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Fisioterapia e Pesquisa

versão impressa ISSN 1809-2950

Fisioter. Pesqui. vol.21 no.4 São Paulo out./dez. 2014

http://dx.doi.org/10.590/1809-2950/11556021042014 

Original Research

Functional capacity and associated factors among longevous senior individuals living in community: a population study in Northeastern Brazil

Capacidad funcional y factores asociados en longevos residentes en una comunidad: estudio de populación en el Noreste de Brasil

Thaís Alves Brito 1  

Marcos Henrique Fernandes 1  

Raildo da Silva Coqueiro 2  

Cleber Souza de Jesus 2  

Roberta Freitas 3  

1Graduate Program in Nursing and Health, Health Departament, UESB - Jequié (BA), Brazil

2Health Department, UESB - Jequié (BA), Brazil

3Physical Therapy Course, UESB - Jequié (BA), Brazil

ABSTRACT

The objective of this study was to determine the prevalence of impaired functional capacity and the associated factors in longevous elderly individuals from a city in the countryside of Northeastern Brazil. This is a cross-sectional, population- and community-based study. The research population consisted of senior citizens aged ≥80 years old, residents of the urban area of ​​Lafaiete Coutinho, Bahia, Brazil. Data were collected in the households through a questionnaire with information on functional, socioeconomic, and demographic aspects and health/behavioral factors. Data analysis was performed using multinomial logistic regression at a significance level of 5%. A total of 94 senior citizens, whose average age was 86.1 years old (±6.39), whereof 59.6% were female, were interviewed. Among the longevous senior individuals, 19.1% were considered independent to instrumental and basic activities of daily living, whereas 56.2% were considered as dependent to instrumental activities of daily living, and 24.7% to both basic and instrumental activities of daily living. There has been an association between impaired functional capacity, both for basic and instrumental activities of daily living, and the variables referring to sex and drug use; another one was between race/color and instrumental activities of daily living dependence. We got to the conclusion that there was high prevalence (80.9%) of longevous senior citizens who depend on instrumental and basic activities of daily living. Also, the impairment of functional capacity on longevous senior citizens was associated with female sex, non-white race/color, and use of one or more drugs.

Key words: Avtivities of Daily Living; Aged 80 and Over; Health of Elderly

RESUMEN

El objetivo de eso estudio fue determinar la prevalencia del comprometimiento de la capacidad funcional y los factores asociados en ancianos longevos de una municipalidad del interior del Noreste brasileño. Es un estudio con diseño trasversal, de base poblacional y comunitaria. La populación incluyó ancianos con edades ≥80 años, los cuales viven en la región urbana de Lafaiete Coutinho, Bahia, Brasil. La recolección de datos fue domiciliar por medio de cuestionario con informaciones cuanto al capacidad funcional o socioeconómica y demográfica y las condiciones de salud o factores comportamentales. El análisis de datos fue realizado desde la regresión logística multinomial, con un nivel de significancia del 5%. Se entrevistaron 94 ancianos con media de 86,1 años (±6,39), un 56,9% como género femenino. De los ancianos longevos, el 19,1% fueron considerados independientes para actividades instrumentales y básicas de vida cotidiana, un 56,2% eran dependientes solo en las actividades instrumentales de vida cotidiana y el 24,7% eran dependientes en actividades básicas e instrumentales de vida cotidiana. Se verificó una asociación entre comprometimiento de la capacidad funcional para las actividades básicas de vida cotidiana y para las instrumentales, y las variables género y uso de medicamentos; y entre la variable raza/color y dependencia para actividades instrumentales de vida cotidiana. Por lo tanto, se concluso que hubo alta prevalencia (un 80,9%) de ancianos longevos dependientes para las actividades instrumentales y/o básicas de vida cotidiana y que el comprometimiento de la capacidad funcional en ancianos longevos se asoció al género femenino, a la raza/color no blanca y al uso de uno o más medicamentos.

Palabras-clave: Actividades Cotidianas; Anciano de 80 o más Ânos; Salud del Anciano

INTRODUCTION

The rapid growth of the elderly population in Brazil and the consequent change in the demographic and epidemiological profile of the country have generated social and economic challenges and raised the need for studies and research in the field of aging.

It is worth noting the significant increase in the number and percentage of longevous seniors, that is, individuals that have equal to or greater than 80 years of age. Although they represent about 1.3% of the world population, this age group is the population segment that is growing faster1. In Brazil, while the annual geometric average growth rate of the general elderly population is approximately 3.3%, between older seniors is about 5.4%, one of the highest in the world2.

Functional capacity is one of the most important indicators of the health status of the elderly population and, therefore, emerges as a new paradigm of health3. Healthy aging, in this new light, becomes the result of the multidimensional interaction between physical health, mental health, independence in daily living, social integration, family support and economic independence4 , 5.

Assessment of functional capacity is a challenge to be faced, in view of the heterogeneity of the aging process and the influences of different factors to which families, seniors and society may be subject. In Brazil, few studies address the functional capacity and its determinants in the population of the longevous seniors living in community5 , 6.

Ageing does not occur homogeneously and may vary according to socioeconomic status, access to information and education, culture and the region where the elderly reside7. Thus, the situation and the location of the individual can influence the process of aging and dictate how this individual will experience health in this stage of life. From this perspective, the objective of this study was to determine the prevalence of impaired functional capacity and associated factors among the elderly seniors in a city in the Brazilian Northeast.

METHODOLOGY

It is a cross-sectional study using data of the "Estado nutricional, comportamentos de risco e condições de saúde dos idosos de Lafaiete Coutinho-BA" (Nutritional status, risk behaviors and health conditions of the elderly in Lafaiete Coutinho-BA) population and community basis survey. The municipality of Lafaiete Coutinho had, during the period of data collection, a population of 4,162 inhabitants, 2.4% of these (n=100) corresponding to the number of longevous seniors.

Were excluded from analysis subjects who, at the time of the interview, did not have an informant if they were unable to understand the instructions due to cognitive problems, assessed using the Mini Mental State Examination (MMSE)8.

A census was conducted in January 2011, from the listing of elderly enrolled in the Estratégia de Saúde da Família (Family Health Strategy), which covers 100% of the population, to identify the elderly seniors, non-institutionalized and living in the city. Of the 100 individuals identified, four refused to participate and two were not located at home. Thus, the survey consisted of 94 (94%) longevous seniors.

It was created and used a form, excerpt from the Pesquisa Saúde, Bem-estar e Envelhecimento (SABE - Health, Welfare and Aging Research) questionnaire9 increased by the International Physical Activity Questionnaire (IPAQ) long form, the Brazilian version10. The following information was used: functional capacity (dependent variable), measured from the basic activities of daily living (BADL)11 and instrumental activities of daily living (IADL)12; socioeconomic and demographic characteristics, health status, and behavioral factors (independent variables).

The elderly were classified as independent when they did not report the need of help to perform any BADL and IADL, and dependents when reported needing assistance in at least one dimension of each activity. As proposed by Hoyemans et al.13, a range of hierarchical functional disability was built distinguishing three categories: independent (reference category); dependent in IADL; dependent in BADL and IADL.

For the health and behavioral factors, the categorization of variables was measured using the following criteria: depression symptoms, assessed by the Geriatric Depression Scale (GDS) short form of 15 items (score <6 points determines the absence of symptoms and ≥6 determining the presence of symptoms)14; weight status through the body mass index (BMI<22 kg/m2=underweight, 22 kg/m2≤IMC≤27 kg/m2=adequate and BMI> 27 kg /m2=overweight)15 and physical activity, considering 'insufficiently active' who performed less than 150 minutes per week in moderate or vigorous physical activity and 'active' who performed 150 minutes or more16.

It was proceeded to the descriptive analysis of the variables, and then, as a measure of association, it was estimated the Odds Ratio (OR) and confidence intervals from multinomial logistic regression. In all analyzes, the significance level was 5% (α=0.05). The data were analyzed using the Statistical Package for Social Sciences (SPSS) for Windows, version 15.0.

RESULTS

The characterization of the elderly according to socioeconomic and demographic variables, the health conditions and behavioral factors are presented in Table 1. The mean age was 86.1 years (standard deviation - SD=6.39), age maximum of 105 years. Functional capacity was assessed in 94.6% (n=89) of the study participants, with a higher prevalence of elderly dependent for IADL.

Table 1. Descriptive characteristics of the study population. Lafaiete Coutinho, Bahia, Brazil. 2011 

Variable % of responses n %
Sex
   Female
   Male  
100
56
38

59.6
40.4
Can read and write
   Yes
   No
100
20
74

21.3
78.7
Marital status
   With union
   No union
100
42
52

44.7
55.3
Race/Color
   White
   Not white
91.5

15
71

17.4
82.6
Per capita income (R$)
   ≤255.00
   255.00–510.00
   >510.00
93.6
39
37
12

44.3
42.0
13.6
Participation in religious activity
   Yes
   No
97.9

87
5

94.6
5.4
Physical activity
   Active
   Insufficiently active
97.9
24
68

26.1
73.9
Body Mass Index
   Normal weight
   Underweight
   Overweight
91.5
40
32
14

46.5
37.2
16.3
Self-perceived health
   Positive
   Negative
92.5
34
53

39.0
51.0
Health compared
   Better
   Equal
   Worse
87.2

51
15
16

62.2
18.3
19.5
Hospitalization
   None
   More than one
98.9
64
29

68.8
31.2
Number of chronic diseases
   No
   One
   Two or more
98.9
15
30
48

16.1
32.3
51.6
Falls
   No
   Yes
100
68
26

72.3
27.7
Depression symptoms
   No symptoms
   With symptoms
85.1
57
23

71.3
28.7
Functional capacity
   Independent
   Dependent for IADL
   Dependent for BADL
94.6
17
50
22

19.1
56.2
24.7

IADL: instrumental activities of daily living; BADL: basic activities of daily living

The prevalence of independence, dependence on BADL and dependence in BADL and IADL as exposure to socioeconomic and demographic variables are presented in Table 2. It was found that the elderly women have 4.65 times higher chance of addiction to BADL and 4.20 times higher for IADL compared to men. Also, it was noticed a 4.69 times greater chance of dependence for IADL among nonwhites compared with those who reported they were white (Table 2).

Table 2. Association between socioeconomic and demographic variables and functional capacity. Lafaiete Coutinho, Bahia, Brazil, 2011 

Variables Functional capacity p-value
Independent Dependent IADL Dependent BADL
% % ORadjusted (95%CI) % ORadjusted (95%CI)
Sex
   Female
   Male  

70.6
29.4

34.0
76.0

1.0
4.65 (1.40–15.40)

36.3
63.7

1.0
4.20 (1.08–16.32)
0.026
Can read and write
   Yes
   No

35.3
64.7

14.0
86.0

1.0
3.35 (0.93–12.00)

31.8
68.2

1.0
1.16 (0.30–4.46)
0.092
Marital status
   With union
   No union

52.9
47.1

46.0
54.0

1.0
1.32 (0.43–3.97)

40.9
59.1

1.0
1.62 (0.45–5.82)
0.756
Race/Color
   White
   Not white

35.3
64.7

10.4
89.6

1.0
4.69 (1.20–18.25)

16.7
83.3

1.0
2.72 (0.55–13.36)
0.063
Per capita income (R$)
   >510.00
   255.00–510.00  
   ≤255.00

13.3
73.4
13.3

10.4
37.5
52.1

1.0
0.65 (0.10–3.97)
4.90 (0.56–44.34)

19.0
33.3
47.7

1.0
0.32 (0.04–2.22)
2.5 (0.25–24.37)
0.066

IADL: instrumental activities of daily living; BADL: basic activities of daily living; p-value for the Pearson ?2 test; Odds ratio adjusted for other categories of functional capacity

As described in Table 3, among the health conditions and behavioral aspects, only the use of drugs was associated with impaired functional capacity, both in dependence for IADL, as well as for IADL and BADL.

Table 3. Association between health and biological variables and functional ability in the elderly seniors. Lafaiete Coutinho, Bahia, Brazil, 2011 

Variables Functional capacity p-value
Independent Dependent IADL Dependent BADL
% % ORadjusted (95%CI) % ORadjusted (95%CI)
Body Mass Index
   Normal weight
   Underweight
   Overweight

64.7
29.4
5.8

39.5
37.5
23.0

1.0
2.00 (0.60–7.18)
6.36 (0.72–56.20)

42.1
47.4
10.5

1.0
2.47 (0.59–10.26)
2.75 (0.21–35.83)
0.256
Physical activity
   Active
   Insufficiently active

47.0
53.0

24.5
75.5

1.0
2.74 (0.86–8.68)

18.2
81.8

1.0
4.00 (0.94–16.92)
0.107
Number of chronic diseases
   No
   One
   Two or more

18.7
31.3
50.0

14.0
32.0
54.0

1.0
1.37 (0.25–7.39)
1.44 (0.30–6.92)

18.2
31.8
50.0

1.0
1.05 (0.15–6.92)
1.03 (0.17–5.94)
0.987
Use of medications
   Do not use
   Uses (one or more)

61.5
38.5

20.5
79.5

1.0
2.71 (1.29–5.69)

22.2
77.8

1.0
2.17 (0.95–4.95)
0.036
Hospitalization
   None
   More than one

76.5
23.5

70.0
30.0

1.0
1.39 (0.39–4.97)

63.6
36.4

1.0
1.85 (0.45–7.66)
0.686
Self-perceived health
   Positive
   Negative

52.9
47.1

36.7
63.3

1.0
1.93 (0.63–5.91)

23.5
76.5

1.0
3.65 (0.84–15.91)
0.206
Compared health
   Better
   Equal
   Worse

66.6
20.0
13.4

65.9
14.9
19.2

1.0
0.75 (0.16–3.47)
1.45 (0.26–7.86)

41.2
29.4
29.4

1.0
2.38 (0.42–13.38)
3.57 (0.53–23.95)
0.427
Falls
   No
   Yes

70.6
29.4

80.0
20.0

1.0
0.60 (0.17–2.09)

54.5
45.5

1.0
2.00 (0.52–7.63)
0.085
Depression symptoms
   No symptoms
   With symptoms

88.2
11.8

70.5
29.5

1.0p3.14 (0.62–15.75)

60.0
40.0

1.0
5.00 (0.82–30.28)
0.186

IADL: instrumental activities of daily living; BADL: basic activities of daily living; p-value for the Pearson ?2 test; Odds ratio adjusted for other categories of functional capacity

DISCUSSION

The municipality of Lafaiete Coutinho has low health indicators and quality of life (4,487° position in the national ranking, Municipal Human Development Index - longevity)17, and has peculiar characteristics, some typically rural, although this research has been conducted with the elderly of the urban area.

From the age of 80, even with healthy aging, we expect some degree of physiological impairment in functional capacity of the elderly. However, the frequency and intensity of this impairment are varied18. Nusselder, Looman and Mackenbach19 reported that the functional dependence, observed mainly in older individuals is associated with sociodemographic factors, such as educational level and income; behavioral, such as physical inactivity, obesity and alcohol consumption; and psychosocial problems, such as loss of autonomy and depression symptoms.

Among the socioeconomic factors studied, women showed stronger association with impairment of functional capacity. Corroborating these data, a study conducted in 22 provinces of China, based on a study with 8,805 elderly people between the ages of 80 and 105 years, found that women of 80 years or more were seriously disadvantaged in functional capacity when compared to men of the same age20.

The greater impairment in functional capacity in older women may be related to differences in health status and lifestyle between sexes. In general, the life expectancy of women is higher than men. However, this does not mean longer survival for women to have better health, since they have a higher prevalence of non-fatal disabling conditions, such as osteoporosis, osteoarthritis and depression21. To that, it can be added the fact that women have greater loss of muscle mass with aging, characterized as a potential factor responsible for the decreased functional capacity22.

The race/color variable was associated with impaired functional capacity, with higher prevalence of dependence for IADL (75%) of non-white compared to white. In line with these findings, a population-based cross-sectional study, conducted by Duca et al.23 on 598 individuals that have more than or equal to 60 years of the urban area of Pelotas, Rio Grande do Sul, Brazil, found association of functional disability in basic activities with the skin colors of brown, black, among others.

This way, it becomes important to interpret the association of functional capacity with race/color carefully. Face of social inequalities in Brazil, which is a developing country, and the Northeast in particular, exposures throughout life may be influenced by ethnic differences. Thus, race/color can be directly linked to the socioeconomic status of the elderly.

The elderly population, by registering greater likelihood of frailty and health problems, frequently use health services and medications. The use of one or more drugs showed a two-fold higher prevalence of dependence in BADL and IADL and 72% higher for dependence only in IADL when compared to those seniors who do not use them. A similar association was found in cross-sectional and population based study conducted with 397 elderly residents in the urban area of Ubá, Minas Gerais, Brazil, by Nunes et al.24.

The relation between impaired functional capacity and use of medications may be influenced by other factors, such as presence of chronic diseases25 that, despite not having been associated with impaired functional capacity in this study, had a high prevalence given that 83.9% of the elderly seniors suffer from one or more chronic diseases. The culture of medicalization becomes worrisome given the pronounced adverse reactions in this group, the possibility of iatrogenic and misuse of drugs, requiring the family and health professionals with special attention to the elderly of more advanced age.

The results presented in this study were derived from cross-sectional, inadequate to grasp temporal evolutionary relations of the functional disability and, thereby, to make direct measurements of risk. This way, the type of analysis applied did not aim to determine the etiologic nature of disability in longevous seniors, but to explore an aspect of unreleased analysis in the context of the reality of the Northeast of Brazil.

Functional capacity is an important marker of successful aging and quality of life for seniors. The difficulty or inability of the elderly is associated with the prediction of fragility, dependency, institutionalization, death and mobility problems, causing complications over time and generating long-term care and high cost26.

Therefore, the goal in health care becomes not only to prolong life, but primarily to maintain the functional capacity of the individual, so that those will remain autonomous and independent by the largest possible period. For this to occur, maintaining the health of the elderly should be based on the principles of the Sistema Único de Saúde (SUS - Unified Health System) with the goal of universal access and comprehensive care through strategies, and not ponctual programs, tailored to the needs of this population group.

CONCLUSION

Based on these results, we concluded that there is a high prevalence (80.9%) of elderly seniors dependent for IADL and/or BADL and their impaired functional capacity is associated with female sex, to race/color non-white and the use of one or more drugs.

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Study conducted at the Núcleo de Epidemiologia do Envelhecimento of the Universidade Estadual do Sudoeste da Bahia (UESB) - Jequié (BA), Brazil.

Financing source: none

Approval at the Research Ethics Committee n. 064/2010.

Received: April 2013; Accepted: September 2014

Correspondence to: Thaís Alves Brito - Rua da Itália, 11 - Caixa Postal 04 - Centro - CEP: 45200-970 - Jequié (BA), Brazil - E-mail: thaisbrito03@yahoo.com.br

Conflict of interests: nothing to declare.

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