Functioning and associated factors in older adult users of primary health careABSTRACT
Population aging is a major challenge for public health, society, and policymakers worldwide. This challenge becomes increasingly complex in developing countries. Our research evaluated the functioning and factors associated with clinical and sociodemographic aspects of older adult users of Primary Health Care in Fortaleza city. A cross-sectional analytical study was conducted using the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to measure functioning. Mann-Whitney and Kruskall-Wallis tests were employed for bivariate analyses, along with negative binomial regression for multivariate analysis. Age was associated with the loss of functioning across all WHODAS 2.0 domains (p<0.01). Respondents who presented clinical decompensation related to any comorbidity performed worse in the self-care (p<0.05), school and work activities (p<0.05), life activities (p<0.05), participation (p<0.05), and total domains (p<0.01). Our findings reinforce the key role of Primary Health Care as a strategic space to preserve functioning in the older adult population.
Keywords
Health of the elderly; Aging; Disability studies; Primary health care; Health promotion
RESUMO
O envelhecimento populacional é um importante desafio para a sociedade e para os formuladores de políticas no mundo. Esse desafio se torna ainda mais complexo nos países de média e baixa renda. Assim, neste estudo buscou-se avaliar a funcionalidade e os fatores associados aos aspectos clínicos e sociodemográficos de idosos usuários da Atenção Primária à Saúde. Este é um estudo transversal, analítico, realizado em uma unidade básica de saúde na cidade de Fortaleza (CE). Para avaliar a funcionalidade, foi utilizado o Whodas 2.0. Procedeu-se com os Testes de Mann-Whitne e Kruskall-Wallis para as análises bivariadas e com Análise de Regressão Negativa Binomial para a multivariada. A idade associou-se com a perda da funcionalidade em todos os domínios do Whodas (p<0,01). Os participantes que apresentaram descompensação clínica para alguma comorbidade obtiveram piores desempenhos nos domínios “autocuidado” (p<0,05),” atividades escolares e de trabalho” (p<0,05), “atividades da vida” (p<0,05), “participação” (p<0,05) e no domínio total (p<0,01). Os resultados reforçam o papel estratégico da Atenção Primária à Saúde como espaço estratégico para manter a funcionalidade na população idosa.
Descritores
Saúde do Idoso; Envelhecimento; Estudos sobre Deficiência; Atenção Primária em Saúde; Promoção da Saúde
RESUMEN
El envejecimiento de la población es un gran desafío para la sociedad y para la elaboración de políticas a nivel mundial. Este desafío se vuelve aún más complejo en los países de ingresos medianos y bajos. Así, este estudio buscó evaluar la funcionalidad y los factores asociados a los aspectos clínicos y sociodemográficos de las personas mayores usuarias de atención primaria de salud. Se trata de un estudio analítico transversal realizado en una unidad básica de salud de la ciudad de Fortaleza (Ceará, Brasil). Se utilizó Whodas 2.0 para evaluar la funcionalidad. Se utilizaron las pruebas de Mann-Whitney y de Kruskal-Wallis para el análisis bivariado; y el análisis de regresión binomial negativa para el análisis multivariado. La edad se asoció con la pérdida de funcionalidad en todos los dominios de Whodas (p<0,01). Los participantes que presentaron descompensación clínica por alguna comorbilidad tuvieron peores rendimientos en los dominios “autocuidado” (p<0,05), “actividades escolares y laborales” (p<0,05), “actividades de la vida” (p<0,05), “participación” (p<0,05) y en el dominio total (p<0,01). Los resultados destacan el papel estratégico de la atención primaria de salud como un espacio estratégico para mantener la funcionalidad de la población de los adultos mayores.
Palabras clave
Salud del Anciano; Envejecimiento; Estudios de discapacidad; Atención primaria de salud; Promoción de la salud
INTRODUCTION
Population aging is a major complex challenge for global public health. Data from the World Health Organization (WHO) estimates that about 1.2 billion people will be aged 60 or over by 2025 which would correspond to a fifth of the world’s population1.
Brazil follows this global population aging profile, as according to the Brazilian Institute of Geography and Statistics (IBGE) the percentage of older adults aged 60 and over currently corresponds to 12.9% of the total population, and the latest census projections estimate that this age group will correspond to approximately 24% in 20402. This demographic transition and population aging are accompanied by major challenges for the social security and health systems3. Among the main factors that negatively impact aging are deep social inequality, poverty entrenchment, low education, and mistreatment, in addition to barriers to access of health services4 , 5.
However, the population aging process differs across world regions. In high-income countries, the increase of the older adult population has been accompanied by healthy aging, recognized as the well-being provided by the maintenance of functional capacity at old age6 , 7. In this case, the ease of access to social and health resources appears to have behaved as protective factors against disability and dependence in this population8.
In middle- and low-income countries, the aging process is characterized by a higher prevalence of chronic diseases which often negatively impact autonomy and independence, consequently reducing the functioning of the older adult population9. The most prevalent comorbidities in this population include hypertension, heart disease, arthritis, diabetes, lung diseases, cancer, and depression. All these conditions are potentially disabling, incurring an increased risk of mortality10. Use of continuous treatment, frequently polypharmacy, characterized by the use of potentially inappropriate medications at home by older adults can lead to adverse effects such as reduced functioning11.
Functioning is a generic term that indicates the positive aspects of one’s interaction with contextual factors (personal and environmental), and is conceived as an interactive process between its components (body functions and structures, activity, participation, environmental, and personal factors)12. The term was introduced by WHO and made official with the publication of the International Classification of Functioning, Disability and Health (ICF)13. Notably, the use of functioning in generating health indicators has been discussed, as information on deaths (mortality) and occurrence of diseases (morbidities) may not provide sufficient indicators to express the population’s demand for health services. Knowing how many people die or are affected by certain diseases is insufficient; we must know the impact associated with these diseases on people’s lives, information that would be crucial for countries with equitable health systems like Brazil14.
To ensure the practical application of the ICF model, WHO proposed the World Health Organization Disability Assessment Schedule (WHODAS 2.0), an instrument to measure functioning in various populations due to its generic, standardized, and easy-to-apply nature15. Additionally, it has been used to assess functioning in populations with the most varied health issues, including inflammatory diseases, strokes, psychiatric, skeletal, cardiac, and neurological disorders, as well as in populations without a specific health condition16 , 17. By providing information on the functioning level of Primary Health Care users, WHODAS 2.0 enables better planning of health actions relevant to the target population, allowing to provide a patient-centered health care that is not only curative, but also preventive and to improve quality of life18.
In Brazil, some studies have employed WHODAS 2.0 as an assessment tool for the older adult population with various objectives, including investigating its normative data to assess disability19, analyzing the association of socioeconomic and demographic factors with frailty5, and even estimating the prevalence and factors associated with functional dependence20. However, research seeking to assess functioning and its associated factors in older adults using Primary Health Care, as well as general studies conducted in low-income countries, are still scarce21. This study evaluated the functioning and factors associated with clinical and sociodemographic aspects of older adult users of Primary Health Care in a large capital city in northeast Brazil.
METHODOLOGY
Study type and location
This is a cross-sectional, analytical study conducted with older adult users of Primary Health Care in Fortaleza city, Ceará, Brazil. Data collection took place from April to September 2019 in a Primary Health Care Center (PHC) that serves approximately 22,000 inhabitants. Of these, 5,567 are older adults, and more than a quarter are registered and seek care at the unit21. Importantly, this study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines22.
Population, inclusion and exclusion criteria
Our study population consisted of older adults aged 60 years or older of all genders23 selected through convenience sampling, totaling 182 participants. They were approached as soon as they visited the PHC for a scheduled medical appointment or on spontaneous demand. Thus, for logistical reasons during collection, they made up the study sample.
Older adults with significant cognitive impairment assessed by the Mini-Mental State Examination (MMSE) were excluded. MMSE comprises 30 points and assesses the following dimensions: spatial and temporal orientation, registration, attention and calculation, recall, language, and constructive ability24, for which the following cut-off points were adopted: a minimum of 24 points for older adults with four or more years of schooling and a minimum of 17 points for older adults with less than four years of schooling24.
Instruments and variables collected
A three-block questionnaire based on the individual registration form of the e-SUS Primary Care strategy (e-SUS AB), a tool for recording patient data on the Primary Care Health Information System (SISAB), was employed. Data collection was performed via interviews by a healthcare professional trained for this procedure.
The first block of questions addressed the socioeconomic characteristics of the study population, containing the following variables: ‘gender,’ ‘age’ (60-70 years; 71-79 years; ≥80 years), ‘ethnicity/race’ (White, Mixed-race, Black), ‘schooling’ (illiterate; complete primary education; complete secondary education; tertiary education), ‘marital status’ (single/divorced; married/stable union; widowed), ‘religion’ (yes/no), ‘monthly income’ (up to 1 minimum wage; 1 to 3 minimum wages; >3 minimum wages), ‘smoking habit’ (yes/no), ‘frequent alcohol consumption’ (yes/no), and ‘employment status’ (employed; self-employed; retiree/pensioner; unemployed).
The second block addressed clinical aspects and comorbidities. The variable ‘clinical decompensation related to any comorbidity,’ characterized by an acute worsening of chronic disease symptoms and no improvement up to the interview date, was categorized by clinical medical assessment performed upon instrument application and then dichotomized (yes/no). ‘Number of comorbidities’ (1, 2, 3, >4) and the ‘number of medications used at the time of collection’ (none; 1 to 4; >5) were also investigated.
Finally, the third block comprised the WHODAS 2.0 six life domains: cognition, mobility, self-care, getting along, life activities, and participation, assessed via questions answered by the individual. WHODAS 2.0 has been tested in various cultures and is available in over 30 languages. Studies conducted during its development covered 19 countries with diverse populations and levels of health25. Among its strengths are its direct correlation with the ICF and the availability of solid psychometric properties. WHODAS 2.0 is available in three versions: the longest, with 36 items; a shorter one, with 12 items; and a mixed version, in which the 12 questions from the short version are answered with an option to add up to 24 more questions if changes are reported. In the present study, an interviewer administered the 36-item version so that the results could be better read and understood. WHODAS 2.0 enables the quantification of individuals’ functioning profiles across its domains, with guidelines and application instructions available free of charge25. It has already been validated for use among older adults in Brazil19 , 26 and has been adopted in various research with the same population group worldwide27 - 29. Analysis of WHODAS 2.0 answers yields scores for each of its domains ranging from 0 (best functioning) to 100 (worst functioning). Scoring can follow either a simple or complex method which assigns different weights to responses for more significant questions, also enabling comparisons between different groups18. This study adopted complex scoring.
This project was approved by the Research Ethics Committee under opinion number 3,212,748.
Data analysis
After entering the questionnaires using double data entry to ensure accuracy and internal consistency, the database was adjusted to correct inconsistencies in WHODAS 2.0, as suggested in the literature30.
Sample characteristics were presented by simple frequency distribution for all nominal variables. Medians and interquartile ranges were employed for numerical variables. Bivariate analysis was performed using the Mann-Whitney test for dichotomous variables, and the Kruskal-Wallis test for variables with more than two categories, given their non-parametric distribution. Variables with statistical significance of up to 20% were included in the final model employing negative binomial regression analysis. Confidence intervals, incidence rate ratios, and p-values were reported for both the crude and adjusted models. All analyses used the Stata® software, version 12.0.
RESULTS
Table 1 presents the study sample characteristics. Most participants were women (67%) between60 and 70 years old (33.5%). Only 10.5% were over 80 years of age. Regarding schooling level, 51% have completed primary education and 14.1% declared themselves illiterate. Over half (53.5%) reported a monthly income of up to one minimum wage and more than two-thirds are retirees or pensioners. Due to the established criteria, 12 patients were excluded from the study, resulting in a total of 170 participants.
Sociodemographic characteristics of older adults treated at a Primary Healthcare Center in Fortaleza city, CE, 2019
Table 2 presents the clinical and comorbidity aspects. Over half of the participants (51.1%) reported clinical decompensation in at least one comorbidity. Just over 69% were diagnosed with two or more comorbidities and 60% use one to four medications daily. Approximately 12% of the participants reported frequent alcohol consumption and smoking habits. Slightly more than one-third (36.4%) reported regular physical activity.
Sociodemographic characteristics of older adults treated at a Primary Healthcare Center in Fortaleza city, CE, 2019
Table 3 presents the medians and interquartile ranges for each of the six domains assessed by WHODAS 2.0. Participants had greater difficulty in performing activities related to the ‘mobility’ and ‘participation’ domains. No reduced functioning was observed in the ‘self-care’ and ‘getting along’ domains. The median of the total score shows that, in general, there is a low functioning level among the older adults studied.
Medians and Interquartile Ranges of the WHODAS 2.0 domains of older adults treated at a Primary Healthcare Center in Fortaleza city, CE, 2019
Table 4 shows the distribution of medians and variances of the WHODAS 2.0 scores according to socioeconomic factors, clinical aspects, and comorbidities of the studied older adults. Among these characteristics, age was statistically significant across all WHODAS 2.0 domains (p<0.01). Schooling level was associated with the domains of ‘cognition’ (p<0.01), ‘school and work activities’ (p<0.01), ‘life activities’ (p<0.01), ‘participation’ (p<0.01), and the total domain (p<0.01). Participants who showed clinical decompensation related to any comorbidity performed worse in the ‘self-care’ (p<0.05), ‘school and work activities’ (p<0.05), ‘life activities’ (p<0.05), ‘participation’ (p<0.05), and total domains (p<0.01). The number of comorbidities was associated with a decline in ‘getting along’ (p<0.01), ‘participation’ (p<0.01), and total (p<0.01) domains. The number of medications was associated with almost all WHODAS 2.0 domains (p<0.01), except for self-care and getting along.
Table 5 summarizes the binomial negative regression analysis for the crude and adjusted models. In the final model, considering the total WHODAS 2.0 domain, the following variables were identified as risk factors for functional impairment: being over 80 years old (IRR: 1.97; 95%CI: 1.39-2.79); living alone (IRR:1.39; 95%CI: 1.03-1.86); using five or more medications (IRR: 2.01; 95%CI: 1.10-3.67); having smoking habit (IRR: 1.48; 95%CI: 1.01-2.17); and having at least three or more comorbidities (IRR: 1.48; 95%CI: 1.07-2.05). In-depth analysis of the final model showed that some variables remained statistically associated with decreased functioning in most WHODAS 2.0 domains, behaving as important risk factors for the study population. These included being over 80 years old, being Black or Mixed-race, and total number of medications being used.
DISCUSSION
Our results showed important associations between schooling levels and functioning impairment in older adults. These findings are highly relevant, particularly for two reasons: they demonstrate that functioning can be hindered by various factors beyond the physical/motor dimension, highlighting its complex and multidimensional nature; and they reinforce the hypothesis that factors related to social inequalities contribute to poorer functioning levels in the population5 , 19 , 31. In Brazil, other studies conducted with older adults have also identified the impact of socioeconomic characteristics like schooling, income, and gender, on functioning impairment32 , 33.
We found that men over 80 years of age exhibited higher chances of impaired functioning. Among the explanatory factors, reduced functioning was associated with a decrease in independence and autonomy to perform activities of daily living. In this regard, the international literature evinces the association between being a man, aged 85 years or older, and the occurrence of domestic accidents like falls34. Additionally, people over 80 years old are more susceptible to vulnerabilities35. These data can contribute to Primary Health Care, especially in identifying the most vulnerable groups of older adults. This broadens the possibilities for multiprofessional interventions by means of health promotion activities and accident prevention strategies for this population.
In our study, individuals who presented clinical decompensation related to any comorbidity were associated with decreased functioning, concurring with findings identified in similar studies conducted in Portugal34 and in Brazil3. Additionally, they align with other studies that have associated aging to a higher prevalence of chronic diseases and the inability to perform activities of daily living. International studies show that individuals with severe chronic diseases are more likely to suffer reduced functioning36, and that the decrease in functional capacity may be associated with the occurrence of chronic diseases like depression37. This highlights the need to plan policies specifically aimed at individuals with chronic diseases aiming to reduce functional decline. Primary Health Care can be a particularly favorable field for these actions or policies, as it represents users’ primary point of contact with the health system.
Use of medications was associated with greater functioning impairment among the study participants, a relevant result as over 85% of Brazilian older adults have at least one chronic disease38. Additionally, polypharmacy negatively impacts the quality of life of this population, and can represent a worsening of quality of life in 75.3% of cases36. Polypharmacy was also associated with greater vulnerability in older adults, as they are more susceptible to the adverse effects of medications and interactions between various types of drugs39. As such, there is a need for integrated interprofessional actions strongly associated with pharmaceutical services to ensure adequate healthcare with minimal harm to those assisted.
We also draw attention to the association between sedentary lifestyle and loss of functioning among older adults. A survey conducted with 1,395 older adults in Finland found that inactive participants had low functioning levels when compared with those who exercised at least twice a week40. In Brazil, a study conducted in six municipalities showed that, in addition to a sedentary lifestyle, low family income was also associated with decreased functional capacity41.
It is well stablished that practicing regular physical activities has a positive impact on improving quality of life and reducing the consumption of continuous prescription drugs in older adults. Adopting physical exercise programs is efficient in preventing functional and cognitive losses42. Resistance training, for example, improve the physical performance of older adults by increasing strength and muscle mass, reducing episodes of falls, improving physical symptoms, mobility, equilibrium, body mass, and functioning43. Additionally, aerobic exercises show cognitive improvements among patients with dementia44. Thus, physical activity promotion can be a strategy for minimizing functioning-related losses among older adults. Considering the primary care context of the present study, the promotion of physical activity groups for older adults might be a promising intervention45.
We highlight the relation between participation and factors such as gender, age, income, level of physical activity, comorbidities, and use of medications which have already been reported in the literature as associated with changes in participation among older adults46 - 49. Healthcare professionals and managers should make efforts to reduce the impact of these variables on the participation of older adults. Moreover, health actions and policies could be designed and directed specifically at this group since their characteristics are clearly outlined. Another important observation regarding these results is the evidence that social determinants of health (such as income and gender) can act together with behaviors (levels of physical activity) and biological (sex and age) and clinical (comorbidities and use of medications) variables, composing a multifactorial framework that impact the participation of older adults. This finding suggests that one-factor interventions may be insufficient to address the issue.
This set of findings reinforce the importance of health promotion and disease prevention actions as effective strategies to maintain functioning in older adults. In this regard, Primary Health Care assumes a strategic role considering the wide range of multiprofessional activities that can be developed for this population. On the other hand, healthcare professionals should aim to encourage the execution of these activities, seeking to promote a healthy culture that goes beyond medication. Additionally, our findings, together with information already published, reinforce the need for a more consistent and complex approach to the topic in Brazil. Actions foreseen by the Brazilian National Health Promotion Policy could be encouraged, especially in the section related to body practice and physical activity50.
The strengths of this study include the use of WHODAS 2.0, a reliable questionnaire for measuring functioning that can be employed under various health conditions and applied to large sample sizes. However, the study presents limitations, such as the study sample which was chosen for convenience and composed of users of only one PHC in a capital city, resulting in sample profile heterogeneity in variables like gender and age, characteristic of the population studied.
CONCLUSION
Our findings show the impact of clinical and sociodemographic variables on functioning, represented by WHODAS 2.0 domains: cognition (gender, age, schooling, smoking habit, frequent alcohol consumption, and number of medications used); mobility (gender, age, smoking habit, frequent alcohol consumption, physical activity, and number of medications used); self-care (age, smoking habit, and clinical decompensation related to any comorbidity); getting along (age and number of comorbidities); domestic activities (gender, age, physical activity, and number of medications used); school or work activities (age, schooling, physical activity, number of medications used, and clinical decompensation related to any comorbidity); life activities (age, schooling, physical activity, number of medications used, and clinical decompensation related to any comorbidity); and participation (gender, age, monthly income, physical activity, number of comorbidities, number of medications used, and clinical decompensation related to any morbidity).
Moreover, this study contributes to the field of health research by presenting a functioning profile of older adult users of Primary Health Care, information that enables the design of studies that are more aligned with the user profile, thus increasing the reliability of the knowledge produced. Public administrators in charge of primary care settings can benefit from this study in planning a service that is more consistent with the demands and health condition of the older adult population, thus respecting the precept of equity in health. Consequently, patients would receive patient-centered healthcare services.
REFERENCES
-
1. 1. OMS. Organização Mundial da Saúde. Relatório mundial de envelhecimento e saúde [Internet]. Brasília, DF; 2005 [cited 2024 Dez 18]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/envelhecimento_ativo.pdf
» https://bvsms.saude.gov.br/bvs/publicacoes/envelhecimento_ativo.pdf -
2. 2. IBGE. Instituto Brasileiro de Geografia e Estatística. Fortaleza [Internet]. 2023 [cited 2024 Dez 18]. Available from: https://cidades.ibge.gov.br/brasil/ce/fortaleza/panorama
» https://cidades.ibge.gov.br/brasil/ce/fortaleza/panorama -
3. Cruz DT, Vieira MT, Bastos RR, Leite ICG. Factors associated with frailty in a community-dwelling population of older adults. Rev Saude Publica. 2017;51:106. doi: 10.11606/S1518-8787.2017051007098
» https://doi.org/10.11606/S1518-8787.2017051007098 -
4. WHOQOL. The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med. 1995;41:1403-9. doi: 10.1016/0277-9536(95)00112-K
» https://doi.org/10.1016/0277-9536(95)00112-K -
5. Cruz DT, Leite ICG. Falls and associated factors among elderly persons residing in the community. Rev Bras Geriatr Gerontol. 2018;21:551-61. doi: 10.1590/1981-22562018021.180034
» https://doi.org/10.1590/1981-22562018021.180034 -
6. Chatterji S, Byles J, Cutler D, Seeman T, Verdes E. Health, functioning, and disability in older adults: present status and future implications. Lancet. 2015;385(9967):563-75. doi: 10.1016/S0140-6736(14)61462-8
» https://doi.org/10.1016/S0140-6736(14)61462-8 -
7. Lima-Costa MF, Facchini LA, Matos DL, Macinko J. Mudanças em dez anos das desigualdades sociais em saúde dos idosos brasileiros (1998-2008). Rev Saude Publica. 2012;46(Suppl 2):100-7. doi: 10.1590/S0034-89102012005000059
» https://doi.org/10.1590/S0034-89102012005000059 -
8. Virues-Ortega J, Vega S, Seijo-Martinez M, Saz P, Rodriguez F, et al. A protective personal factor against disability and dependence in the elderly: an ordinal regression analysis with nine geographically-defined samples from Spain. BMC Geriatr. 2017;17:42. doi: 10.1186/s12877-016-0409-9
» https://doi.org/10.1186/s12877-016-0409-9 -
9. Beard JR, Officer AM, Carvalho IA, Sadana R, Pot AM. The world report on ageing and health. Gerontologist. 2016; 387(10033):2145-2154. doi: 10.1016/S0140-6736(15)00516-4
» https://doi.org/10.1016/S0140-6736(15)00516-4 -
10. Porciúncula RCR, Carvalho EF, Barreto KML, Leite VMM. Perfil socioepidemiológico e autonomia de longevos em Recife-PE, Nordeste do Brasil. Rev Bras Geriatr Gerontol. 2014;17:315-25. doi: 10.1590/S1809-98232014000200009
» https://doi.org/10.1590/S1809-98232014000200009 -
11. Lopes LM, Figueiredo TP, Costa SC, Reis AMM. Utilização de medicamentos potencialmente inapropriados por idosos em domicílio. Cien Saude Colet. 2016;21(11):3429-38. doi: 10.1590/1413-812320152111.14302015
» https://doi.org/10.1590/1413-812320152111.14302015 - 12. OMS. Organização Mundial da Saúde. Classificação internacional de funcionalidade, incapacidade e saúde: CIF. São Paulo: Edusp; 2015.
-
13. Barreto MCA, Andrade FG, Castaneda L, Castro SS. A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) como dicionário unificador de termos. Acta Fisiátr. 2021;28(3):207-13. doi: 10.11606/issn.2317-0190.v28i3a188487
» https://doi.org/10.11606/issn.2317-0190.v28i3a188487 -
14. Stucki G, Bickenbach J. Functioning: the third health indicator in the health system and the key indicator for rehabilitation. Eur J Phys Rehabil Med. 2017;53:134-8. doi: 10.23736/S1973-9087.17.04565-8
» https://doi.org/10.23736/S1973-9087.17.04565-8 -
15. 15. Castro SS, Leite CF, Baldin JE, Accioly MF. Validation of the Brazilian version of Whodas 2.0 in patients on hemodialysis therapy. Fisioter Mov. 2018;31:e003130. doi:10.1590/1980-5918.031.ao30
» https://doi.org/10.1590/1980-5918.031.ao30 -
16. Carlozzi NE, Kratz AL, Downing NR, Goodnight S, Miner JA, et al. Validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (Whodas 2.0) in individuals with Huntington disease (HD). Qual Life Res. 2015;24:1963-71. doi: 10.1007/s11136-015-0930-x
» https://doi.org/10.1007/s11136-015-0930-x -
17. Magistrale G, Pisani V, Argento O, Inceti CC, Bozzali M, et al. Validation of the World Health Organization Disability Assessment Schedule II (Whodas-II) in patients with multiple sclerosis. Mult Scler. 2015;21(4):448-56. doi: 10.1177/1352458514543732
» https://doi.org/10.1177/1352458514543732 -
18. 18. Castro SS, Leite CF, editores. Avaliação de saúde e deficiência manual do WHO Disability Assessment Schedule Whodas 2.0. [Internet]. 2015 [cited 2024 Dez 18]. Available from: https://iris.who.int/bitstream/handle/10665/43974/9788562599514_por.pdf
» https://iris.who.int/bitstream/handle/10665/43974/9788562599514_por.pdf -
19. Ferrer MLP, Perracini MR, Rebustini F, Buchalla CM. Whodas 2.0-BO: normative data for the assessment of disability in older adults. Rev Saude Publica. 2019;53:19. doi: 10.11606/S1518-8787.2019053000586
» https://doi.org/10.11606/S1518-8787.2019053000586 -
20. Pinto Junior EP, Silva IT, Vilela ABA, Casotti C, Pinto FJM, et al. Dependência funcional e fatores associados em idosos corresidentes. Cad Saude Colet. 2016;24:404-12. doi: 10.1590/1414-462X201600040229
» https://doi.org/10.1590/1414-462X201600040229 - 21. Fortaleza. Secretaria Municipal de Saúde. Plano Municipal de Saúde de Fortaleza 2018-2021. Fortaleza; 2018.
-
22. Ebrahim S, Clarke M. Strobe: new standards for reporting observational epidemiology, a chance to improve. Int J Epidemiol. 2007;36:946-8. doi: 10.1093/ije/dym246
» https://doi.org/10.1093/ije/dym246 -
23. 23. Brasil. Lei n° 14.423, de 22 de julho de 2022. Diário Oficial da União [Internet]. 2022 Jul 25 [cited 2024 Dez 18]. Available from: https://www.planalto.gov.br/ccivil_03/\_Ato2019-2022/2022/Lei/L14423.htm
» https://www.planalto.gov.br/ccivil_03/\_Ato2019-2022/2022/Lei/L14423.htm -
24. Melo DM, Barbosa AJG. O uso do Mini-Exame do Estado Mental em pesquisas com idosos no Brasil: uma revisão sistemática. Cienc Saude Colet. 2015;20:3865-76. doi: 10.1590/1413-812320152012.06032015
» https://doi.org/10.1590/1413-812320152012.06032015 -
25. Castro SS, Leite CF. Translation and cross-cultural adaptation of the World Health Organization Disability Assessment Schedule: WHODAS 2.0. Fisioter Pesqui. 2017;24:385-91. doi: 10.1590/1809-2950/17118724042017
» https://doi.org/10.1590/1809-2950/17118724042017 -
26. Grou TC, Castro SS, Leite CF, Leite CF, Carvalho MT, et al. Validação da versão brasileira do World Health Organization Disability Assessment Schedule 2.0 em idosos institucionalizados. Fisioter Pesqui. 2021;28(1):77-87. doi: 10.1590/1809-2950/20024628012021
» https://doi.org/10.1590/1809-2950/20024628012021 -
27. Almazán-Isla J, Comín-Comín M, Damián J, Alcalde-Cabero E, Ruiz C, et al. Analysis of disability using Whodas 2.0 among the middle-aged and elderly in Cinco Villas, Spain. Disabil Health J. 2014;7:78-87. doi: 10.1016/j.dhjo.2013.08.004
» https://doi.org/10.1016/j.dhjo.2013.08.004 -
28. Ćwirlej-Sozańska A, Wilmowska-Pietruszyńska A. Assessment of health, functioning and disability of a population aged 60-70 in south-eastern Poland using the WHO Disability Assessment Schedule (Whodas 2.0). Ann Agric Environ Med. 2018;25:124-30. doi: 10.5604/12321966.1228392
» https://doi.org/10.5604/12321966.1228392 -
29. Salinas-Rodríguez A, Rivera-Almaraz A, Scott A, Manrique-Espinoza B. Severity levels of disability among older adults in low and middle-income countries: Results from the study on global ageing and adult health (Sage). Front Med (Lausanne). 2020;7:562963. doi: 10.3389/fmed.2020.562963
» https://doi.org/10.3389/fmed.2020.562963 -
30. Castro SS, Leite CF, Coenen M, Buchalla CM. The World Health Organization Disability Assessment Schedule 2 (Whodas 2.0): remarks on the need to revise the Whodas. Cad Saude Publica. 2019;35. doi: 10.1590/0102-311x00000519
» https://doi.org/10.1590/0102-311x00000519 -
31. Gale CR, Cooper C, Aihie Sayer A. Prevalence of frailty and disability: findings from the English longitudinal study of ageing. Age Ageing. 2015;44:162-5. doi: 10.1093/ageing/afu148
» https://doi.org/10.1093/ageing/afu148 -
32. Lopes GL, Santos MIPO. Funcionalidade de idosos cadastrados em uma unidade da Estratégia Saúde da Família segundo categorias da Classificação Internacional de Funcionalidade. Rev Bras Geriatr Gerontol. 2015;18:71-83. doi: 10.1590/1809-9823.2015.14013
» https://doi.org/10.1590/1809-9823.2015.14013 - 33. Paula AFM, Ribeiro LHM, D’Elboux MJ, Guariento ME. Avaliação da capacidade funcional, cognição e sintomatologia depressiva em idosos atendidos em ambulatório de Geriatria. Rev Bras Clin Med. 2013; 11(3):212-8.
-
34. Fontes AP, Botelho MA, Fernandes AA. A funcionalidade dos mais idosos (>75 anos): conceitos, perfis e oportunidades de um grupo heterogêneo. Rev Bras Geriatr Gerontol. 2013;16:91-107. doi: 10.1590/S1809-98232013000100010
» https://doi.org/10.1590/S1809-98232013000100010 -
35. Cabral JF, Silva AMC, Mattos IE, Neves AQ, Luz LL, et al. Vulnerabilidade e fatores associados em idosos atendidos pela Estratégia Saúde da Família. Cien Saude Colet. 2019;24:3227-36. doi: 10.1590/1413-81232018249.22962017
» https://doi.org/10.1590/1413-81232018249.22962017 -
36. Tegegn HG, Erku DA, Sebsibe G, Gizaw B, Seifu D, et al. Medication-related quality of life among Ethiopian elderly patients with polypharmacy: a cross-sectional study in an Ethiopia university hospital. PLoS One. 2019;14:e0214191. doi: 10.1371/journal.pone.0214191
» https://doi.org/10.1371/journal.pone.0214191 -
37. Klompstra L, Ekdahl AW, Krevers B, Milberg A, Eckerblad J. Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period. BMC Geriatr. 2019;19:187. doi: 10.1186/s12877-019-1194-z
» https://doi.org/10.1186/s12877-019-1194-z -
38. Martins GA, Acurcio FA, Franceschini SCC, Priore SE, Ribeiro AQ. Uso de medicamentos potencialmente inadequados entre idosos do município de Viçosa, Minas Gerais, Brasil: um inquérito de base populacional. Cad Saude Publica. 2015;31(11):2401-12. doi: 10.1590/0102-311X00128214
» https://doi.org/10.1590/0102-311X00128214 -
39. Almeida NA, Reiners AAO, Azevedo RCS, Silva AMC, Cardoso JDC, et al. Prevalence of and factors associated with polypharmacy among elderly persons resident in the community. Rev Bras Geriatr Gerontol. 2017;20:138-48. doi: 10.1590/1981-22562017020.160086
» https://doi.org/10.1590/1981-22562017020.160086 -
40. Sulander T. The association of functional capacity with health-related behavior among urban home-dwelling older adults. Arch Gerontol Geriatr. 2011;52:e11-e14. doi: 10.1016/j.archger.2010.03.018
» https://doi.org/10.1016/j.archger.2010.03.018 -
41. Ribeiro LHM, Neri AL. Exercícios físicos, força muscular e atividades de vida diária em mulheres idosas. Cienc Saude Colet. 2012;17:2169-80. doi: 10.1590/S1413-81232012000800027
» https://doi.org/10.1590/S1413-81232012000800027 -
42. Rodriguez-Larrad A, Arrieta H, Rezola C, Kortajarena M, Yanguas, JJ, et al. Effectiveness of a multicomponent exercise program in the attenuation of frailty in long-term nursing home residents: study protocol for a randomized clinical controlled trial. BMC Geriatr. 2017;17:60. doi: 10.1186/s12877-017-0453-0
» https://doi.org/10.1186/s12877-017-0453-0 -
43. Kidd T, Mold F, Jones C, Ream E, Grosvenor W, et al. What are the most effective interventions to improve physical performance in pre-frail and frail adults? A systematic review of randomised control trials. BMC Geriatr. 2019;19:184. doi: 10.1186/s12877-019-1196-x
» https://doi.org/10.1186/s12877-019-1196-x -
44. Jia R, Liang J, Xu Y, Xu Y, Wang YQ. Effects of physical activity and exercise on the cognitive function of patients with Alzheimer disease: a meta-analysis. BMC Geriatr. 2019;19:181. doi: 10.1186/s12877-019-1175-2
» https://doi.org/10.1186/s12877-019-1175-2 -
45. Sá PHVO, Cury GC, Ribeiro LCC. Atividade física de idosos e a promoção da saúde nas unidades básicas. Trab Educ Saúde. 2016;14:545-58. doi: 10.1590/1981-7746-sip00117
» https://doi.org/10.1590/1981-7746-sip00117 -
46. Park SM, Jang SN, Kim DH. Gender differences as factors in successful ageing: a focus on socioeconomic status. J Biosoc Sci. 2010;42:99-111. doi: 10.1017/S0021932009990204
» https://doi.org/10.1017/S0021932009990204 -
47. Ma R, Romano E, Vancampfort D, Firth J, Stubbs B, et al. Physical multimorbidity and social participation in adult aged 65 years and older from six low- and middle-income countries. J Gerontol: Series B. 2021;76:1452-62. doi: 10.1093/geronb/gbab056
» https://doi.org/10.1093/geronb/gbab056 -
48. Yokote T, Yatsugi H, Chu T, Liu X, Kishimoto H. Associations between various types of activity and physical frailty in older Japanese: a cross-sectional study. BMC Geriatr. 2023;23(1):785. doi: 10.1186/s12877-023-04501-0
» https://doi.org/10.1186/s12877-023-04501-0 -
49. Murphy TE, McAvay GJ, Agogo GO, Allone HG. Personalized and typical concurrent risk of limitations in social activity and mobility in older persons with multiple chronic conditions and polypharmacy. Ann Epidemiol. 2019;37:24-30. doi: 10.1016/j.annepidem.2019.08.001
» https://doi.org/10.1016/j.annepidem.2019.08.001 - 50. Brasil. Ministério da Saúde. Política Nacional de Promoção da Saúde. Brasília, DF; 2006.
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Financing source: nothing to declare
Publication Dates
-
Publication in this collection
14 Apr 2025 -
Date of issue
2025
History
-
Received
01 Dec 2023 -
Accepted
23 Dec 2024
