Advanced activities of daily living and incidence of cognitive decline in the elderly: the SABE Study

Dias, Eliane Golfieri; Andrade, Fabíola Bof de; Duarte, Yeda Aparecida de Oliveira; Santos, Jair Lício Ferreira; Lebrão, Maria Lúcia

doi:10.1590/0102-311X00125014

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ARTICLE • Cad. Saúde Pública 31 (8) • Aug 2015 • https://doi.org/10.1590/0102-311X00125014 copy

Advanced activities of daily living and incidence of cognitive decline in the elderly: the SABE Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

The objective of this study was to evaluate the association between advanced activities of daily living (AADL) and incidence of cognitive decline. The sample consisted of non-institutionalized older adults who participated in the second (2006) and third (2010) waves of the Health, Wellbeing, and Aging (SABE) cohort study in São Paulo, Brazil. Cognitive decline was measured using a modified Mini-Mental State Examination. Advanced activities of daily living covered 12 social, productive, physical, and leisure-time activities that involve higher cognitive functions. Other covariates included socio-demographic conditions, overall health, lifestyle, and functional disability. The association between the independent variables and incidence of cognitive decline was assessed by multiple Poisson regression. Incidence of cognitive decline was 7.9%. Mean number of AADL in 2006 was significantly higher among elders who had not developed cognitive decline. Multivariate analysis showed that the number of AADL performed was a significant inverse predictor of cognitive decline.

Activities of Saily Living; Aged; Dementia; Health of the Elderly; Occupational Therapy

Covariates	Final	Excluded	Total	p-value
Covariates	sample (%)	population (%)	population (%)	p-value
Gender *				< 0.001
Female	63.1	49.8	59.6
Male	36.9	50.2	40.4
Schooling (years)				0.37
0-3	39.8	35.0	38.5
4-7	39.9	41.5	40.3
≥ 8	20.4	23.4	21.1
Lives alone				0.41
No	87.1	84.9	86.5
Yes	12.9	15.1	13.5
Marital status				0.79
Without partner	41.2	40.2	40.9
With partner	58.8	59.8	59.1
Self-rated income sufficiency				0.62
Insufficient income	54.1	52.4	53.7
Sufficient income	45.9	47.6	46.3
Age (years) *				< 0.001
60-74	83.4	72.1	80.4
≥ 75	16.6	27.9	19.6
Self-reported diseases
Hypertension				0.36
No	36.3	39.7	37.2
Yes	63.7	60.3	62.8
Diabetes				0.36
No	80.0	77.5	79.3
Yes	20.0	22.5	20.7
Heart disease				0.20
No	79.1	75.1	78.1
Yes	20.9	24.9	21.9
Cerebrovascular diseases **				0.03
No	94.8	91.0	93.8
Yes	5.2	9.0	6.2
COPD **				0.01
No	89.7	84.3	88.3
Yes	10.3	15.7	11.7
Joint disease				0.10
No	65.0	72.2	66.9
Yes	35.0	27.8	33.1
Osteoporosis				0.12
No	76.4	81.2	77.7
Yes	23.6	18.8	22.3
Cancer **				0.02
No	96.5	92.6	95.5
Yes	3.5	7.4	4.5
Number of self-reported diseases				0.48
None	15.9	17.5	16.3
1	29.5	25.3	28.4
≥ 2	54.7	57.2	55.3
Presence of depressive symptoms				0.18
No	86.8	83.3	85.9
Yes	13.2	16.7	14.1
Self-rated health				0.14
Excellent/Very good/Good	48.6	42.2	46.9
Fair/Bad	51.4	57.8	53.1
MMES abbreviated				0.72
Mean	17.0	16.9	17.0
Tobacco consumption ***				0.003
Never smoked	55.2	42.9	51.9
Used to smoke	32.7	39.2	34.4
Currently smokes	12.1	17.9	13.7
Alcohol consumption				0.14
None	67.5	68.9	67.9
Moderate	26.8	21.9	25.5
Alcohol abuse	5.7	9.2	6.6
Difficulty in ≥ 1 ADL (BADL+IADL)	30.8	35.8	32.1	0.12
Number of AADL in 2006 (mean) *	5.0	4.3	4.8	< 0.001
Performance of AADL *				< 0.001
0-5	57.7	69.6	60.8
≥ 6	42.3	30.4	39.2
Impaired mobility ***				0.001
No	89.0	81.6	87.1
Yes	11.0	18.4	12.9

	Total sample (%)	Decline in 2010 (%)		p-value
	Total sample (%)	No	Yes	p-value
Gender
Female	63.1	92.0	8.0	0.952
Male	36.9	92.2	7.8
Schooling (years)
0-3	39.8	86.2	13.8	< 0.001
4-7	39.9	94.8	5.2
≥ 8	20.4	98.4	1.6
Marital status
Without partner	58.5	92.1	7.9	0.983
With partner	41.5	92.1	7.9
Sufficient income
No	54.1	92.1	7.9	0.983
Yes	45.9	92.1	7.9
Age (years)
60-74	83.4	95.0	5.0	< 0.001
≥ 75	16.6	77.5	22.5
Number of self-reported diseases
None	15.9	90.9	9.1	0.065
1	29.5	95.6	4.4
≥ 2	57.3	90.5	9.5
Tobacco consumption
Never smoked	55.2	92.3	7.7	0.188
Used to smoke	32.7	90.4	9.6
Currently smokes	12.1	95.8	4.2
Alcohol consumption
None	67.5	90.5	9.5	0.004
Moderate	26.8	97.4	2.6
Alcohol abuse	5.7	85.7	14.3
Self-rated health
Excellent/Very good/Good	48.6	94.0	6.0	0.037
Fair/Bad	51.4	90.3	9.7
Presence of depressive symptoms
No	86.8	92.5	7.5	0.266
Yes	13.2	89.7	10.3
Difficulty in ADL
No	69.2	95.7	4.3	< 0.001
Yes	30.8	83.9	16.1

	Incidence of decline in 2010
	Crude	Adjusted
	IR (95%CI)	IR (95%CI)
Schooling (years) [reference = 0-3 years]
4-7	0.38 (0.22-0.65) *	0.50 (0.31-0.81) **
≥ 8	0.11 (0.04-0.31) *	0.20 (0.06-0.62) **
Gender [male]	1.02 (0.56-1.840	0.91 (0.46 -1.83)
Age (years) [reference = 60-74 years]
≥ 75	4.51 (2.74-7.42) *	3.29 (2.03-5.33) *
Alcohol consumption [reference = none]
Moderate	0.27 (0.12-0.60) **	0.61 (0.29-1.29)
Alcohol abuse	1.50 (0.63-3.61)	2.44 (1.04-5.72) ***
Tobacco consumption [reference = never smoked]
Currently smokes	0.53 (0.21-1.32)	0.46 (0.17-1.24)
Used to smoke	1.24 (0.75-2.03)	0.99 (0.77-1.76)
Number of self-rated diseases [reference = none]
1	0.48 (0.23-1.02)	0.58 (0.28-1.18)
≥ 2	1.04 (0.53-2.02)	0.86 (0.42-1.77)
Presence of depressive symptoms [reference = no]
Yes	1.37 (0.79-2.37)	0.80 (0.49-1.30)
Difficulty in ADL (reference = no)
Yes	3.76 (2.24-6.31) *	2.15 (1.26-3.65) **
Number of AADL	0.74 (0.67-0.81) *	0.85 (0.76-0.96) ***

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[1] Correspondence: E. G. Dias, Rua Martinho da Silva 107, apto 83B, São Paulo, SP 04124-080, Brasil. egolfieri@yahoo.com.br