Use of the activities and participation profile to assess the functioning of physically inactive elderly

Introduction: Physical inactivity negatively impacts the functional status of the elderly during aging. Objective: To describe the activity and participation profile of physically inactive elderly and to investigate associated factors. Methods: A cross-sectional study with physically inactive elderly, aged ≥ 60 years, both sexes, with good cognitive function and independent gait. Personal factors, clinical history, history of falls in the last year, and identification of activity and participation profiles were investigated. Nonparametric statistical tests (SPSS 20.0) were performed, considering p < 0.05 significant. Results: The elderly (n = 36) had a mean age of 72.5 years (±7.7). Most were women (78%), with one to four years of education (69%), retired (72%), referring episodes of falling (58%) and affected by two to four comorbidities (53%). In the activities and participation profile, most of the physically inactive elderly presented mild problems for: crawling, kneeling, squatting, walking long distances, walking on different surfaces, walking around obstacles, climbing, and using public transportation. However, kneeling, squatting, walking on different surfaces, and climbing represented higher percentages of elderly who presented some problem. The advancement of age (p = 0.045), female sex (p = 0.022), episodes of falls (p = 0.037), and comorbidities (p = 0.031) were identified as factors that can impact functioning. Conclusion: The physically inactive elderly presented a mild problem in activities and participation items that are more related to strength and walking. Elderly aged over 70, female, with episodes of falls and comorbidities were significantly associated with reduced or impaired functioning.


Introduction
An increase in life expectancy has been occurring at an accelerated rate in many countries in recent years. A prolonged life span may be accompanied by several changes in the structure and function of body systems, causing changes in the behavior of this population. 1 Understanding the health-related problems of the elderly becomes essential to adapt health care to their needs. 2 Elderly people may present health problems with a predominance of chronic non-communicable diseases, which can impact autonomy, increasing the degree of dependence and disability. [3][4][5] In the field of gerontology, assessing functional status is as important as assessing the other diseases that impact this population. The identification of a potential impairment profile facilitates the selection of preventive strategies and can prolong the onset of physical frailty that occurs at advanced ages, contributing to the establishment of early interventions. 1,6,7 The loss of body functions for the elderly population results in drastic consequences and undesirable events such as organic alterations, susceptibility to falls, and social isolation. Furthermore, the level of inactivity is increased, which is a factor of great concern, as the elderly often have insufficient activity levels. 6 This extreme inactive behavior reduces functioning, resulting from decreased functional mobility and an inability to perform tasks, directly impacting well-being and quality of life. 1,6 Several instruments are used to assess functional status in this specific group, however, lack of standardized instruments with a good level of accuracy for use in studies leads to difficulty in obtaining health measures for older people. 8 A recognized tool to describe functioning is the International Classification of Functioning, Disability and Health (ICF), published by the World Health Organization (WHO), which intends to unify a system for coding health information, with a standardized language that enables global health communication. 8,9 This tool addresses several aspects related to In chapter 4 of the ICF (WHO), the "activities and participation" component, deals with all aspects related to mobility, which is fundamental for healthy aging are adressed. 11 A decline in mobility is associated with decreased functioning, 11 and assessing these driving motorized vehicles.
Each APP item is scorable using a range from zero to four. The sum of the scores ranges from 0 to 100, and the corresponding score is obtained by dividing the

Results
A total of 85 elderly individuals were interviewed, of which 49 were excluded for not meeting the eligibility criteria. Therefore, 36 elderly individuals were included in the data analysis, with a mean age of 72.5 (± 7.7) years (range of 60 to 90 years), predominantly female (78%), with one to four years of schooling (69%), retired (72%), reporting a fall in the last year (58%), and having two to four comorbidities (53%) ( Table 1).
The scores obtained by the APP showed that the elderly presented mild problems for the following items: crawling, kneeling, squatting, walking long distances, walking on different surfaces, walking around obstacles, climbing, and using public transportation.
Study participants showed no problems executing the requested tasks for remaining items of the APP. None of the APP activities were classified as a "complete problem". The item, driving motorized vehicles, received a score of 9 (not applicable) in 32 elderly subjects (89%).
No item on the APP received a score of 8 (not specified) ( Table 2).
Clearly, many older adults experience driving anxiety and self-limit their driving with age or development of    Our study also indicated the consistency of a recurrent profile in research in the Brazilian context, with a predominance of females (78%), characterizing a process known in gerontology as the feminization of old age. Some of the explanations for this phenomenon are due to women's tendency to have a lower-risk job, lower percentages of violent deaths (accidents and murders), less alcohol and tobacco consumption, and a greater concern with their own health, with more positive attitudes towards self-care. 1 Regarding functioning, in general, women present higher levels of problems, as confirmed in the APP when compared to men. 1,27 The study by Pinheiro et al. 24 showed that elderly women presented functional decline with age, especially in aspects related to mobility and flexibility, corroborating our findings in which 100% of the women had difficulty in completing the tasks of kneeling and squatting.
A study with a sample composed of 63.1% elderly women with characteristics similar to those of the Studies developed by Pinheiro et al. 24 and Alves et al. 30 showed that a greater need for assistance in activities of daily living is associated with an increased risk of falls.
One study reported that those who had history of falls and could not get up without help were more likely to experience functional decline than those who had no history of falls or who had a history of falls but could get up without help. 35 When the event of falls was related to the performance in the APP, the elderly who had already experienced at least one episode of falling were almost thirteen times more likely to have mild difficulty in performing activities, negatively impacting functioning and highlighting the importance of assessing functional impairment, especially in the older population with a history of falling.
As the main limitation of this study, we point to the type of sample (intentional, non-probabilistic) and