Evaluation of the influence of nutritional status, measures of frailty and level of physical activity on the quality of life of long-lived individuals

Avaliação da influência do estado nutricional, medidas de fragilidade e nível de atividade física com a qualidade de vida de idosos longevos

Maria Daniela Clementino Rita Maria Monteiro Goulart About the authors

Abstract

Introduction:

Aging is a worldwide phenomenon that has favored an increase in people aged 80 years and older. Objective: To assess the influence of nutritional status (NS), measures of frailty, and physical activity level (PAL) on the quality of life (QoL) of long-lived people.

Method:

The study was carried out from Oct 2016 to Sept 2017 with 103 individuals aged 80 years or more. NS was classified according to the PAHO Health, Well-Being and Aging (SABE) survey; waist circumference (WC) and calf perimeter (CP) was based on the WHO classification; handgrip strength (HGS) and gait speed (GS) used the classification proposed by Lauretani; PAL was classified according to the IPAQ short form; the WHOQoL-bref and WHOQoL-old were applied to measure QOL. Variables were assessed using the Mann-Whitney U and t-tests.

Results:

69.2% were women, with an average age of 82.75 (± 2.98) years, and only WC showed a significant association (p <0.001). The older women without dynapenia exhibited better QoL in the physical domain (p = 0.004), social relationships (p = 0.022), self-reported QoL (p = 0.017) of the WHOQoL-bref and social participation facet (p = 0.025) of WHOQOL-old. Comparison of QoL with NS and PAL showed a significant difference in self-reported QoL (p = 0.027) for the former and past, present and future activities for the latter (p = 0.050).

Conclusion:

Obesity and the absence of dynapenia were positively associated with the QoL of long-lived individuals. PAL was associated with positive QoL in one facet of the WHOQoL-old.

Keywords:
Aged, 80 and over; Nutritional Status; Physical Activity; Quality of Life

Resumo

Introdução:

Envelhecimento é um fenômeno mundial que favoreceu o aumento de idosos com 80 anos ou mais.

Objetivo:

Avaliar a influência do estado nutricional (EN), medidas de fragilidade, nível de atividade física (NAF) com a qualidade de vida (QV) de idosos longevos.

Método:

Estudo realizado de out/2016 a set/2017 com 103 idosos ≥80 anos. O EN foi classificado segundo OPAS/SABE; circunferência abdominal (CA) e da panturrilha (CP) utilizou-se a classificação WHO; força de preensão palmar (FPP) e velocidade de marcha (VM) utilizou-se a classificação proposta por Lauretani; NAF foi classificado segundo IPAQ versão curta; para a mensuração da QV foram utilizados WHOQoL-bref e old. As variáveis foram avaliadas através do Test t e teste U de Mann-Whitney.

Resultados:

69.2% eram mulheres, média de 82.75 (±2.98) anos, apenas a variável CA apresentou associação significativa (p<0.001). As idosas sem dinapenia apresentaram melhor QV no domínio físico (p=0.004), relação social (p=0.022) e autoavaliação da QV (p=0.017) do WHOQoL-bref e na faceta de participação social (p=0.025) do WHOQoL-old. Comparada a percepção de QV pelo EN, houve diferença significativa na autoavaliação da QV (p=0.027), pelo NAF observou-se diferença significativa na faceta atividades passadas, presentes e futuras (p=0.050).

Conclusão:

A obesidade e ausência de dinapenia associaram-se positivamente com a QV dos longevos. O NAF foi associado com a QV positiva em uma faceta do WHOQoL-old.

Palavras-chave:
Idoso de 80 anos ou mais; Estado Nutricional; Atividade Física; Qualidade de Vida

Introduction

The aging population is a worldwide phenomenon with significant repercussions in Brazil. The increased life expectancy in the country has resulted in a rise in the proportion of individuals aged 80 years or older [11 Pereira, LF, Lenardt, MH, Michel,T, Carneiro, NHK, Bento, LF. Retrato do perfil de saúde-doença de idosos longevos usuários da atenção básica de saúde. Rev Enferm UERJ. 2015;23(5):649-55.], called older adults, very old adults, advanced older adults or long-lived older adults [22 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Envelhecimento e saúde da pessoa idosa. Brasília: Ministério da Saúde; 2006.,33 Nogueira SL. Capacidade funcional, nível de atividade física e condição de saúde de idosos longevos: um estudo epidemiológico [dissertation]. Viçosa: Universidade Federal de Viçosa; 2008.].

The prevalence of long-lived adults has important implications for the healthcare area due to the presence of comorbidities and a higher incidence of functional decline [44 Lourenço TM, Lenardt MH, Kletemberg DF, Seima MD, Tallmann AEC, Neu DKM. Capacidade funcional no idoso longevo: uma revisão integrativa. Rev Gaucha Enferm. 2012;33(2):176-85.]. During the aging process, natural senescent structural, physiological and functional changes occur [55 Sousa JAV, Lenardt MH, Grden CRB, Kusomota L, Dellaroza MSG, Betiolli SE. Physical frailty prediction model for the oldest old. Rev Latino-Am. Enfermagem. 2018;(26):e3023.]. These changes include reduced height, a greater relationship between fat and muscle mass, lower body water level, weight loss (after the age of 80) [66 Curiati JAE, Kasai JYT, Nóbrega TCM. Senescência e Senilidade. In: Jacob Filho W, Kikuchi EL. Geriatria e Gerontologia: Básicas. Rio de Janeiro: Elsevier, 2011; p. 11-8.] and a decline in muscle tissue that interferes in the mobility of older people [77 Skopinski F, Resende, TL, Schneider RH. Imagem corporal, humor e qualidade de vida. Rev Bras Geriat Gerontol. 2015;18(1):95-105.]. For some individuals, these changes may be more marked, increasing the risk of morbidity and mortality, while others remain robust even at advanced age. Within the heterogeneity resulting from the aging process, the concept of frailty has been increasingly discussed [55 Sousa JAV, Lenardt MH, Grden CRB, Kusomota L, Dellaroza MSG, Betiolli SE. Physical frailty prediction model for the oldest old. Rev Latino-Am. Enfermagem. 2018;(26):e3023.]. The physical characteristics of frailty involve fatigue, muscle weakness, physical inactivity, slow gait and weight loss [88 Liberalesso TEM, Dallazen F, Bandeira VAC, Berlezi EM. Prevalência de fragilidade em uma população de longevos na região Sul do Brasil. Saude Debate. 2017;41(113):553-62.]. Inadequate nutritional status (NS), combined with a sedentary lifestyle, is a risk factor for chronic noncommunicable diseases (NCDs) in the population and physical inactivity raises the risk of comorbidities related to their development. Thus, preventive measures such as engaging in physical activity and a healthy diet are essential to reduce the physiological effects of aging, increase well-being, enhance cardiovascular health and mitigate chronic inflammatory conditions [99 Trindade ACAC, Araujo MYC, Rocha APRM, Codogno JS. Level of physical activity and the occurrence of chronic diseases in patients of the public healthcare system in Presidente Prudente-SP. J Phys Educ. 2016;27(e2724):3-8.].

Dias, Salvador and Cucato [1010 Dias RMR, Salvador EP, Cucato GG. O enfoque da educação física. In: Domingues MA, Lemos ND. Gerontologia: os desafios nos diversos cenários da atenção. Barueri: Manole; 2010. p. 3-10.] reported that physical activity improves independence, disease control, physical aptitude (skills and capacities to perform activities), and the quality of life (QoL) of older adults, in addition to promoting socialization.

Thus, understanding the aging process is a necessary challenge to increase longevity and improve the QoL of this population. Nutrition, physical activity and frailty are aspects that should be studied, since they play an important role in the physical changes caused by the aging process. The aim of this study was to assess the nutritional status, measures of frailty, physical activity level and their relation with the quality of life in older adults aged 80 years or more.

Method

This is quantitative cross-sectional study, using probability sampling with no intervention [1111 Marotti J, Galhardo APM, Furuyama RJ, Pigozzo MN, Campos TN, Laganá DC. Amostragem em pesquisa clínica: tamanho da amostra. Rev Odontol Univ Cid Sao Paulo. 2008;20(2):186-94.]. Data were collected between October 2016 and September 2017, from 103 long-lived older adults of both sexes from different communities in São Paulo state.

Participants were selected at five institutions that offer free activities in education, sports, leisure and culture, in addition to healthcare services for older people. These include the House for Older Adults in São José dos Campos (n=29), Laboratory for the Study of Movement (LEM) of Clínícas Hospital in São Paulo (n=25), Higher Physical Education School (ESEF) in Jundiaí (n=18), Integrated Center for Health and Education in Old Age (CISE) in São Caetano do Sul (n=17) and São Judas Tadeu University (USJT) in São Paulo (n=14). All the subjects met the following inclusion criteria: age greater than or equal to 80 years; able to complete the questionnaires and perform the proposed tests. No exclusion criteria were established, since all the older adults were volunteers. When subjects were unwilling to take part in a test, they were considered absent in the database.

The data were collected by a team of researchers (physical education teachers, pharmacists, nutritionists and psychologists) trained and standardized for the collection and assessment techniques. A Plenna® portable digital scale with a maximum load of 150 kg and accurate to 0.1kg was used to measure body weight. Height was measured by a Welmy® portable stadiometer, with 0.5cm graduations and maximum height of 2m. During measurements, the subjects were asked to remain standing, with their feet together and not wearing shoes, staring at a fixed point on a horizontal line. Waist circumference (WC) and calf perimeter (CP) were measured with a nonelastic tape measure, accurate to 1 mm. WC was determined with individuals standing, arms at their sides and feet together, with the tape wrapped around the largest abdominal circumference. For CP, the subject remained seated with legs bent at 90O, and the tape was placed around the largest circumference of the right calf.

Instruments

Nutritional status was determined by body mass index (BMI) and analyzed according to the cutoff points recommended by the Pan American Health Organization (PAHO/SABE Survey) [1212 Opas/Sabe. Organização Pan Americana de Saúde. Salud bienestar y envejecimiento (SABE) en América Latina y el Caribe. 2001 [cited 2020 May 20]. Available from: https://tinyurl.com/yxb8s3xu
https://tinyurl.com/yxb8s3xu...
], with the older adults classified as low weight (< 23.0 kg/m2), normal weight (23.0 - 28.0 kg/m2), overweight (28.0 - 30.0 kg/m2) and obesity (> 30.0 kg/m2).

WC <94cm was classified as normal for men and < 80cm for women; high risk between 94 and 102 cm for men and between 80 and 88 cm for women; very high risk > 102 cm for men and > 88 cm for women [1313 World Health Organization. Diet, nutrition and the prevention of chronic diseases. WHO Tech Rep Ser. 2003;916:1-149.]. Three measures of CP were taken and an average of CP >31cm was considered adequate [1414 Who. World Health Organization. Physical Status: the use and interpretation of anthropometry. Tech Rep Ser. 1995;854:1-463.].

Handgrip strength (HGS) is a measure of the muscle strength of middle-aged and older adults, in addition to allowing analysis of functional performance during the aging process [1515 Virtuoso JF, Balbé GP, Hermes JM, Amorim Jr EE, Fortunato AR, Mazo GZ. Força de preensão manual e aptidões físicas: um estudo preditivo com idosos ativos. Rev Bras Geriat Gerontol. 2014;17(4):775-84.]. This was checked three times with a Jamar® hydraulic dynamometer and the average of the three values calculated. The subjects were asked to use their dominant hand, with a 20-second interval between each attempt. The result was classified according to the recommendations for older adults, where ≥ 20kg/f is considered adequate for women and ≥ 30kg/f for men [1616 Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5):1851-60.]. Older people with lower than recommended HGS were considered dynapenic, an indicator of frailty.

Gait speed (GS) is used to assess balance and physical mobility [1717 Novaes RD, Miranda AS, Dourado VZ. Usual gait speed assessment in middle-aged and elderly Brazilian subjects. Rev Bras Fisioter. 2011;15(2):117-22.] and was evaluated using the 4-meter walk test. To that end, two chairs were used to demarcate the start and end of the walk. The test was repeated three times and the average was used as the final time. A Seiko® digital stopwatch measured the time to complete the test. The speed was obtained by dividing the 4 meters traveled by the time in seconds, with a value <.8 m/s considered compromised mobility [1616 Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5):1851-60.]. The decrease in GS was deemed physical frailty in older adults.

In order to establish physical activity level (PAL), the data were collected in a battery of activities established in the metabolic equivalent (MET). The data obtained were transferred to the International Physical Activity Questionnaire (IPAQ) - short form [1818 Matsudo S, Araujo T, Matsudo V, Andrade D, Andradre E, Oliveira LC, et al. Questionário internacional de atividade física (IPAQ): estudo de validade e reprodutibilidade no Brasil. Rev Bras Ativ Fis Saude. 2001;6(2):1-14.]. The participants were classified as very active, active, irregularly active and sedentary. When the older person engaged in more than one activity, each one was considered for PAL classification.

The World Health Organization Quality of Life (WHOQOL) questionnaire was translated to Portuguese by Fleck [1919 Fleck MPA. O instrumento de avaliação de qualidade de vida da Organização Mundial da Saúde (WHOQOL-100): características e perspectivas. Cienc Saude Colet. 2000;40(5):33-8.] and Fleck, Chachamovich, Trentini [2020 Fleck MPA, Chachamovich E, Trentini C. Development and validation of the Portuguese version of the WHOQOL-OLD module. Rev Saude Publ. 2006;40(5):785-91.] in the short form (WHOQoL-bref) and the specific version for older adults (WHOQoL-old). In relation to the final score, high scores (maximum score = 100) mean a high QoL and low score (minimum score = 0) a low QoL.

Statistical analysis

The Statistical Package for the Social Sciences (SPSS), version 21.0 was used for statistical analysis. The data were presented as descriptive statistics (mean and standard deviation), median, interquartile range, absolute and relative frequency. The chi-squared test was applied to determine the association between the variables studied and sex. When the assumption was not met, Fisher’s exact test was used for situations in which each variable has only two response possibilities. The test was not applied for variables with more response possibilities and which did not meet the assumption.

The t-test was used to compare QoL with GHS. Cohen’s d was adopted to determine the effect size in the test. When the domains or facets did not exhibit normal distribution, the Mann-Whitney U test was used.

Spearman’s correlation was applied to assess the association between GS and QoL. This correlation varies between 1 and -1 to measure the degree of association between two variables. Zero r values show no association, and values near zero (negative or positive) indicate a very weak association between the variables. The closer the r values to 1 or -1, the stronger the association between the variables [2121 Martinez EZ. Bioestatística para os cursos de graduação da área da saúde. São Paulo: Blucher; 2015. p. 87-100.].

One-way ANOVA was used to compare QoL, nutritional status (NS) and PAL, followed by Tukey’s test. The effect size was examined using partial eta squared, presented in percentage. A 5% significance level was adopted (p<0.05).

Ethical aspects

This study was approved by the Research Ethics Committee of São Judas Tadeu University (USJT) under protocol number 56493317.00000.0089. The participants gave written informed consent in accordance with the National Health Council’s Resolution 466, of December 12, 2012).

Results

Most of the 103 older adults were women (69.2%), with an average age of 82.75 (±2.98) years, minimum age of 80 and maximum of 94 years, 87.7% white, 58.7% widowed, 51.7% with elementary education, 66.3% do not live alone and 51.9% earn between 1 and 2 minimum monthly wages (≈USD200-400).

Table 1 shows that when nutritional status variables, WC, CP, GHS, GS, and PAL are compared by sex, only WC shows a significant association (p< 0.001), and 81.7% of the women exhibited a very high risk for cardiovascular diseases.

Table 1
Distribution of older adults according to anthropometric measures, handgrip strength, gait speed and physical activity level. São Paulo, 2016-2017

The older people without dynapenia, assessed using HGS, showed better QoL in the physical domain (83.9, p=0.004), social relationships (83.3, p=0.022) and self-reported quality of life (75.0, p=0.017) of the WHOQoL-bref and the social participation facet (p=0.025) of the WHOQoL-old (Table 2).

Table 3 shows there was no significant correlation between gait speed (GS) and any QoL domain or facet assessed.

Comparison of perceived QoL (in its different domains and facets) according to nutritional status reveals a significant difference only in self-reported QoL (p=0.027) (Table 4). The obese older adults demonstrated significantly higher perceived QoL when compared to overweight individuals.

Table 5 shows a significant difference in QoL only in past, present and future activities (p=0.050) when compared by PAL; however, Tukey’s test found no statistically significant difference.

Table 2
Distribution of older people according to handgrip strength and quality of life, classified by sex. São Paulo, 2016-2017
Table 3
Distribution of older adults according to gait speed and quality of life. São Paulo, 2016-2017
Table 4
Distribution of older adults according to nutritional status and quality of life. São Paulo, 2016-2017
Table 5
Distribution of older adults according to physical activity level and quality of life. São Paulo, 2016-2017

Discussion

This study discusses themes relevant to the nutritional status, frailty, physical activity and quality of life of adults older than 80 years. With respect to frailty, individuals without dynapenia showed better perceived quality of life. Self-reported QoL was also higher in obese older adults.

In the present study, 30.3% of the subjects exhibited excess weight (overweight and obesity). In the review by Lira, Goulart and Alonso [2222 Lira S, Goulart RMM, Alonso AC. A relação entre o estado nutricional e a presença de doenças crônicas e seu impacto na qualidade de vida de idosos: revisão integrativa. Rev Aten Saude. 2017;15(53):81-6.], the authors report that the youngest older adults with excess weight displayed more satisfaction with life and better perception of the aspects that influence QoL. However, this population has greater risk for NCDs, particularly cardiovascular diseases and diabetes mellitus. Low weight was found in 14.7% of the individuals. In a study performed with community-dwelling older adults, the highest prevalence of frailty was observed in malnourished older people. According to the authors, malnutrition increases the risk of frailty nearly five-fold [2323 Lins MEM, Marques APO, Leal MCC, Barros RLM. Frailty risk in community-dwelling elderly assisted in Primary Health Care and associated factors. Saude Debate. 2019;43(121):520-9.].

Visceral abdominal fat assessed by WC showed a much greater risk for cardiovascular disease in the older individuals studied. A similar result was found by Nascimento et al [2424 Nascimento MM, Pereira LGD, Cordeiro PRN, Araújo LMG. Comparison and agreement of criteria for the BMI classification of physically active elderly women living in the Backlands, semi-arid Region. J Hum Growth Dev. 2017;27(3):342-9.], where long-lived adults obtained an average value of 89.0±9.84, with a risk for metabolic complications.

Assessment of adiposity should be more effective, since overweight, obesity, hypertension, type 2 diabetes and abdominal obesity increase the risk of morbidities and mortality [2424 Nascimento MM, Pereira LGD, Cordeiro PRN, Araújo LMG. Comparison and agreement of criteria for the BMI classification of physically active elderly women living in the Backlands, semi-arid Region. J Hum Growth Dev. 2017;27(3):342-9.,2525 Fan H, Li X, Zheng L, Chen X, Ian Q, Wu H, et al. Abdominal obesity is strongly associated with Cardiovascular Disease and its Risk Factors in Elderly and very Elderly Community-dwelling Chinese. Sci Rep. 2016;6:1-9.]. WC reflects visceral fat and has proved to be strongly associated with cardiovascular disease and mortality when compared to BMI [2525 Fan H, Li X, Zheng L, Chen X, Ian Q, Wu H, et al. Abdominal obesity is strongly associated with Cardiovascular Disease and its Risk Factors in Elderly and very Elderly Community-dwelling Chinese. Sci Rep. 2016;6:1-9.].

In the present study, 51.0% of the older adults were considered sedentary according to the IPAQ classification. A similar finding was reported by Queiroz et al. [2626 Queiroz BM, Coqueiro RS, Leal Neto JS, Borgatto AF, Barbosa AR, Fernandes MH. Inatividade física em idosos não institucionalizados: estudo de base populacional. Ciênc Saude Colet. 2014;19(8):3489-96.] in a group aged 80 years or older, where 72.8% of the individuals were considered physically inactive, according to the IPAQ long form. The authors found an increasing trend in the proportion of sedentary older people, concomitant to the decline in active and very active older adults, age being the factor for the reduction in PAL.

A sedentary lifestyle was an indicator for frailty. A decrease in physical activity may cause a drop in handgrip strength and gait speed [2323 Lins MEM, Marques APO, Leal MCC, Barros RLM. Frailty risk in community-dwelling elderly assisted in Primary Health Care and associated factors. Saude Debate. 2019;43(121):520-9.].

Regular physical activity is important in maintaining the health of older people, which should be increasingly encouraged in long-lived adults. Oliveira et al [2727 Oliveira DV, Trelha CS, Lima LL, Antunes MD, Nascimento Jr JRA, Bertolini SMMG. Physical activity level and associated factors: an epidemiological study with elderly. Fisioter Mov. 2019;32:e003238.] found a significant association between PAL and perceived health (p = 0.037), number of drugs used (p = 0.008) and the history of near falls among older individuals in the last semester (p = 0.038), demonstrating that physical activity was important in reducing actions associated with health-related variables.

Perceived QoL in the presence or absence of dynapenia, showed that the older adults without dynapenia obtained a higher QoL score in the physical and social relationships domains and social participation facet. This result indicates that this population may feel less confident in performing activities of daily living such as taking medication, eating, personal hygiene, and selecting and putting on clothes, which may reflect in their being more willing and comfortable in environments that promote social interaction when compared to dynapenia.

Despite older men exhibiting naturally greater HGS than their female counterparts, the former displayed no significant values, suggesting that these individuals may or may not have dynapenia, since it does not interfere in their perceived QoL.

A number of authors refer to HGS as grip strength [2828 Lino VTS, Rodrigues NCP, O'Dwyer G, Andrade MKN, Mattos IE, Portela MC. Handgrip Strength and Factors Associated in Poor Elderly Assisted at a Primary Care Unit in Rio de Janeiro, Brazil. PloS One. 2016;11(11):e0166373.,2929 Mihara Y, Matsuda K, Ikebe K, Hatta K, Fukutake M, Enoki K, et al. Association of handgrip strength with various oral functions in 82-to 84-year- old community-dwelling Japanese. Gerodontology. 2018:1-7.,3030 Lindblad A, Dahlin-Ivanoff S, Bosaeus I, Rothenberg E. Body composition and hand grip strength in healthy community-dwelling older adults in Sweden. J Aging Res Clin Practice. 2015;4(1):54-8.], but few studies assess this variable in individuals older than 80 years. With increasing age, HGS declines and dynapenia is associated with greater risk of disease, falls, disability, cardiovascular mortality and morbidity [2828 Lino VTS, Rodrigues NCP, O'Dwyer G, Andrade MKN, Mattos IE, Portela MC. Handgrip Strength and Factors Associated in Poor Elderly Assisted at a Primary Care Unit in Rio de Janeiro, Brazil. PloS One. 2016;11(11):e0166373.,2929 Mihara Y, Matsuda K, Ikebe K, Hatta K, Fukutake M, Enoki K, et al. Association of handgrip strength with various oral functions in 82-to 84-year- old community-dwelling Japanese. Gerodontology. 2018:1-7.].

A Swedish study investigated HGS in one hundred and two functionally independent individuals aged 80 years or older. The authors assessed HGS at two different moments and found that it declined over a four-year period in older men but not in women, albeit with no significant different. Despite this decline, the older men exhibited higher HGS than that of women [3030 Lindblad A, Dahlin-Ivanoff S, Bosaeus I, Rothenberg E. Body composition and hand grip strength in healthy community-dwelling older adults in Sweden. J Aging Res Clin Practice. 2015;4(1):54-8.].

Mihara et al. [2929 Mihara Y, Matsuda K, Ikebe K, Hatta K, Fukutake M, Enoki K, et al. Association of handgrip strength with various oral functions in 82-to 84-year- old community-dwelling Japanese. Gerodontology. 2018:1-7.] investigated the association between HGS and oral functions (occlusal strength, masticatory performance, saliva flow, repetitive saliva swallowing performance, tongue pressure and mouth-opening distance) in octogenarians from a Japanese community. Dynapenia was found in 50.4% of older men and 68.9% in women. HGS was significantly correlated with all the oral functions assessed. The authors reported that since it was a cross-sectional study, a causal relation between HGS and oral functions cannot be confirmed, which opens the possibility for further studies with long-lived individuals.

In the present study, the obese older men had higher self-reported QoL. A similar result was observed by Tavares et al. [3131 Tavares DMS, Bolina AF, Dias FA, Ferreira PCS, Santos NMF. Overweight in rural elderly: association with health conditions and quality of life. Cienc Saude Coletiva. 2018;23(3):913-22.], where overweight older people considered their QoL to be good and obtained higher scores in the social relationships domain; however, they exhibited a lower score in the physical domain of the WHOQoL-bref. The authors reported that this association was related to the high number of morbidities found in the older adults, since excess weight can cause unfavorable health conditions.

When physical activity was observed, only past, present and future activities showed a significant difference (p=0.050) in relation to the positive perceived QoL of older individuals, but no significant difference was found between older women and men or at different PALs.

Guedes et al. [3232 Guedes DP, Hatmann AC, Martini FAN, Borges MBB, Bernardelli Jr R. Quality of life and physical activity in a sample of Brazilian older adults. J Aging Health. 2012;24(2):212-26.] found a significant difference in the average scores of autonomy (p < 0.001) and past, present and future activities (p = 0.002) in favor of the men. When the authors assessed older men and women, sensory abilities and social participation exhibited better self-reported QoL. The authors also observed that physically active older adults obtained higher self-reported QoL in sensory abilities (76.39 for women; 83.26 for men), autonomy (62.13 for women; 71.72 for men) and intimacy (53.84 for women; 63.07 for men), in addition to the overall QoL score (62.27 for women; 70.45 for men).

A study with 850 individuals aged 60 years and older from the rural zone of Uberlândia, Minas Gerais (MG) state showed that active older adults obtained higher average QoL scores in the physical (p<0.001); psychological (p=0.001) and environmental (p<0.001) domains of the WHOQoL-bref. The authors concluded that older people active in leisure activities display better physical and functional conditions when compared to their inactive counterparts [3333 Pegorari MS, Dias FA, Santos NMF, Tavares DMS. Prática de atividade física no lazer entre idosos de área rural: condições de saúde e qualidade de vida. Rev Educ Fis. 2015;26(2):233-41.].

A study with older adults in the Older People in Movement Program in Curitiba, Paraná state also assessed the relation between PAL and QoL. Older subjects that take slow walks obtained good QoL scores, but the moderate to vigorous physical activity group exhibited higher QoL scores in both instruments (WHOQoL-bref and WHOQoL-old) [3434 Vagetti GC, Barbosa Filho VC, Moreira NB, Oliveira V, Mazzardo O, Campos W. The Association Between Physical Activity and Quality of Life Domains Among Older Women. J Aging Phys Activ. 2015;23:524-33.]. The authors suggest that regular physical activity may improve the QoL of older people, in addition to providing benefits for functional capacity and overall health status, thereby contributing to healthier aging. Physical activity should be encouraged in order to provide physiological benefits to the cardiovascular and muscle systems of older adults.

However, in both studies [3333 Pegorari MS, Dias FA, Santos NMF, Tavares DMS. Prática de atividade física no lazer entre idosos de área rural: condições de saúde e qualidade de vida. Rev Educ Fis. 2015;26(2):233-41.,3434 Vagetti GC, Barbosa Filho VC, Moreira NB, Oliveira V, Mazzardo O, Campos W. The Association Between Physical Activity and Quality of Life Domains Among Older Women. J Aging Phys Activ. 2015;23:524-33.] the sample was composed of young-old people not only those aged 80 years and older, making it necessary to determine the relation between the physical activity and quality of life in this specific population. It is known that active older adults perform better in the activities of daily living, primarily those that provide an independent life. Thus, studies on these issues, mainly with long-lived individuals, are needed to enhance their healthcare, given that there is a trend for life expectancy to increase worldwide.

Since this is a cross-sectional study, a cause and effect relation cannot be established between the factors associated with the QoL of older people. A limitation of the study is the higher proportion of women, which may have compromised the investigation of the association with the QoL domain assessed. However, this does not invalidate the results obtained, since this proportion is in line with the distribution of older women in Brazil. Sample size may have influenced the absence of some associations.

Conclusion

Obesity and the absence of dynapenia showed a positive association with the quality of life of long-lived adults. Physical activity was associated with positive quality of life only in the past, present and future activities facet of the WHOQoL-old; however, no significant difference was found between the different physical activity levels. For the older people of the present study, being sedentary, irregularly active, active or very active did not influence the perceived quality of life of this population. There is a need for longitudinal studies with a larger number of long-lived individuals in order to deepen the discussion and investigate the cause-effect relation between physical activity level and quality of life, since cross-sectional studies preclude this analysis.

However, this study revealed relevant factors that may influence the quality of life of long-lived adults. Understanding the multifactorial factors of quality of life in these individuals allow health professionals to make better decisions in relation to actions and strategies that mitigate frailty in older adults.

Acknowledgements

We thank the Coordination for the Improvement of Higher Education Personnel (CAPES), the research team and the study participants.

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Publication Dates

  • Publication in this collection
    07 Sept 2020
  • Date of issue
    2020

History

  • Received
    22 June 2019
  • Accepted
    06 July 2020
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