Disability in instrumental activities of daily living
					among older adults: gender differences

Alexandre, Tiago da Silva; Corona, Ligiana Pires; Nunes, Daniella Pires; Santos, Jair Lício Ferreira; Duarte, Yeda Aparecida de Oliveira; Lebrão, Maria Lúcia

doi:10.1590/S0034-8910.2014048004754

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Sumário

Original Articles • Rev. Saúde Pública 48 (3) • June 2014 • https://doi.org/10.1590/S0034-8910.2014048004754 copy

Disability in instrumental activities of daily living among older adults: gender differences

Incapacidade em atividades instrumentais de vida diária em idosos: diferenças de gênero

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults.

METHODS

The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome.

RESULTS

The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women.

CONCLUSIONS

The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.

Aged; Disabled Persons; Personal Autonomy; Activities of Daily Living; Gender and Health

	Baseline (2000)				Follow up (2006)

Variable	Men (n = 462)		Women (n = 572)		Men (n = 190)		Men (n = 60)		Women (n = 243)		Women (n = 118)

	Means and %	SD	Means and %	SD	Independent means and %	SD	Dependent means and %	SD	Independent means and %	SD	Dependent means and %	SD
Sociodemographic
Age (years) (mean)	67.4	0.3	67.3	0.2	72.3^b	0.4	75.1^b	1.1	71.7^b	0.3	75.5^b	0.7
Marital status (with conjugal life)	82.7^a		45.6^a		81.6		85.7		39.7		34.7
Social Vulnerability Index (mean)	2.6^a	0.1	2.3^a	0.1	2.6	0.1	2.9	0.3	2.4	0.1	2.4	0.1
Accompanied living condition (yes)	93.1^a		80.9^a		91.3		91.2		79.2		82.0
Schooling (years) (mean)	7.5	2.1	4.7	0.2	5.7^b	0.6	4.1^b	0.7	4.6	0.4	4.1	0.5
Behavioral
Smoking
Non-smokers	27.5^a		70.6^a		29.7		29.4		76.0^b		61.9^b
Former smokers	49.0^a		18.5^a		56.3		58.4		15.1^b		32.3^b
Current smokers	23.5^a		10.9^a		14.0		12.2		8.9^b		5.8^b
Weekly alcohol intake
Non-drinkers	47.1^a		71.7^a		47.9^b		78.4^b		75.7		84.6
Drank once a week	25.5^a		22.9		23.9^b		4.1^b		17.1		12.5
Drank two to six days a week	13.2^a		3.3^a		13.6^b		8.7^b		5.9		2.9
Drank every day	14.2^a		2.1^a		14.6^b		8.8^b		1.3		–
Practice of physical activity (active)	34.9		35.3		–		–		–		–
Health status
Hypertension (yes)	48.5		51.6		62.1		67.8		60.1^b		74.1^b
Diabetes (yes)	17.6		16.1		17.0^b		34.9^b		19.4		10.7
Chronic lung disease (yes)	11.3		10.5		12.1		14.1		10.0		11.9
Heart disease (yes)	18.1		14.6		24.7		33.1		17.1^b		29.6^b
Stroke (yes)	4.2		3.0		5.8^b		35.2^b		2.9^b		11.8^b
Osteoarthritis (yes)	19.3^a		39.3^a		25.8^b		12.3^b		41.4^b		59.8^b
Number of diseases (mean)	1.18^a	0.1	1.34^a	0.1	1.5^b	0.1	1.9^b	0.1	1.5^b	0.1	2.0^b	0.1
Falls in previous 12 months (yes)	19.0^a		31.1^a		19.4		32.0		31.1		40.0
Hospitalization in previous 4 months (yes)	5.3		3.2		9.7		15.8		4.5^b		16.0^b
Fracture in previous 12 months (yes)	1.0		1.5		1.3^b		8.9^b		3.4		3.1
Score on Mini Mental State Exam (mean)	16.8	0.2	17.1	0.1	16.9^b	0.2	13.2^b	0.7	17.3^b	0.1	14.9^b	0.4
Geriatric Depression Scale (≥ 6 points)	8.6^a		16.2^a		6.0		13.1		8.4^b		23.6^b
Perception of hearing
Good	72.5^a		79.1^a		68.6		54.0		82.9		78.7
Poor	27.5^a		20.9^a		31.4		46.0		17.1		21.3
Perception of close vision
Good	16.8		14.4		74.8		62.2		79.7^b		64.9^b
Poor	83.2		85.6		25.2		15.4		20.3^b		35.1^b
Perception of far vision
Good	50.6^a		42.2^a		68.7^b		40.6^b		73.7^b		60.0^b
Poor	49.4^a		57.8^a		31.3^b		59.4¹		26.3^b		40.0^b
Hand grip strength (mean)	34.6^a	0.5	21.8^a	0.2	33.3^b	0.7	26.3^b	1.3	20.1^b	0.4	17.8^b	0.4
Body mass index
Ideal	53.8^a		44.0^a		55.0		44.7		48.1		42.3
Underweight	20.2^a		15.7^a		23.1		28.5		20.0		15.7
Overweight	14.5^a		12.2^a		13.0		11.9		11.1		13.8
Obesity	11.5^a		28.1^a		8.9		14.9		20.8		28.2
Sit-and-stand test (seconds) (mean)	11.8^a	0.2	13.2^a	0.2	14.4	0.4	16.3	0.9	15.1^b	0.3	16.7^b	0.6
One-Leg Standing Balance (seconds) (mean)	8.8	0.1	8.6	0.1	8.4	0.2	7.1	0.7	8.2^b	0.2	6.9^b	0.5

Variable	Incidence density (%)			Incidence Rate Ratio

	Men	95%CI	Women	95%CI	Women/Men	95%CI
Unadjusted	25.2	18.5;35.1	44.7	36.7;54.8	1.77	1.75;1.80
Adjusted for social vulnerability (SVI > 1)
Without vulnerability	6.6	0.9;148.5	39.2	25.9;62.2	5.91	5.46;6.41
With vulnerability	25.2	18.9;34.3	38.9	32.3;47.4	1.55	1.52;1.57
Adjusted for chronic diseases^a
Without disease	25.5	15.3;45.9	25.1	15.9;42.0	0.98	0.95;1.01
One or more diseases	22.3	15.9;32.5	43.6	36.4;52.8	1.95	1.92;1.99
Adjusted for social vulnerability and chronic diseases
Without vulnerability and without disease	^b	^b	^b	^b	^b	^b
Without vulnerability and with one or more diseases	^b	^b	47.7	32.0;74.3	^b	^b
With vulnerability and without disease	29.1	17.4;52.6	28.5	18.2;47.3	0.98	0.95;1.01
With vulnerability and with one or more diseases	23.6	16.7;34.6	42.7	34.8;52.9	1.81	1.77;1.84

Variable	Unadjusted IRR	Adjusted IRR	95%CI (adjusted IRR)	p
Men (n = 250)
Age (years)
60 to 69	1	1
70 to 79	1.43	1.52	0.82;2.78	0.174
80 or more	3.97	3.24	1.73;6.08	0.000
Perception of hearing
Good	1	1
Poor	2.03	1.99	1.10;3.59	0.023
Stroke
No	1	1
Yes	2.53	3.33	1.32;8.38	0.011
Mini Mental State Exam	0.93	0.91	0.86;0.97	0.003

Women (n = 361)
Age (years)
60 to 69	1	1
70 to 79	2.15	1.92	1.29;2.87	0.001
80 or more	2.76	2.02	1.04;3.89	0.035
Osteoarthritis
No	1	1
Yes	1.37	1.08	0.72;1.63	0.699
Hand grip strength
1^st tercile	1	1
2^nd tercile	1.50	1.10	0.62;1.95	0.749
3^th tercile	2.32	1.69	0.95;3.02	0.073
Perception of hearing
Good	1	1
Poor	1.79	1.68	1.09;2.58	0.018
Mini Mental State Exam	0.94	0.95	0.90;0.99	0.018
One leg balance	0.89	0.92	0.87;0.97	0.005

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Tiago da Silva Alexandre Av. Dr. Arnaldo, 715 01246-904 São Paulo, SP, Brasil E-mail: tsfisioalex@gmail.com