Factors associated with functional disability of elderly in Brazil: a multilevel analysis

Reproducibility and concordance of functional autonomy tests in older adult women: a comparative study of face-to-face and virtual assessments

Introduction

The literature does not explore functional assessments carried out remotely and in older women in virtual environments.

Objective

This study analyzed the reproducibility and agreement in applying functional autonomy tests face to face (FF) and virtually (V).

Methods

A single evaluator carried out two evaluations. The following tests were performed: walking 10 m, rising from the sitting position (RSP), rising from the ventral decubitus position (RVDP), and sitting and rising from a chair and walking around the house (SRCW).

Results

No significant changes were identified between V and FF (p > 0.05 for all). No significant changes were identified between tests considering FF and V conditions (p > 0.05 for all). The highest value for the intraclass correlation coefficient was <0.0001 for the SRCW (CL, r = 0.98 CI95%: 0.969-0.990 and ICC, r = 0.99 CI95%: 0.984-0.995), and the lowest was <0.0001 for the RSP (CL, r = 0.91 CI95%: 0.853-0.954 and ICC, r = 0.95 CI95%: 0.921-0.976). Regarding agreement between tests, a variation was found between the lowest value of 0.07 ± 0.74 BIAS for the RVDP and the highest value of 0.32 ± 1.89 BIAS for the SRCW.

Conclusion

The tests used in the present study showed good reproducibility and agreement in older people when carried out face to face and virtually.

Sedentary Behavior, Obesity, and Disabilities in Community-Dwelling Older Adults: Analysis of the Brazilian National Health Survey 2019

Research suggests that sedentary behavior (SB) and obesity are associated with disabilities in basic activities (BADL) and instrumental (IADL) activities of daily living. However, there is a lack of studies investigating this association in community-dwelling older adults. Thus, the aim of this study was to investigate the association between different SB typologies, isolated and in conjunction with obesity, and their associations with BADL and IADL disabilities in community-dwelling Brazilian older adults. This was a cross-sectional study using data from older adults (≥60 years) who participated in the Brazilian National Health Survey (2019). The exposures were obesity (BMI > 27 kg/m2) and the amount of time spent daily on SB watching television (SB TV < 3 and ≥3 h/day) and engaging in leisure activities (SB leisure < 3 and ≥3 h/day), analyzed both separately and jointly. The outcomes were BADL and IADL disabilities. The main results showed that isolated SB TV ≥ 3 h/day (OR: 1.26; 95% CI: 1.14; 1.39) and SB TV ≥ 3 h/day combined with obesity (OR: 1.55; 95% CI: 1.37; 1.75) increased the odds of BADL and IADL disabilities. Obesity alone (OR: 1.21; 95% CI: 1.07; 1.36) increased only the odds of BADL disabilities. Moreover, SB leisure ≥ 3 h/day without obesity reduced the odds of IADL disabilities (OR: 0.56; 95% CI: 0.41; 0.76). Ideally, older adults should be encouraged to prevent obesity, reduce excessive periods spent in SB watching TV, and increase the daily periods spent in leisure activities, thus minimizing the likelihood of disabilities in functional activities.

Functional disability and its associated factors among community- dweller older adults living in Gondar Town, Ethiopia: a community-based cross-sectional study

BACKGROUND

Functional disability is an emerging public health concern that has an impact on the health and quality of life of older adults. If functional disability recognized early, it will be possible to support them to live independently. Although functional disability is extensively researched in developed countries; studies are scarce in Sub-Saharan Africa, particularly Ethiopia. Therefore, this study aims to assess the prevalence and associated factors of functional disability in activities of daily living among older adults in Gondar town, Ethiopia.

METHODS

A community-based cross-sectional study was conducted from April to June 2022. Multistage sampling techniques were used to recruit 607 older adults aged 60 years and older. A pre-tested interview-administered questionnaire was used to assess functional disability in basic activities of daily living and instrumental activities of daily living using the Katz Index and Lawton scale, respectively. Bivariate and multivariable logistic regression models were employed. The findings of the study were presented by descriptive statistics and an adjusted odds ratio with 95% CI was used to determine statistical significance.

RESULTS

The prevalence of functional disability in basic activities of daily living and instrumental activities of daily living among older adults was 34.5% and 54.4, respectively. Age 80 and older [AOR = 2.41, CI (1.41-4.10)], low-income status [AOR = 2.58, CI (1.50-4.46)], multimorbidity [AOR = 2.97, CI (1.92-4.60)], depression [AOR = 2.97, CI (1.63-5.40)], and low level of physical activity [AOR = 3.31, CI (2.11-5.17)] were associated with basic activities of daily living. Age 80 and older (AOR = 3.11, CI = 1.94-5.00), multimorbidity [AOR = 3.06, CI (2.10-4.46)], and depression [AOR = 3.52, CI (2.10-4.46)] were associated with instrumental activities of daily living.

CONCLUSION AND RECOMMENDATIONS

Our study finding revealed that functional disability affects a large number of older adult residents. The age group of 80 years and older, low-income status, a low level of physical activity, multimorbidity, and depression were associated with basic and instrumental activities of daily living. Therefore, health interventions designed to increase older adults' level of physical activity, management of multimorbidity, and depression, more care for elders 80 years and older, and supporting older adults financially for health insurance coverage could be an important strategy to reduce functional disability among older adults.

Patient activation levels and socioeconomic factors among the Amazonas population with diabetes: a cross-sectional study

BACKGROUND

The presence of chronic conditions such as type 2 diabetes mellitus (T2DM) requires behavioral lifestyle changes mediated by individuals' motivation for change and adherence to treatment. This study aims to explore activation levels in individuals with T2DM treated in primary care facilities and to identify the association between demographic, clinical, psychosocial factors, and patient activation amongst populations in the Brazilian state of Amazonas.

METHODS

SAPPA is a cross-sectional study conducted in Amazonas, approved by the Universidade Federal do Amazona's IRB in Brazil. Individuals with T2DM were evaluated in their homes (n = 4,318,325). The variables were sex, age, skin color, education level; health-related variables such as body mass index, nutritional behavior, and frequency of physical activity. Measures related to patient self-management behaviors over the past 6 months (Patient Activation Measure - PAM-13) were included in the survey. Descriptive and frequency data are presented as mean (standard deviation (SD)) or numeric percentage). Statistical testing was performed using IBM SPSS V.26, and a p-value of < 0.050 showed significance. Activation levels were dichotomized into low activation (Levels 1 and 2) and high activation (Levels 3 and 4). A multivariate linear model assessed the association between the PAM-13 score and the following variables: age, sex, BMI, skin color, number of comorbidities, burden of symptoms, and number of medications.

RESULTS

Logistic regression analyses indicated a statistically significant association between sex, age, education, self-rated health, and general satisfaction with life. men were 43% more likely to score lower levels (p < 0.001). The results also indicated that advanced age had lower PAM levels (p < 0.001). Participants with fewer years of education were 44% more likely to have lower levels of PAM (p = 0.03). Worse self-rated health (p < 0.001) and lower general life satisfaction (p = 0.014) were associated with lower PAM levels.

CONCLUSIONS

Low patient activation was associated with worse sociodemographic, health, and psychological conditions in the Amazon population. The low level of patient activation observed in this sample highlights an important impediment to diabetes disease management/self-management in disadvantaged populations.

Socioeconomic status and self-rated health in Iran: findings from a general population study

Background

There are large gaps in health and well-being among different groups of the society. Socioeconomic factors play a significant role in determining the health status of the society. The present study was conducted to examine socioeconomic inequality in health status among the adult population of Khorramabad city, the capital of Lorestan province, wester part of Iran.

Methods

A cross-sectional study was conducted on 1348 participants selected through multistage sampling. A valid and reliable questionnaire was used for data collection. The wealth index as an indicator of the socioeconomic status (SES) was used to categorize the subjects in terms of the SES. The concentration index and concentration curve was used to measure socioeconomic inequity in poor self-rated health (SRH) of population. Finally, after determine the status of inequity in poor SRH, a decomposition analysis approach was used to identify the most important determinants of this inequity.

Results

The prevalence of poor SRH was 18.91% in all subjects, 38.52% in the lowest SES group, and 11.15% in the highest SES group. The value of the concentration index for poor SRH was − 0.3243 (95% CI − 0.3996 to − 0.2490), indicating that poor SRH was more concentrated among the poor. The results of decomposition analysis showed that SES (41.2%), higher body mass index (28.6%) and lack of physical activity (26.9%) were the most important factors associated with the concentration of poor SRH in the poor groups.

Conclusion

Identification of socioeconomic factors affecting on health status is the first step for proper policymaking. Policymakers and health system managers at the national and subnational levels can use the results of this study as well as other similar domestic studies to design and implement proper interventions to promote equity and improve the health status of population.

Association of Functional Disability and Biopsychosocial Factors in Older Adults With Low Back Pain Who Live in the Amazonas State Brazil: A Cross-Sectional Study

OBJECTIVE

The purpose of this study was to identify social and clinical factors associated with levels of functional disability (FD) in older adults with low back pain (LBP) in the city of Manaus, Amazonas, Brazil.

METHODS

A cross-sectional study of 557 adults with LBP aged ≥60 years was completed. Sociodemographic and clinical features, pain intensity (Numeric Rating Scale), FD (Roland Morris Disability Questionnaire), physical activity (International Physical Activity Questionnaire-short version), body mass index, educational level, health perception, emotional level, and self-reported diseases were evaluated. Statistical analysis was used to verify the association between quantitative variables and a group; Student t test or Mann-Whitney test, and analysis of variance (normality assumption) or Kruskal-Wallis test (non-parametric), P value of less than .05.

RESULTS

There were 81.3% female participants, 54.9% self-reported their race and/or skin color as brown, and 37.8% were sedentary. Pain intensity scores were 6.26 ± 2.19 in female participants and 5.82 ± 1.84 in male participants. Mean FD scores were 11.68 ± 6.08 for female participants and 9.61 ± 5.76 for males participants, although 39.7% of the total group presented with severe disability (score ≥14) and FD was associated with female sex (P = .001), physical activity (P≤ 0.001), body mass index (P≤ .001), emotional level (P < .001), and health perception (P < .001).

CONCLUSION

In this group of older adults with LBP, FD was associated with female sex, level of physical activity, body mass index, emotional level, and health perception. Many factors that were identified with FD are modifiable; therefore, interventions, such as nutrition education and re-conceptualization of self-emotional and health perception, may have potential to help in preventing and reducing FD.

Fatores associados à limitação da mobilidade funcional em idosos do Município de São Paulo, Brasil: análise comparativa ao longo de 15 anos

Este estudo teve como objetivo analisar a prevalência de limitação na mobilidade funcional autorreferida e os fatores associados no período entre os anos 2000 e 2015, em idosos residentes no Município de São Paulo, Brasil. Para as presentes análises foram utilizados os dados das quatro ondas (2000, 2006, 2010 e 2015) do Estudo Saúde, Bem Estar e Envelhecimento (SABE). Foram conduzidos modelos de regressão para analisar as características demográficas, socioeconômicas, comportamentais e relativas à saúde dos indivíduos associadas à limitação da mobilidade em cada onda do estudo, e análise multinível para a comparação entre as quatro ondas. Os resultados indicaram aumento nas prevalências de limitações na mobilidade autorreferida, mais evidente no ano de 2006. Foi observado, ainda, associação com condições crônicas de saúde, como a história de AVC (RP = 1,43; IC95%: 1,29; 1,58, em 2000), a presença de doenças osteoarticulares (RP = 1,35; IC95%: 1,23; 1,49, em 2015), e a queixa de “dor nas costas” (RP = 1,33; IC95%: 1,22; 1,45, em 2006), bem como com aspectos socioeconômicos, como a renda insuficiente (RP = 1,17; IC95%: 1,07; 1,28, em 2010). Em um contexto de envelhecimento populacional acelerado, esses resultados trazem informações relevantes para a promoção de políticas públicas voltadas à prevenção de declínio da mobilidade em pessoas idosas.

Rheumatic diseases and associated factors in older adults: a Brazilian population-based study

Introduction: Rheumatic diseases have high occurrence in older adults, which may lead to a reduction in independence and quality of life. Objective: To calculate prevalence and to identify factors associated with rheumatic diseases in older adults of the urban area of a municipality in Southern Brazil. Methods: Cross-sectional population-based study, conducted in 2008 in the city of Bagé-RS, Brazil with older adults aged 60 years or over. The outcome was defined from the question "Has any doctor told you that you have rheumatism, arthritis or arthrosis?" Poisson regression was used for the crude and adjusted analysis. Results: A total of 1,593 participants were interviewed. 27.3% (95% CI 25.0-29.5) reported having medical diagnosis of at least one of the rheumatic diseases studied. In the adjusted analysis, it was found that female sex (RP=2.86; 95% CI 2.28-3.59; p≤0.001), without schooling (RP=1.24; 95% CI 1.0-1.58; p=0.047), not living alone (RP=1.29; 95% CI 1.03-1.61; p=0.024), poor self-perception of health (PR=1.54; 95% CI 1.63-2.02; p=0.001), spinal problems (PR=1,96; 95% CI 1.67-2.31; p≤0.001), fall in the last year (PR=1.22; 95% CI 1.04-1.43; p=0.013), incapacity for instrumental activities of daily living (PR=1.20; 95% CI 1.02-1.41; p=0.028) and healthcare appointment in the last 3 months (PR=1.20; 95% CI 1.01-1.42; p=0.035) were associated with the presence of rheumatic diseases (rheumatism, arthritis and arthrosis). Conclusion: It is suggested that care of musculoskeletal problems of the spine should be increased, in order to reduce falls and functional disability in older adults, based on actions focused on the prevention of these problems.

Healthy aging determinants and disability among older adults: SABE Colombia

Objective.

To identify the main factors associated with disability in older adults in Colombia, adjusted according to structural and intermediary determinants of healthy aging.

Methods.

This study used cross-sectional data from 23 694 adults over 60 years of age in the SABE Colombia nationwide survey. Structural determinants such as demographic and socioeconomic position variables were analyzed. Intermediary variables were classified into three blocks: intrinsic capacity, physical and built environment, and health care systems. Data analysis employed multivariate logistic regression.

Results.

The prevalence of overall disability was 21% for activities of daily living, 38% for instrumental activities of daily living, and 33% for mobility disability. Disability was associated with sociodemographic structural determinants such as older age, female sex, rural residence, never married/divorced, living alone, low educational level, and Indigenous/Black ethnicity. With regard to determinants of socioeconomic position, net low income, poor socioeconomic stratum, insufficient income perception, and a subsidized health insurance scheme exerted a major influence on disability. Intermediary determinants of intrinsic capacity, such as poor self-rated health, multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, no social support, and no participation in activities, were significantly associated with disability.

Conclusions.

Actions that affect the main factors associated with disability, such as reducing health inequities through policies, strategies, and activities, can contribute significantly to the well-being and quality of life of Colombian older adults.

The Impact of Age on Mortality and Disability in Patients With Ischemic Stroke Who Underwent Cerebral Reperfusion Therapy: A Brazilian Cohort Study

Introduction: The main driver for increased stroke prevalence is the aging of the population; however, the best evidenced-based strategies for stroke treatment and prevention are not always followed for older patients. Therefore, the aim was studying the association of age with clinical outcomes (mortality and functional disability) in stroke patients who underwent cerebral reperfusion therapy at hospital discharge and 90 days after ictus. Methods: This was a retrospective (stroke databank analysis) cohort study of participants who had been diagnosed with ischemic stroke and undergone intravenous cerebral reperfusion therapy or mechanical thrombectomy. The variable of interest was patient age, which was categorized into four groups: (1) up to 59 years; (2) 60 to 69 years; (3) 70 to 79 years old; and (4) above 79 years. The primary outcome was mortality at hospital discharge and 90 days after stroke, and the secondary outcome was functional capacity at hospital discharge and 90 days after stroke. Results: A total of 281 patients was included in the study (235 treated by thrombolysis alone, and 46 treated with mechanical thrombectomy). The mean age of the total sample was 67 ± 13.1 years. The oldest patients had the most unfavorable outcomes, except for mortality rate, at hospital discharge (mRS > 2; OR: 1.028; 95% CI 1.005 to 1.051; p = 0.017; mRS > 3; OR: 1.043, 95% CI 1.018 to 1.069; p = 0.001) and 90 days after stroke (mRS > 2; OR: 1.028; 95% CI 1.005 to 1.051; p = 0.017; mRS > 3; OR: 1.043, 95% CI 1.018 to 1.069; p = 0.001). Conclusion: Cerebral reperfusion was a viable treatment for ischemic stroke in both elderly and very elderly patients, as it did not increase mortality. However, it was observed that older individuals had worse functional outcomes at hospital discharge and 90 days after stroke.

Prevalence of Older Adult Disability and Primary Health Care Responsiveness in Low-Income Communities

In Brazil and in most low- and middle-income countries (LMICs), information about how prepared the health care system is for the rapid aging of the population is scarce. We investigated the prevalence of disability and areas of life affected by disability among elders of the public primary health care in São Paulo and Manaus, Brazil. We investigated whether people with disability visited a primary care professional more frequently, the individual characteristics associated with disability, and differences by city. We randomly selected participants aged ≥60 years (n = 1375). The main outcome was disability, evaluated with the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0). Exposure variables were consultation with a family physician, sociodemographic characteristics, health status, social support, and lifestyle. The prevalence of global disability was higher in Manaus (66.2% vs. 56.4% in São Paulo). In both cities, participation and mobility were the areas of life most affected by disability. The number of consultations with a family physician was not associated with disability. The high prevalence of disability and associated risk factors indicates that public primary health care is not meeting the needs of elders in both cities. It is warning because most elders in LMICs live in more underserved communities compared to Brazil.

Factors associated with functional capacity in the elderly enrolled in the Family Health Strategy

The study investigated the prevalence of functional capacity decline and its associated factors in the older people enrolled in the Family Health Strategy (ESF) in a city in the south of Minas Gerais. This is an observational, cross-sectional, population-based study with 406 elderly (70.49 years ± 6.77). The functional capacity was evaluated by the Short Physical Performance Battery (SPPB), and its associated factors were evaluated by a structured questionnaire including sociodemographic, economic, clinical and physical aspects. The analysis of plasma levels of inflammatory mediators was performed by the ELISA method. Multiple linear regression was used for the analyses (p < 0.05). The prevalence of functional decline in the sample was 57.6% and factors associated with functional capacity were advanced age, female gender, number of medications, depressive symptoms, high plasma concentrations of the soluble receptor of tumor necrosis factor alpha 1 (sTNFR1) and low handgrip strength. The results demonstrated that functional capacity was associated with a network of multidimensional factors. This study contributes to the practice of ESF professionals by indicating the main factors that can guide actions to promote and prevent the decline of functional capacity in the elderly population.

Subjective memory complaint and its relationship with cognitive changes and physical vulnerability of community-dwelling older adults

Memory complaint (MC) is common in older adults and can be confirmed by people close to them, such as family members and caregivers. Studies show an association between MC and cognitive impairment and, hence, physical vulnerability may exacerbate MC. However, the relationship between MC and physical vulnerability is not yet clear in the literature.\.

Objective

to investigate the association between MC, cognitive impairment, and physical vulnerability.

Methods

this is a cross-sectional study. We evaluated 100 older adults with a mean age of 65 years or over. The Memory Complaint Scale (MCS), Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Vulnerable Elderly Research-13 (VES-13), Geriatric Depression Scale and a sociodemographic questionnaire were applied.

Results

participants were divided into two groups according to results on the MCS-A (elderly) and MCS-B (informant). Correlations were found between the MCS-A and the MMSE (p=.045/ρ=.201), ACE-R/Visual-Spatial (p=.048/ρ=.199), and ACE-R/Attention-Orientation (p=.026/ρ=.223). For the MCS-B, correlations were found with total score on the ACE-R (p=.044/ρ=-.202) and the ACE-R/Visual-Spatial (p=0.003/ρ=-.291).

Conclusion

MC reported by the informant indicate the need to assess, in more depth, the cognition of the older adult. Thus, for clinical practice, screening of MC through an informant is advised.

[Multimorbidity profile associated with disability among the elderly living in the Metropolitan Region of Belo Horizonte, Brazil]

The scope of this paper was to investigate the associations of disability in three domains (BADL, IADL and mobility) with cardiovascular diseases, diabetes and multimorbidity profile, among the elderly living in the Metropolitan Region of Belo Horizonte (MRBH). A cross-sectional study was conducted with a representative sample of 2,172 elderly persons (60 years and over). Disability, for each domain (BADL, IADL and mobility), was assessed as reporting great difficulty or need for help to perform at least one activity among those investigated, and self-reported diseases included arterial hypertension, myocardial infarction or angina, stroke, diabetes, and combinations of these diseases. Adjusted Poisson regression was used, and the attributable population fraction was also estimated. A major contribution of Cerebral Vascular Accidents (strokes) to disability in all domains was observed, especially BADLs, as well as the presence of infarction or angina in disability in IADLs and mobility, especially when combined with diabetes and hypertension. The multimorbidity profile can be used to identify vulnerable groups, which should be the target of prevention and rehabilitation, reducing the financial and social cost of this event among the elderly.

Associated factors with physical activity and social activity in a sample of Brazilian older adults: data from the FIBRA Study

OBJECTIVE

This study investigates associated factors to participation in four domains of physical activity and social activities among 2344 community-dwelling older adults (72.3 ± 5.5 years; 65.6% female) without cognitive impairment, residents in six Brazilian cities.

METHOD

An adapted version of Minnesota Leisure Time Activity Questionnaire was used to measure physical activity in four different domains. An inventory of social activities was developed for research. Age, gender and family income were assessed by self-report. Comparisons of frequencies and logistic regression analyzes were performed.

RESULTS

All sociodemographic variables were affecting the activity engagement profile of the sample. Have higher family income showed association with high level of leisure time, occupational and transportation physical activity, result supported by the literature. The gender associated with high level of activity varied according to the specific domain of the analyzed activity indicator. Have less age proved to be associated with higher level of activity in all indicators associated with age, highlighting the increasing age as the major barrier to performance physical and social activities in old age.

CONCLUSIONS

Allow the active involvement of older people is the great challenge of public policies that promote active aging.

Estimativas de expectativa de vida livre de incapacidade funcional para Brasil e Grandes Regiões, 1998 e 2013

Resumo A expectativa de vida aos 60 anos no Brasil aumentou cerca de 9 anos em pouco mais de meio século. Trata-se de um ganho de sobrevida generalizado, mas que também ocorre de forma heterogênica entre as Grandes Regiões do país. Por outro lado, pouco se sabe, ainda, como os aumentos da expectativa de vida aos 60 anos por região podem ser acompanhados por acréscimos ou decréscimos tanto nos anos vividos com incapacidade, quanto nos vividos livre de incapacidade. O objetivo deste artigo é analisar, para 1998 e 2013, aumentos na Expectativa de Vida Total e suas componentes: Expectativa de Vida Livre de Incapacidade Funcional (EVLI) e com Incapacidade Funcional (EVCI), aos 60, 70 e 80 anos para a população do Brasil e Grandes Regiões. O estudo utilizou informações sobre incapacidade funcional da PNAD de 1998 e PNS de 2013 e empregou o método de Sullivan para estimação da EVLI por sexo e idade. No geral, os resultados mostraram que, entre 1998 e 2013, concomitantemente aos ganhos na EV, ocorreu um crescimento na EVLI. Contudo, os ganhos na EVLI não foram estatisticamente significativos para as regiões Norte e Centro-Oeste. Ou seja, com exceção dessas regiões, além de viver mais, a população idosa de 60 anos poderia esperar viver um número maior de anos com saúde.

WHODAS 2.0-BO: normative data for the assessment of disability in older adults

OBJECTIVE:

To examine the normative data of WHODAS 2.0-BO for older Brazilians (World Health Disability Assessment Schedule – Brazilian version for older people) and its distribution according to sex, age, health, subjective health perception, performance in a mobility test and presence of chronic diseases and depression.

METHODS:

Cross-sectional study, with 350 participants with 60 years of age or older, men and women, patients of a geriatric specialized center for medical consultations or rehabilitation. The older adults were evaluated using a semi-structured questionnaire containing demographic and clinical data (WHODAS 2.0-BO) and the geriatric depression scale (GDS), having been subsequently subjected to a mobility test (Timed Up and Go). The data were analyzed via their distribution in percentiles of the population and via analysis of variance.

RESULTS:

Two-hundred and sixty-six (76%) participants were women, and the average age was 71.8 (DP = 6.7) years old. The average score in WHODAS 2.0-BO was 4.3 (DP = 5.2) points, the highest value found having corresponded to 33 points. The average time for the Timed Up and Go test was 10.0 (SD = 3.2) seconds. About 30% of the older adults did not report any difficulties in the tasks evaluated by WHODAS 2.0-BO and half of the sample scored up to two points.

CONCLUSIONS:

A score corresponding to 12 points in the 90 percentile on a scale from zero to 40 was observed, which suggests severe disability. The score in WHODAS 2.0-BO increased with the advance in age, as well as in the presence of comorbidities, negative health perception, depression, high blood pressure, visual and hearing impairment and mobility impairment.

Quality of life among elderly residents in the Gaza Strip: a community-based study

BACKGROUND

In Palestine, persons older than 60 years of age comprise 4.6% of the population in this decade and will remain relatively stable until the year 2020, when it is expected to begin to rise. The quality of life (QoL), which reflects well-being and health status, is under-reported in this vulnerable group in the Gaza Strip.

OBJECTIVE

Determine QoL and associated factors in persons aged older than 60 years.

DESIGN

A community-based cross-sectional study.

SETTING

Five Gaza Strip governorates.

SUBJECTS AND METHODS

Subjects were selected by convenience sampling. We used the validated Arabic WHOQOL-BREF to assess QoL and used descriptive, univariate and multivariate methods to analyze the data.

MAIN OUTCOME MEASURES

QoL, overall satisfaction with health and factors associated with good QoL.

SAMPLE SIZE

235 community-dwelling elderly.

RESULTS

The response rate was 85.5% (201/235). Mean age (SD) was 69 (7.95) years old and females accounted for 57.7% (116/201) of the sample. Almost half (44.2%, 90/201) of the elderly scored in the category of good QoL. The mean (SD) for overall QoL and perceived satisfaction with health was 3.3 (1.1) and 3.4 (1.0), respectively, on a 5-point Likert scale. The social relationship domain had the highest QoL score (65.4 [15.3]), whereas physical and environmental domains received equally lower scores (60.5 [15.2] and 60.5 [12.5] respectively). Multivariate analysis showed that factors associated with good QoL were higher education (OR: 3.1, CI 95%: 1.03-9.4) and perceived high satisfaction with health (OR: 3.6, CI 95%: 1.8-7.3).

CONCLUSION

More years of education and higher satisfaction with health were associated with a better perception of QoL. Interventions should be focused more on physical and environmental aspects in the life of elderly persons.

LIMITATIONS

Cross-sectional design, use of convenience sample and some possibly important factors not studied.

CONFLICT OF INTEREST

None.

[Factors associated with the self-rated health of elderly frequenters of low-budget community restaurants in Belo Horizonte]

The scope of this paper was to evaluate the self-rated health among elderly frequenters of low-budget community restaurants (RP) in Belo Horizonte (BH) and the factors associated with this outcome. It involved a cross-sectional study in all RP and BH cafeteria. The self-rated health was classified as bad and very bad; average; good and very good. Sociodemographic and economic variables were considered to be possible associated factors, as well as those related to physical health and social resources. In the univariate analysis, the Chi-square test and Mann-Whitney tests were used. In the multivariate analysis a model of ordinal logistic regression was created. The sample consisted of 279 elderly people, the majority (68.5%) being male. Most of the elderly (57.5%) considered their health as being good or very good. Factors associated with better health perception in the multivariate analysis (p-value < 0.05) were satisfaction with relationships with friends, not having diabetes or any other cardiovascular disease and finally, the low frequency and lack of problems that hinder the elderly from doing the things they need or want to do. Such studies contribute to the understanding of the health perception of elderly people associated with several factors that can influence healthy aging.

Contribution of chronic diseases to the prevalence of disability in basic and instrumental activities of daily living in elderly Brazilians: the National Health Survey (2013)

Abstract: This study’s objective was to assess the contribution of selected chronic diseases to the prevalence of disability in elderly Brazilians, based on data from the National Health Survey (PNS 2013). Disability was defined as some degree of difficulty in performing ten activities, considering three levels: (i) without disability; (ii) disabled only in some instrumental activity of daily living (IADL); and (iii) disabled in some basic activity of daily living (BADL). The multinomial additive hazards model was the attribution method used to assess the contribution of each self-reported chronic condition (hypertension, diabetes, arthritis, stroke, depression, heart disease, and lung disease) to the prevalence of disability in this population, stratified by sex and age bracket (60 to 74 years and 75 or older). Study participants included 10,537 elderly Brazilians with a mean age of 70.0 years (SD = 7.9 years) and predominance of women (57.4%). Prevalence rates for disability in at least one IADL and at least one BADL were 14% (95%CI: 12.9; 15.1) and 14.9% (95%CI: 13.8; 16.1), respectively. In general, the contribution of chronic diseases to prevalence of disability was greater in younger elderly (60 to 74 years) and in the group with greatest severity (disabled in BADL), highlighting the relevance of stroke and arthritis in men, and arthritis, hypertension, and diabetes in women. This knowledge can help orient health services to target specific groups, considering age, sex, and current illnesses, aimed at preventing disability in the elderly.

Self-perceived quality of health and satisfaction by elderly seen by the Family Health Strategy team

OBJECTIVE

To verify the profile of elderly followed up by Family Health Strategy teams and the influence of self-reported chronic diseases on demographic variables, describing self-perception and satisfaction with quality of health.

METHODS

This is a cross-sectional population- based study carried out with 301 elderly residents in two areas of a city in southern Brazil. Data were collected through a questionnaire based on the Health, Well-Being, and Aging Study adapted by researchers, and a playful scale to assess satisfaction with health. For the statistical analysis, the χ2 test was used (p<0.05).

RESULTS

Regarding cognitive assessment, the majority was classified as independent (86.4%), not requiring caregiver assistance to answer the questionnaire. The population was predominantly female (55.8%), White (64.8%), married (51.2%), and catholic (82.1%). A total of 47.5% considered their current health status as regular. Regarding satisfaction with health, 72.4% were happy, even reporting having at least one chronic health problem (58.5%).

CONCLUSION

The presence of chronic diseases was reported by most respondents, and the practice of self-medication is significantly more frequent among the aged. Nevertheless, the degree of satisfaction with their health status was predominantly positive, both related to the previous year and compared to others of the same age.

Gender, childhood and adult socioeconomic inequalities in functional disability among Chinese older adults

BACKGROUND

Gender difference and life-course socioeconomic inequalities in functional disability may exist among older adults. However, the association is less well understood among Chinese older population. The objective is to provide empirical evidences on this issue by exploring the association between gender, childhood and adult socioeconomic inequalities in functional disability.

METHODS

Data from the 2013 wave of the China Health and Retirement Longitudinal Study (CHARLS) was utilized. Functional disability was assessed by the activities of daily living (ADL) and instrumental activities of daily living (IADL). Childhood socioeconomic status (SES) was measured by birthplace, father's education and occupation. Adult SES was measured in terms of education and household income. Multivariate logistic regressions were conducted to assess the association between gender, childhood and adult SES and functional disability.

RESULTS

Based on a sample of 18,448 older adults aged 45 years old and above, our results showed that the prevalence of ADL and IADL disability was higher among women than men, but gender difference disappeared after adult SES and adult health were controlled. Harsh conditions during childhood were associated with functional disability but in multivariate analyses only father's education was associated with IADL disability (OR for no education = 1.198; 95% CI = 1.062-1.353). Current SES such as higher education and good economic situation are protective factors of functional disability.

CONCLUSIONS

Childhood and adult SES were both related to functional disability among older adults. Our findings highlight the need for policies and programs aimed at decreasing social inequalities during childhood and early adulthood, which could reduce socioeconomic inequalities in functional disability in later life.

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain

OBJECTIVE

Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care.

METHODS

We sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55-74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more).

RESULTS

Participants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity.

CONCLUSIONS

This was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status.

Back Complaints in the Elders in Brazil and the Netherlands: a cross-sectional comparison

Background

although back pain is most prevalent in older adults, there is a paucity of studies investigating back pain in older people. Our objective was to characterize and compare Brazilian and Dutch older adults presenting to primary care with a new episode of back pain. We also aimed to investigate whether socio-demographic characteristics were associated with pain severity and disability.

Methods

we sourced data on 602 Brazilian and 675 Dutch participants aged ≥55 years with a new episode of back pain from the Back Complaints in the Elders consortium. We analyzed country differences in participants' characteristics, and associations between socio-demographic/clinical characteristics and pain severity and pain-related disability.

Results

the two populations differed in most characteristics. More Dutch participants were smokers, heavy drinkers, and reported back stiffness. More Brazilian participants were less educated, had higher prevalence of comorbidities; higher levels of pain intensity, disability and psychological distress. When controlling for the effect of country, being female and having altered quality of sleep were associated with higher pain intensity. Altered quality of sleep, having two or more comorbidities and physical inactivity were associated with higher disability. Higher educational levels were negatively associated with both pain and disability outcomes.

Conclusions

back pain is disabling in the older population. Our country comparison has shown that country of residence is an important determinant of higher disability and pain in older people with back pain. Irrespective of country, women with poor sleep quality, comorbidities, low education and who are physically inactive report more severe symptoms.

Health Related Quality of Life and Its Socio-Demographic Determinants among Iranian Elderly People: a Population Based Cross-Sectional Study

Introduction: In the stage of demographic transition, the rate of elderly is increasing and their health condition is a matter of concern. Thus, the objective of this study was to investigate the health related quality of life (QoL) and the associated socio-demographic determinants among Iranian elderly people.

Methods: We conducted a cross-sectional study with a representative samples of 750 elderly people whom community dwelling in urban area of Babol, in the north of Iran. In a household survey, the demographic data were collected and the health related QoL was assessed with a validated standard short form questionnaire (SF-36). The multiple linear regression analysis was performed to determine the demographic characteristics in predicting QoL using SPSS ver 13.

Results: The overall mean (SD) scores of QoL was 62.4(17.2) for men and 51.2 (17.9) for women. The mean scores of QoL in all dimensions in men had significantly higher than women. The adjusted regression coefficient of gender, age, educational level, being couple were significant on overall scores of QoL. Aging is inversely associated while male gender and education at high school or higher and being couple are positively associated in prediction of overall scores of QoL.

Conclusion: The findings indicate that the health related QoL is rather poor in old people particular in women, elderly with low education level and being single. Therefore, healthcare policy makers should consider an urgent health interventional program among elderly people at present stage of demographic transition with emphasis on high risk demographic profiles.

Upper and lower limb functionality and body mass index in physically active older adults

Abstract Introduction: Aging leads to sarcopenia and functional capacity decline, compromising upper (UL) and lower limb (LL) performance of activities. Body mass index (BMI) is an important parameter for the assessment of health conditions in older adults, especially with regard to obesity, since it leads to functional limitations in terms of mobility and task performance. Objective: To investigate the potential association between UL and LL functionality and BMI in physically active older adults; and to characterize this population with regard to BMI and UL and LL functionality. Methods: The data were collected between August 2013 and April 2014. The sample comprised 371 physically active older adults. This study used secondary data from the program “PET Saúde IPA/SMS”. The program interviewed older adults living in areas comprised by the Third Family Health Unit of a neighborhood in Porto Alegre/RS. This paper used questions from the “Instrumento de Avaliação Multidimensional Rápida da Pessoa Idosa” (Instrument for Rapid Multidimensional Assessment of Elderly People, in English) that had to do with UL and LL functionality, weight, height and BMI. Results and Conclusion: There was no association between UL and LL functionality and BMI in physically active older adults. More than half of the sample was overweight. Most participants had functional UL and LL. While occupation, self-perception of health as “good” and “very good”, and physical activity were found to be associated with LL functionality; regular physical exercise was found to be associated with UL and LL functionality.

Correlations between low back pain and functional capacity among the elderly

Abstract Objective: To investigate the association between low back pain and functional capacity among non-institutionalized elderly persons. Method: A cross-sectional observational study of non-institutionalized elderly persons was performed. The Timed Up and Go (TUG) and Sitting-Rising Test (SRT) functional tests were used, together with the Roland Morris Disability Questionnaire (RMDQ). Result: A total of 99 elderly persons of both genders were included. Kendall’s Correlation analysis showed a significant correlation between the RMDQ and the SRT scores for the act of sitting (p=0.001) and the act of lifting (p=0.028). Despite the statistical significance, these two variables were weakly correlated (r=-239;r=-163). The results also identified a statistically significant correlation between the TUG and SRT tests for the act of sitting (r=-222; p=0.003) and the act of lifting (r=-206; p=0.006). Conclusion: It was observed that most of the non-institutionalized elderly persons had good functional capacity. It is also possible to affirm that there is an association between low back pain and functional capacity.

Functional disability and associated factors in elderly stroke survivors in Vitória, Brazil

Abstract Objective: The aim of the present study was to estimate the prevalence of disability and associated factors in elderly stroke survivors. Methods: A cross-sectional study of 230 elderly persons was conducted in the 22 territories of the Estratégia de Saúde da Família (the Family Health Strategy) of Vitória, in the state of Espirito Santo. Patients were assessed using the modified Rankin Scale. Poisson regression with robust variance in crude and adjusted analyses was employed. Results: The majority of subjects were men (52.1%) aged between 60 to 98 years, with a mean age of 75.8 (sd±9.2). The prevalence of disability was 66%. Age ≥80 years, self-perceived limitations in bodily function, considering the physical structure of the street to be a barrier to leaving home and believing street lighting to be insufficient were positively associated with functional disability. Possessing 12 or more years of schooling was inversely associated with the outcome. Conclusions: The high prevalence of disability and associated factors in elderly stroke survivors reinforce the need for a health system that operates continuously and proactively, promoting active aging.

Functional disability for mobility in adults: a population-based study

Abstract Introduction: Functional disability is an important health indicator associated with worse quality of life. Objective: To estimate the prevalence of functional disability for mobility and to identify factors associated with difficulty going up and down stairs in adults aged 40 years or over. Methods: Cross-sectional, population-based study, with residents of the Municipality of Cambé, PR, interviewed in 2011. The dependent variable was the difficulty of going up and down stairs. Analysis of associated factors was performed using Poisson regression for each subgroup (40 - 59 years and 60 years or older). Results: In total, 24% of the subjects presented some kind of difficulty going up stairs (p < .01). In both subgroups, a significantly higher prevalence in women, among those inactive during leisure time and those with a history of cerebrovascular disease was observed. In the subgroup aged 40 to 59 years, age 50 - 59 years, hypertension, diabetes and falls in the previous 12 months were also associated with the outcome. Conclusion: The results suggest the need to expand the actions of health promotion, prevention and control of chronic conditions, especially among middle-aged people.

Is cognitive decline in the elderly associated with contextual income? Results of a population-based study in southern Brazil

The aim of this study was to estimate the association between contextual income and cognitive decline in the elderly in Florianópolis, a medium-sized city in southern Brazil. A nested cross-sectional study was performed in a cohort of elderly ≥ 60 years (n = 1,197), interviewed in the second wave (2013/2014) of the EpiFloripa cohort. Cognitive decline was assessed with the Mini Mental State Examination (MMSE) and contextual income was measured as the mean monthly income of the heads of households. Individual adjustment variables were sex, age, skin color, per capita household income, years of schooling, and time living in the neighborhood. The data were analyzed using multilevel logistic regression. The odds of cognitive decline were twice as high (OR = 1.99; 95%CI: 1.03; 3.87) in elderly living in census tracts with the lowest income quintile compared to those in the highest quintile, independently of individual characteristics. In conclusion, the socioeconomic environment is related to cognitive decline and should be considered in public policies with a focus on health of the elderly.

Dependence for food-related activities in the elderly

The objective of this study was to describe dependence for the activities of food shopping, preparing meals and eating in elderly residents from the city of Pelotas, Rio Grande do Sul. Bivariate analysis and ordinal logistic regression were employed to assess the three dependencies and exposure variables studied. Of the 1,451 older adults assessed, 21.1% required assistance for some activities where this care was given predominantly by son/daughter and partners. The highest prevalence of dependence was for food shopping (20.7%), followed by preparing meals (11.5%) and eating (2.0%). Elderly aged 80 years or older were more likely to be in a greater dependence category than individuals aged 60-69 years, with odds ratios of 5.0 for men and 7.1 for women. The odds ratio in individuals who self-rated their health as regular, poor or very poor was approximately 2.3 times greater, proving similar for both genders. Women with no partner had a 1.7 times greater chance of dependence whilst individuals with greater educational level exhibited 70.0% protection for their reference category; men with lower socioeconomic level had a 5.3 times greater chance of dependence than individuals with higher socioeconomic level. These results highlight the most vulnerable subgroups for dependencies and the importance of a family caregiver.

Functional disability of adults in Brazil: prevalence and associated factors

OBJECTIVE

To estimate the prevalence and factors associated with functional disability in adults in Brazil.

METHODS

We used information from the health supplement of the National Household Sample Survey in 2008. The dependent variable was the functional disability among adults of 18 to 65 years, measured by the difficulty of walking about 100 meters; independent variables were: health plan membership, region of residence, state of domicile, education level, household income, economic activity, self-perception of health, hospitalization, chronic diseases, age group, sex, and color. We calculated the gross odds ratios (OR), and their respective confidence intervals (95%), and adjusted them for variables of study by ordinal logistic regression, following hierarchical model. Sample weights were considered in all calculations.

RESULTS

We included 18,745 subjects, 74.0% of whom were women. More than a third of adults reported having functional disability. The disability was significantly higher among men (OR = 1.17; 95%CI 1.09;1.27), people from 35 to 49 years (OR = 1.30; 95%CI 1.17;1.45) and 50 to 65 years (OR = 1.38; 95%CI 1.24;1.54); economically inactive individuals (OR = 2.21; 95%CI 1.65;2.96); adults who reported heart disease (OR = 1.13; 95%CI 1.03;1.24), diabetes mellitus (OR = 1.16; 95%CI 1.05;1.29), arterial systemic hypertension (OR = 1.10; 95%CI 1.02;1.18), and arthritis/rheumatism (OR = 1.24; 95%CI 1.15;1.34); and participants who were admitted in the last 12 months (OR = 2.35; 95%CI 1.73;3.2).

CONCLUSIONS

Functional disability is common among Brazilian adults. Hospitalization is the most strongly associated factor, followed by economic activity, and chronic diseases. Sex, age, education, and income are also associated. Results indicate specific targets for actions that address the main factors associated with functional disabilities and contribute to the projection of interventions for the improvement of the well-being and promotion of adults' quality of life.

Prevalência da assistência domiciliar prestada à população idosa brasileira e fatores associados

Avaliar a prevalência e os fatores associados à assistência domiciliar na população idosa brasileira. Estudo transversal de base populacional com indivíduos de 60 anos ou mais, residentes na área urbana de 100 municípios, localizados em 23 estados brasileiros. Foi utilizado modelo de regressão de Poisson para análise bruta e ajustada. Foram entrevistados 6.624 idosos e a prevalência da assistência domiciliar foi de 11,7%. Após ajuste, a ocorrência foi maior entre as mulheres, nos mais velhos, com menor escolaridade e poder aquisitivo, com diagnóstico de morbidade crônica, história de queda, hospitalização prévia e consulta médica nos últimos três meses. Os resultados destacam a maior utilização da assistência domiciliar por idosos mais vulneráveis. Esse achado indica uma contribuição da assistência domiciliar à promoção da equidade na atenção à saúde no país, principalmente em decorrência da expansão da Estratégia Saúde da Família. Os resultados podem subsidiar a organização do processo de trabalho de profissionais e gestores na atenção básica à saúde.

Paid Work and Physical Activity Preserve Functional Capacity in Elderly People: EpiFloripa Study

Objective: To investigate the prevalence and association between functional disability and health conditions in elderly people. Method: A cross-sectional, population-based study with 1,705 elderly residents in urban region of Florianópolis, Brazil, from September 2009 to July 2010. The functional disability was classified according to the difficulty in accomplishing six basic activities of daily living. The crude and adjusted multinomial logistic regression was used to identify the associated factors. Results: The prevalence of mild functional disability was 38.9%, and it was positively associated with being female, older age, reporting four or more chronic diseases, overweight, and negative self-perception of health. High education and income, having paid work, and being physically active in leisure activities reduced the chance of presenting it. The prevalence of moderate/severe disability was 11.7% and positively associated with older age, presence of depressive symptoms, four or more chronic diseases, and negative self-perception of health. High education, paid work, and being physically active in leisure activities also reduced the chance of presenting moderate/severe disability. Conclusion: Being gainfully employed, having a high level of education, and being physically active in their leisure time reduced the chance of presenting disability. The negative self-perception of health was the factor that most increased the chance of presenting functional disability.

Functional capacity and its associated factors in the elderly with low back pain

OBJECTIVE:

To assess the level of functional capacity in subjects aged 60 years and older, who have lower back pain, and its association with demographic, socioeconomic, work-related, lifestyle-related and disease mentioned variables.

METHODS:

A cross-sectional study was conducted with 246 elderly registered at the Family Health Strategy of Vila São Paulo, Bauru,SP, Brazil, who reported lower back pain and were sampled by a two-stage cluster technique. The subjects were interviewed at home by using a multidimensional instrument (demographic; socioeconomic aspects; life style; work characterization; disease mentioned), and also the IPAQ, the Nordic and the Roland Morris questionnaires. A bivariate and multivariate descriptive logistic regression analysis was carried out.

RESULTS:

The prevalence of lower back pain in men was of 25.1% and in women it was of 35.1%. The mean score in the functional capacity assessment was 10.46 ± 5.62. A fraction of 67.5% of the elderly demonstrated an inappropriate functional capacity. The age group from 70 to 80 years old, the subjects reporting three or more diseases and the sedentary group presented an independent association with inappropriate functional capacity.

CONCLUSION:

The older, sedentary subjects and who reported more than three diseases presented low functional capacity. Level of Evidence III, Cross Sectioning.

Relação entre a competência funcional da memória episódica e os fatores associados à independência funcional de idosos saudáveis

OBJETIVO: O objetivo deste estudo foi descrever a relação entre competência funcional da memória episódica e fatores associados à independência de idosos saudáveis do município de Juiz de Fora, Minas Gerais, Brasil. MÉTODOS: Trata-se de estudo transversal, descritivo e exploratório em que 60 idosos saudáveis compuseram a amostra final. Para avaliar a capacidade funcional, foram utilizadas as escalas de Katz e de Lawton & Brody. A memória episódica foi avaliada utilizando-se teste de West & Thorn, validado e adaptado para a população brasileira por Yassuda, Lasca e Neri em 2005. A análise estatística foi realizada por meio do software estatístico Sphinx Léxica e Eureka, versão 5.0. RESULTADOS: Foi encontrada associação estatisticamente significante entre escolaridade e desempenho em tarefa de memória episódica e entre esta e três itens da escala de avaliação das atividades instrumentais de vida diária, embora inconclusiva. CONCLUSÕES: Acredita-se que esses resultados se devam ao fato de existir muitas diferenças entre os estudos com relação à metodologia empregada e a escolha dos instrumentos que avaliam tanto a memória episódica, quanto a capacidade funcional de idosos. Além disso, a hipótese de que no envelhecimento saudável existe uma capacidade de, frente às perdas graduais na memória episódica, compensá-las utilizando outras estratégias e recursos, deve receber atenção de futuras pesquisas.

[Disability and use of health services by the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a population-based study]

This study focused on the association between disability and use of health services among elderly individuals in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The study included 1,624 elderly patients (≥ 60 years) selected by representative sampling. The dependent variable was use of health services, based on three descriptors: number of physician visits, home consultations, and hospitalizations. The target independent variable was disability, including difficulty in performing activities of daily living (ADL) and instrumental activities of daily living (IADL). IADL was only associated with hospitalization (PR = 1.62; 95%CI: 1.16-2.26), while ADL was associated with hospitalization (PR = 1.73; 95%CI: 1.24-2.42) and home consultations (PR = 8.54; 95%CI: 4.22-17.27). The findings show increased use of health services (especially more costly ones) among older adults with disabilities, and that functional health dimensions have not oriented health services, still largely conditioned on the presence of diseases.

Avaliação da capacidade funcional dos idosos e fatores associados à incapacidade

O objetivo deste estudo foi avaliar a capacidade funcional e analisar as características associadas à incapacidade dos idosos atendidos em uma Estratégia da Saúde da Família em Montes Claros-MG. Utilizou-se a escala de Lawton e Brody e a escala de Katz, analisadas pela regressão logística multinomial. Foram entrevistados 286 idosos cuja idade variou de 60 a 103 anos, média de 71,2 anos (DP ± 8,3). Destes, 61,9% autorreferiram independentes quanto à capacidade funcional. A dependência apenas na AIVD foi positivamente associada à faixa etária ≥ 75 anos (OR = 8,38), ao sexo feminino (OR = 3,64) e com doença cardíaca (OR = 3,24). A dependência tanto nas AIVD como nas ABVD foi positivamente associada à faixa etária ≥ 75 anos (OR = 6,40), sem companheiro (OR = 3,26), aos que apresentavam AVE (OR = 51,85), doença cardíaca (OR = 4,18) e aos com diabetes (OR = 3,35). A maior proporção de idosos foi considerada independente para a realização de atividades básicas e instrumentais de vida diária. Contudo, uma parcela expressiva ainda apresenta comprometimento do estado funcional. É essencial que as equipes da Estratégia da Saúde da Família busquem a promoção da saúde e a prevenção de doenças, além de intervenções terapêuticas que possam minimizar os fatores que interferem na capacidade funcional.

The association between skin color/race and health indicators in elderly Brazilians: a study based on the Brazilian National Household Sample Survey (2008)

This study analyzed racial inequalities in health in 18,684 elderly Brazilians 65 years or older, interviewed in the National Household Sample Survey in 2008 (PNAD 2008), and who reported their color/race as white, brown, or black. Associations were estimated between self-rated health status, functional incapacity, and number of chronic conditions according to crude and adjusted regression analyses (α = 0.01). The majority of the elderly were white (56.2%). In the adjusted analysis, brown color/races was associated with worse self-rated health status (OR = 1.11; 95%CI: 1.03-1.18) and black color/race was associated with more chronic diseases (PR = 1.07; 95%CI: 1.02-1.13). Brown color/race appeared as a protective factor against functional incapacity. When brown and black elderly were combined in one category (“black”), “black” elderly continued to show worse self-rated health status (OR = 1.09; 95%CI: 1.02-1.16) and lower odds of functional incapacity (OR = 0.83; 95%CI: 0.76-0.92). “Black” color/race lost the association with number of chronic diseases. Color/race explained part of the health inequalities in elderly Brazilians, but other socioeconomic variables had a more striking effect.

Evaluation of the Late-Life Disability Instrument (LLDI) in low-income older populations

OBJECTIVE

To assess the construct and convergent validity of the 16 items of the Late-Life Disability Instrument (LLDI) in Latin American seniors.

METHOD

Exploratory and confirmatory factor analyses were performed to assess the factor structure of frequency and limitation sub-scales of the LLDI. ANOVA and t test were used to determine the convergent and construct validity of the LLDI by exploring associations with physical performance tests, mobility limitations, depression, cognition, self-reported health, as well as with sex, education, and income.

RESULTS

Factor analysis resulted in one-factor solution and acceptable model fit. Participants with better physical function, less mobility limitations, better self-reported health, and intact cognition reported more frequent activities and fewer limitations, indicating good convergent and construct validity of our measure.

CONCLUSION

LLDI is a good instrument to assess disability in low-income populations. Further research is needed to include culturally acceptable activities for the frequency sub-scale.

Prevalência e fatores associados à capacidade funcional de idosos na Estratégia Saúde da Família em Montes Claros, Minas Gerais, Brasil

Objetivou-se mensurar o nível de capacidade funcional de idosos e suas associações, por meio de um estudo transversal com 516 residentes nas áreas circunscritas à Estratégia Saúde da Família no distrito de Grande Santos Reis, Montes Claros-MG. Foram aplicados dois questionários: um de características sociodemográficas, condições de moradia e percepção da própria situação econômica, e outro para a avaliação da capacidade funcional. Foram realizadas abordagens descritiva (frequências absoluta e relativa para variáveis categóricas, média e desvio-padrão para as contínuas) e analítica (teste de associação do qui-quadrado e regressão logística binária hierarquizada). Do total de idosos, 39,5% eram homens (70,4±7,1 anos) e 60,5% mulheres (69,1±6,9 anos); 63,4% com escolaridade de zero a dois anos; 85,7% tinham renda de até dois salários mínimos; 73,1% moravam com seus familiares; 33,9% apresentaram capacidade funcional não adequada, sendo 38,5% mulheres e 27,0% homens. A capacidade funcional não adequada foi associada às mulheres, ter mais que 70 anos de idade, renda de até dois salários mínimos e menor tempo de escolaridade. Há necessidade de direcionar a atenção à saúde do idoso, aliando o incentivo à pesquisa e às ações planejadas e direcionadas para melhorar as condições de saúde e qualidade de vida desse grupo.

Autopercepção de saúde de idosos que vivem em estado de corresidência

OBJETIVOS: Descrever a autopercepção de saúde e os fatores associados em idosos corresidentes e identificar suas características socioeconômicas e de saúde. METODOLOGIA: Trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado com 191 idosos corresidentes, com idade igual ou superior a 60 anos, assistidos pela Estratégia de Saúde da Família em um município do estado da Bahia. Foi aplicado um instrumento de coleta de dados contendo questões sociodemográficas, avaliação funcional, autorrelato de doenças crônicas e autopercepção de saúde. As análises foram feitas com base nas estatísticas descritiva e inferencial, com realização do teste qui-quadrado. RESULTADOS: Constatou-se o predomínio de mulheres (62,8%), com mais de 70 anos (61,3%), casada (50,8%) e com filhos (92,7%). Os idosos mostraram-se satisfeitos com o arranjo familiar em que viviam (96,6%), com a vida que tinham (85,8%) e acreditavam ser a corresidência vantajosa para eles e para a família (79,4%). Apresentaram autopercepção negativa de saúde (59,1%) e independência na realização de atividades da vida diária, tendo sido a hipertensão arterial (70,7%) a mais prevalente. Como fatores associados à autopercepção de saúde foram encontrados: "nível de ajuda para AIVD", "presença de doença crônica", "hipertensão arterial", "doença cardíaca", "reumatismo", "doença de coluna" e "diabetes". CONCLUSÃO: Observou-se que a maioria da população estudada apresenta autopercepção negativa de saúde, associada à existência de doenças crônicas. Apesar de ser uma avaliação subjetiva, a autopercepção de saúde é um importante instrumento para que se conheçam a situação global e o impacto que gera no bem-estar físico, social e mental.

Declínio de atividades instrumentais de vida diária associado à perda de força de preensão palmar em idosos internados em enfermaria geriátrica

OBJETIVO: Verificar a associação entre a capacidade de executar as atividades instrumentais de vida diária (AIVDs) e a força de preensão palmar em idosos sem comprometimento cognitivo internados em enfermaria geriátrica. MÉTODOS: Estudo transversal. Foram incluídos pacientes idosos, com idade igual ou superior a 60 anos, de ambos os gêneros, admitidos em enfermaria de Geriatria. Foram excluídos indivíduos com doenças neurológicas, osteomusculares agudas e respiratórias exacerbadas; com indicação médica de repouso ou com uso de algum aparato clínico, bem como aqueles com déficits cognitivos e/ou delirium. Os dados foram coletados do prontuário e foi realizada a avaliação da capacidade de realizar atividades instrumentais de vida diária, por meio da Escala de Lawton, e a avaliação da força de preensão palmar, por meio da dinamometria do membro superior dominante. Os dados foram descritos em média e desvio- padrão. O teste de correlação de Pearson foi aplicado para verificar associação entre a capacidade de realizar AIVDs e a força de preensão palmar. RESULTADOS: Participaram do estudo 12 idosos (75% mulheres) com idade média de 80,67±6,35 anos. As médias da força de preensão palmar e pontuação total da Escala de Lawton foram 11,96±6,71 quilogramas-força (kgf) e 22,58±1,67 pontos, respectivamente. Verificou-se associação moderada e positiva entre a força de preensão palmar e a pontuação na Escala de Lawton (r=0,640; p=0,025). CONCLUSÃO: A capacidade de realizar AIVDs e a força de preensão palmar apresentaram associação na amostra estudada.

[Socioeconomic and demographic indicators associated with functional disability in the elderly]

This study analyzed the prevalence of functional disability in the elderly and its association with socioeconomic and demographic factors. This was a population-based cross-sectional study with a sample of 631 elders (≥ 60 years). The Katz index and Lawton scale, respectively, were used to evaluate basic and instrumental activities of daily living. Demographic and socioeconomic variables were analyzed. Numerical variables were tested with the Student t test and non-numerical ones with the chi-square test. The odds of functional disability were measured by logistic regression. Prevalence rates of functional disability for basic and instrumental activities of daily living were 15.5% and 26.1%, respectively. Instrumental activities presented more variables significantly associated with the outcome in the final logistic regression model. Prevalence of functional disability was not higher than described in the Brazilian literature. An important association was found between the outcome and independent variables.

Sentido de vida, dependência funcional e qualidade de vida em idosos

Este estudo objetivou avaliar os índices de sentido de vida (SV), qualidade de vida (QV) e dependência funcional (DF) de idosos, e observar se o SV poderia atuar como recurso protetor capaz de diminuir os efeitos da DF na QV. Caracteriza-se por ser transversal, de base domiciliar, com 210 participantes que possuem média de idade de 74 anos (dp= 7,70), a maioria do sexo feminino (68,4%) e com renda média de 868 reais (dp = 1,100). Os instrumentos utilizados foram: Mini-Exame do Estado Mental, medida de independência funcional, questionário de qualidade de vida para idosos, teste de propósito de vida e um questionário sociodemográfico. Os resultados indicaram que a maioria da amostra apresentou altos índices de QV, SV e baixos índices de DF, além disso, a relação entre DF e QV para os idosos com alto SV não foi significativa [β = -0,19; t(93) = -1,92; p > 0,05]. Portanto, a QV dos idosos que apresentaram níveis altos de SV se torna mais protegida contra as alterações dos níveis de DF. Sendo assim, o sentido de vida atuou como recurso psicológico protetor.

Amerindian genetic ancestry protects against Alzheimer's disease

BACKGROUND

Alzheimer's disease (AD) is the most common form of dementia worldwide, and bears remarkable evidence for a differential prevalence among continental populations. In this scenario, estimating ancestry proportions in recently admixed populations is a strategy that can help increasing knowledge about the genetic structure of this complex trait.

AIM/METHODS

Our purpose was to assess mean ancestry estimates for the three main parental contributors to the Brazilian contingent (European, African and Amerindian) using a panel of 12 ancestry informative markers. Outpatients with the late-onset form of AD (n = 120) were compared for ancestry levels with non-cognitively impaired subjects (n = 412) in the Midwest Brazil, controlling for classic clinical, social and anthropometric risk factors.

RESULTS

Our findings show a 3-fold greater genetic Amerindian content among control subjects compared to AD patients (p < 0.001).

CONCLUSION

Our results suggest that the allelic architecture of Native Americans can confer protection against the onset of the disease.

[Social relations and self- rated health: the ageing and health project]

OBJECTIVE

To investigate the association between social relationships and self-perceived health in the elderly.

METHODS

cross-sectional study of a representative sample of elderly individuals covered by the Family Health Program and residents in an area of high health vulnerability in Belo Horizonte, MG. Information was obtained through structured interviews. Factors associated with poor or very poor self-perceived health were identified by multiple logistic regression analysis.

RESULTS

363 out of 371 eligible elderly participated; 17.1% of elderly self-perceived their health as poor. There was a positive dose-response relationship between poor self-perceived health and the number of chronic diseases and the degree of difficulty to perform daily life activities. Elderly individuals who perceived their personal relationships as bad and who could not count on anyone if they became bedridden were more likely to self-rate their health as poor. Working was negatively associated with self-perceived poor health.

CONCLUSION

The results confirm the multidimensional structure of self-perceived health including the issues related to health and social relationships. Our results strengthen the role of social relations on health.

Gerenciamento de doença crônica: equívoco para o grupo etário dos idosos

Alterações nos estilos de vida (mudanças dos hábitos alimentares, aumento do sedentarismo e estresse) e maior expectativa de vida aumentam a incidência das doenças crônicas não transmissíveis, principais causas de óbito e incapacidade no Brasil. Sua gestão passou a ser considerada importante pelos gestores na busca de intervenções e estratégias para reduzir custos, diminuir hospitalizações e combater agravos. Mas a maior parte dos programas de atendimento foca exclusivamente na doença, e isso é um erro. Modelos que funcionem de modo integrado e deem conta das necessidades dos pacientes serão mais efetivos. O objetivo deste artigo foi contribuir para a discussão de políticas e estratégias que permitam a indução de modelos de atenção ao idoso com ênfase em projetos preventivos e resolutivos.

Prevalência e fatores associados à percepção negativa da saúde em pessoas idosas no Brasil

OBJETIVO: Analisar os fatores associados à percepção negativa de saúde em idosos brasileiros. MÉTODOS: Estudo de base populacional com delineamento transversal realizado no ano de 2009, em três cidades do Brasil. A amostra estratificada de forma aleatória simples foi composta de 909 adultos de 60 a 91 anos. Na identificação dos fatores associados com a percepção negativa de saúde (PNS), foi realizada análise bruta e mutivariável por estimativas das Razões de Prevalência (RP), por meio da regressão de Poisson; p < 0.05. RESULTADOS: A prevalência para PNS foi de 49,6%, e após análise multivariada foi observado associação para os homens com o aumento da idade RP = 1,03 (IC = 1,01 - 1,06), risco de desnutrição RP = 1,66 (IC = 1,13 - 2,43) e incapacidade funcional RP = 1,79 (IC = 1,21-1,77). Para as mulheres, o uso superior a dois medicamentos RP = 1,41 (IC = 1,13 - 2,52), hipertensão arterial RP = 1,52 (IC = 1,43 - 1,97) e a incapacidade funcional RP = 1,36 (IC = 1,13 - 1,86). CONCLUSÕES: Quase a metade dos idosos possuem uma PNS, de maneira que ações preventivas de diminuição ao uso de medicamentos e comportamentos que favoreçam melhores condições nutricionais devem estar atreladas às políticas públicas à promoção da autonomia funcional e do bem-estar dos idosos.