOI: 10.1016/j.puhe.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES This study aimed to estimate five harmonized healthy aging indicators covering functional ability and intrinsic capacity among older women and men from Brazil and England and evaluate their association with loneliness. STUDY DESIGN This was a cross-sectional study. METHODS We used two nationally representative samples of men and women aged ≥60 years from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) wave 2 (2019-2021; n = 6929) and the English Longitudinal Study of Aging wave 9 (2018-2019; n = 5902). Healthy aging included five separate indicators (getting dressed, taking medication, managing money, cognitive function, and handgrip strength). Loneliness was measured by the 3-item University of California Loneliness Scale. Logistic regression models stratified by sex and country were performed. RESULTS Overall, age-adjusted healthy aging indicators were worse in Brazil compared with England for both men and women. Considering functional ability, loneliness was negatively associated with all indicators (ranging from odds ratio [OR] = 0.26, [95% confidence interval (CI) 0.13-0.52] in English men regarding the ability to take medication to OR = 0.49 [95% CI 0.27-0.89] in Brazilian women regarding the ability to manage money). Considering intrinsic capacity, loneliness was negatively associated with a higher cognitive function (OR = 0.72; 95% CI 0.55-0.95 in English women) and a higher handgrip strength (OR = 0.61; 95% CI 0.45-0.83 in Brazilian women). Lonely women demonstrated lower odds of a higher number of healthy aging indicators than men in both countries. CONCLUSIONS Country-specific social environments should be targeted by public policies to decrease loneliness and promote healthy aging later in life.
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Affiliation(s)
- J L Torres
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - C T Vaz
- Campos Centro-Oeste Dona Lindu, Universidade Federal de São João del-Rei, Divinópolis, Minas Gerais, Brazil
| | - L C Pinheiro
- Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - L S Braga
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - B S Moreira
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Universidade Federal de Minas Gerais e Fundação Oswaldo Cruz - MG, Belo Horizonte, Minas Gerais, Brazil
| | - C Oliveira
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - M F Lima-Costa
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil; Núcleo de Estudos em Saúde Pública e Envelhecimento, Universidade Federal de Minas Gerais e Fundação Oswaldo Cruz - MG, Belo Horizonte, Minas Gerais, Brazil
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Borelli WV, Leotti VB, Strelow MZ, Chaves MLF, Castilhos RM. Preventable risk factors of dementia: Population attributable fractions in a Brazilian population-based study. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100256. [PMID: 36778926 PMCID: PMC9903643 DOI: 10.1016/j.lana.2022.100256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Knowledge regarding the modifiable risk factors of dementia is fundamental to guide public health policy. We aimed to estimate the population attributable fraction of modifiable risk factors of dementia among adults from a nationwide epidemiological study. Methods We used the public database of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) to calculate the Population Attributable Fraction (PAF) for ten risk factors, including education level, hearing loss, hypertension, alcohol consumption, obesity, active smoking, depression, social isolation, physical inactivity, and diabetes. PAF was estimated for this sample after accounting for the communality of each risk factor. Findings The ten preventable risk factors for dementia accounted for 50·5% of the Population Attributable Fraction in Brazil. Hearing loss (14·2%), physical inactivity (11·2%), and hypertension (10·4%) accounted for the highest PAF among all the risk factors. Considerable variation in the relative contribution of the different risk factors was found in different regions. Interpretation This study might provide an opportunity to change the impact of dementia in Brazil. By targeting modifiable risk factors of dementia, the health of individuals in Brazil might be considerably improved. Funding This study did not receive any funding.
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Affiliation(s)
- Wyllians Vendramini Borelli
- Centro de Neurologia Cognitiva e do Comportamento, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil
| | - Vanessa Bielefeldt Leotti
- Unidade de Bioestatística, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil,Departamento de Estatística, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Matheus Zschornack Strelow
- Centro de Neurologia Cognitiva e do Comportamento, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil
| | - Márcia Lorena Fagundes Chaves
- Centro de Neurologia Cognitiva e do Comportamento, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil
| | - Raphael Machado Castilhos
- Centro de Neurologia Cognitiva e do Comportamento, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS 90035-903, Brazil,Corresponding author.
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Ribeiro FS, de Oliveira Duarte YA, Santos JLF, Leist AK. Changes in prevalence of cognitive impairment and associated risk factors 2000-2015 in São Paulo, Brazil. BMC Geriatr 2021; 21:609. [PMID: 34706666 PMCID: PMC8554830 DOI: 10.1186/s12877-021-02542-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Decreases in prevalence of cognitive impairment and dementia over the last two decades have been observed in different countries for cohorts entering older age. This study aimed to assess the cognitive impairment prevalence and explore associated factors among subjects aged >60 living in São Paulo, Brazil. METHOD Data came from a population-based Health, Welfare and Aging survey conducted in 2000, 2006, 2010, and 2015. Cognitive impairment was detected using the abbreviated Mini-Mental State Exam corrected by formal education years. In total, there were 5922 respondents in the statistical analyses. RESULTS Logistic regression models adjusted for age group, income, race, cardiovascular risk factors, and depression were used to estimate cognitive impairment prevalence. Between 2015 and 2000, respondents were more likely to report formal education, hypertension, diabetes, and overweight/obesity. Moreover, the weighted analyses showed that cognitive impairment prevalence was higher in 2015, even adjusting for sociodemographic and socioeconomic characteristics, cardiovascular risk factors, and depression. CONCLUSION In contrast to decreases in cognitive impairment prevalence in other countries and despite increases in educational years, our findings suggest no secular improvements in cognitive health for the 2015 wave of older adults residing in São Paulo.
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Affiliation(s)
- Fabiana Silva Ribeiro
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
| | | | | | - Anja K Leist
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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