Vulnerability and associated factors among older people using the Family Health Strategy

Cabral, Juliana Fernandes; Silva, Ageo Mário Cândido da; Mattos, Inês Echenique; Neves, Ádila de Queiroz; Luz, Laércio Lima; Ferreira, Daniele Bittencourt; Santiago, Lívia Maria; Carmo, Cleber Nascimento do

doi:10.1590/1413-81232018249.22962017

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ARTICLE • Ciênc. saúde coletiva 24 (9) • Sept 2019 • https://doi.org/10.1590/1413-81232018249.22962017 copy

Vulnerability and associated factors among older people using the Family Health Strategy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective of this study was to analyze the prevalence of vulnerability and associated factors among older people using family health strategies in Várzea Grande, Brazil. A cross-sectional study was performed with 377 community-dwelling older people. The dependent variable, vulnerability, was assessed using the Vulnerable Elders Survey. The independent variables included sociodemographic characteristics and the health status of the study population assessed using the following validated instruments: the Mini-Mental State Examination; Katz ADL scale and Lawton and Brody IADL scale; Geriatric Depression Scale; and Mini Nutritional Assessment Short-Form. Bivariate analysis was conducted using the Mantel-Haenszel chi-squared test with prevalence ratios and multivariate analysis was performed using Poisson regression. The data showed that 49% of the study population were vulnerable. The variables that showed the strongest association with vulnerability were dependence in IADLs (PR = 4.43), presence of depressive symptoms (PR = 1.34), and being aged 80 and over (PR = 1.34). The prevalence of vulnerability found by the present study was high when compared to other studies with community-dwelling older people. The VES-13 was shown to be easy to use in primary healthcare settings and particularly practical for screening vulnerability among older people.

Key words
Aging; Vulnerable populations; Older people

Variable	N	%
Sex
Female	227	60.2
Male	150	39.8
Age group
60-69 years	214	56.8
70-79 years	117	31.0
≥80 years	46	12.2
Race/Skin color
Brown	222	59.2
Black	80	21.3
White	73	19.5
Marital status
Married andliving with partner	212	56.2
Widow	118	31.3
Divorced, separated, single	47	12.5
Education level
Literate	270	71.6
Illiterate	107	28.4
Per capita income
Up to ½ minimum salary	122	32.4
½ to 1 minimum salary	211	56.0
> 1 minimum salary	44	11.7

Variables	N (377)	%
Vulnerability
Yes	185	49.1
No	192	50.9
Ability to performADLs
Dependent	103	27.3
Independent	274	72.7
Ability to performIADLs
Dependent	235	62.3
Independent	142	37.7
Depressive syndromes
Yes	118	31.3
No	259	68.7
Nutritional assessment
Malnutrition	37	9.8
At risk	135	35.8
No risk	205	54.4
Comorbidity(severity level 3 or 4)
Yes	149	39.5
No	228	60.5
Polypharmacy
Yes	82	21.8
No	295	78.3

Variables	Vulnerability
Variables	N	%	Crude PR (CI95%)	P-value
Sex
Male	59	39.3	1	0.002
Female	126	55.5	1.41 (1.12-1.78)	0.002
Age group
60 to 69 years	90	42.1	1
70 to 79 years	60	51.3	1.22 (0.96-1.54)	0.108
80 years and over	35	76.1	1.81 (1.44-2.27)	< 0.001
Per capita income
Over ½ minimum salary	99	47.6	1	0.525
Up to ½ minimum salary	86	50.9	1.07 (0.87-1.31)	0.525
Race/skin color
Black andbrown	145	78.8	1	0.407
White	39	21.2	0.96 (0.87-1.06)	0.407
Family situation
Living with someone	156	48.9	1	0.878
Living alone	29	50.0	1.02 (0.77-1.35)	0.878
Marital status
Living with partner	85	46.0	1	0.403
Living without partner	100	54.1	1.10 (0.88-1.39)	0.403
Education level
Literate	116	43.0	1	< 0.001
Illiterate	69	64.5	1.50 (1.23-1.83)	< 0.001

Variable/Instrument	Vulnerability
Variable/Instrument	N	%	Crude PR (CI95%)	P-value
Ability in ADLs (Katz Scale)
Independent	115	42.0	1	<0.001
Dependent	70	68.0	1.62 (1.33-1.96)	<0.001
Ability in IADLs (Lawton Scale)
Independent	20	14.1	1	<0.001
Dependent	165	70.2	4.99 (3.29-7.55)	<0.001
Depressive symptoms (GDS-15)
No	100	38.6	1	<0.001
Yes	85	72.0	1.87 (1.54-2.26)	<0.001
Nutritional status (MANR)
Without risk	88	42.9	1	0.009
At risk/malnourished	97	56.4	1.31 (1.07-1.61)	0.009
Comorbidity (CIRS-G)
Without comorbidity severity level 3 or 4	99	43.4	1	0.006
With comorbidity severity level 3 or 4	86	57.7	1.33 (1.09-1.63)	0.006
Polypharmacy
No	136	46.1	1	0.028
Yes	49	59.8	1.30 (1.04-1.61)	0.028

Variable	Adjusted PR	CI (95%)	P-value
Age group
60-69 years	1		0.012
70 to 79 years	1.10	(0.90-1.35)
80 years and over	1.32	(1.07-1.63)
Ability to perform IADLs
Independent	1	(2.69-6.33)	< 0.001
Dependent	4.12		< 0.001
Depressive symptoms (GDS-15)
No	1	(1.10-1.52)	0.003
Yes	1.29		0.003
Ability to perform ADLs
Independent	1	(0.99-1.35)	0.070
Dependent	1.16		0.070

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[1] Collaborators

JF Cabral, AMC Silva, and AQ Neves participated in study conception and design anddata analysis and interpretation; DB Ferreira and LM Santiago participated in the critical revision of the manuscript for important intellectual content. IE Mattos, LL Luz, and CN Carmo participated in the final approval of the version to be published and in ensuring data accuracy and integrity.