Associations between frailty syndrome and sociodemographic characteristics in long-lived individuals of a community

ABSTRACT Objective: investigating the association between frailty syndrome and sociodemographic characteristics in long-lived individuals of a community. Method: a cross-sectional study with a proportional stratified sample consisting of 243 long-lived individuals. A structured instrument, scales and tests that comprise evaluating frailty were applied for data collection. Univariate and multivariate analyzes were performed by logistic regression (p<0.05) by Statistica 10(r) software and Odds Ratio (95% Confidence Interval) were calculated for the predictive models. Results: of the 243 long-lived individuals evaluated, 36 (14.8%) were frail, 55 (63.8%) were pre-frail and 52 (21.4%) were not frail. A predominance of females (n=161; 66.3%), widows/widowers (n=158; 65%), who lived with family members (n=144; 59.3%) and in a self-reported satisfactory financial situation (n=108; 44.5%) was observed. A significant association was found between the demographic variable of age (p=0.043) and frailty syndrome. The best predictor model for the syndrome included the variables: gender, age and household companion. Conclusion: the variable of age contributed most to the fragilization process of long-lived individuals residing in the community. It is essential that gerontological nursing care contemplates early detection of this syndrome, considering age as being indicative of care needs.


Method
A cross-sectional study developed with long- The selection of the aged adults was randomly carried out through a draw based on the list of long-lived individuals registered at the UBSs generated by the city's electronic system. Home visits were made, and a new name was drawn in cases of refusal or absence (three attempts for each household).
Inclusion criteria were: a) being ≥80 years of age; b) being enrolled in one of the UBS participating in the study; c) scoring higher than the cutoff point in the Mini Mental State Examination (MMSE) (10) , which was 13 points for illiterates, 18 for having an average or low education level, and 26 points for having a high education level (11) .
The family caregiver was invited to participate in cases where long-lived individuals did not have cognitive conditions (n=36) to answer the research questions, and for which the following inclusion criteria were considered: a) being ≥18 years of age; b) being a family caregiver; c) living with the aged adult for at least three months. Long-lived individuals who were * The UBS were classified as income classes C, D and E; for this study they were considered as high, medium and low (income), since the region did not have classes A and B (9) .  (13) . The highest of three obtained measurements presented in kilograms (Kgf) was considered (14) , adjusted according to gender and body mass index (2) (BMI=weight/height 2 ), and values in the lowest fifth were considered frailty markers, as observed in Figure 1.  In order to evaluate the Gait Speed (GS) marker, the long-lived participants were instructed to walk a distance of six meters (15) in a usual manner on a flat surface marked by two marks of four meters distance from one The results were adjusted according to gender and height (2) , and then divided into two categories based on the median (50th percentile): men ≤166 cm and women ≤152 cm (below or equal to the median); and men > 166 cm and women > 152 cm (above the median).

Gender
The cutoff points were set in the lower fifth Fatigue/exhaustion was evaluated based on selfreporting for a question from the Depression Scale of the Center of Epidemiological Studies (16) : "Do you feel full of energy?" A visual scale was used to measure energy level using a ruler numbered from zero to ten, with zero being the minimum energy level and ten the maximum.
Negative responses provided by long-lived individuals to the question associated with an energy value equal to or less than three points on the ruler were considered as a marker for the syndrome (17) .   (19)(20)  years, widowed, with z low education level (21)(22) , living with a partner and/or family members (21) and receiving up to one minimum wage (22) . It is noticed that they are older women, with years marked only by the increase in life expectancy, who, nonetheless survive in undesirable physical and socioeconomic conditions, and for whom there is no specific care policy in force.
We observed that long-lived women were twice as frail as long-lived individuals, however, a significant association was found between the female gender and frailty. It can be inferred that this result is due to the quantitative study participants, which represent a local  (20) .
An analysis of marital status pointed to a higher proportion of frail widowed older adults, as expected for the age range of the study population and the predominantly female composition of the sample. A similar result was identified in other investigations (5,19) .
However, unlike the longitudinal study with 1887 younger Italian aged adults, no significant association between widowhood and physical frailty was identified (23) . We highlight that widowhood can contribute to social and family isolation, and therefore lead to developing selfcare deficit due to lack of encouragement from a partner.
It is noteworthy that more than half of the frail individuals had 1 to 4 incomplete years of study; however, this variable was not associated with the syndrome, corroborating a national study with community aged adults (5) . Nevertheless, a study conducted with 1,933 Mexican older adults at 65 years of age or older identified a higher probability of the syndrome in the aged with lower education levels (OR=2.51) (7) .
Despite developing countries having higher rates of illiteracy and lower education levels, a significant association between education level and the syndrome is found in developed countries such as Spain (19) and Japan (4) . In this sense, the educational level can be considered a protection factor, since it provides individuals with better access to information and services, as well as financial resources and employment opportunities.
The household situation variable had no significant association for the frail older adults, similar to a study developed with 203 aged people from Curitiba, whose objective was to investigate the association between frailty syndrome and sociodemographic and clinical characteristics of aged adult primary care users (24) . This result differs from those of other studies that observed this relationship among older adults who lived with family members (25) and those living alone (2,4,7) . Social bonds and the support experienced can influence the living with their family members) as an attempt to delay the frailty process and avoiding its negative outcomes.

Conclusion
Regarding the investigated sociodemographic variables, we can conclude that age significantly