Factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil

Cabral, Juliana Fernandes; Galvão, Noemi Dreyer; Andrade, Amanda Cristina de Souza; Silva, Ageo Mário Cândido da

doi:10.1590/1980-549720220019.supl.1

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Revista Brasileira de Epidemiologia

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Original Article • Rev. bras. Epidemiol. 25 (Supl 1) • 2022 • https://doi.org/10.1590/1980-549720220019.supl.1 copy

Factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To analyze factors associated with functional disability in older adults with cancer treated at reference outpatient clinics in the state of Mato Grosso, Brazil.

Methods:

This is a cross-sectional study of 463 older adults aged 60 years or older. The outcome variable was functional disability, evaluated by Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale. The independent variables were sociodemographic characteristics, lifestyle, social support, and health aspects. We performed bivariate and multivariate analyses and calculated prevalence ratios (PR) using Poisson regression with robust variance.

Results:

The prevalence of IADL functional disability was 55.3%. The variables associated with this disability in the multivariate analysis were: not working (PR=1.36; 95% confidence interval — 95%CI 1.03–1.78); low (PR=1.49; 95%CI 1.10–2.03) and moderate (PR=1.30; 95%CI 1.04–1.64) perceived affectionate support; depressive symptoms (PR=1.31; 95%CI 1.10–1.56); malnutrition (PR=1.28; 95%CI 1.03–1.59); having two or more comorbidities (PR=1.30; 95%CI 1.03–1.64), and having a companion to health services (PR=1.39; 95%CI 1.05–1.83).

Conclusion:

In addition to physical health aspects, comorbidities, and malnutrition, functional disability was associated with emotional, social support, and work issues, reinforcing the importance of comprehensive care and actions to maintain and recover functional capacity, promoting a better quality of life, the independence of older adults with cancer, and a reduced risk of adverse biopsychosocial outcomes.

Keywords:
Aged; Functional status; Neoplasms; Medical oncology; Ambulatory care facilities; Epidemiology

Variables		Total	Functional disability (IADL)
		n (%)	Prevalence	PR	95%CI	p-value
		n (%)	n (%)	PR	95%CI	p-value
Gender^* * up to 5 respondents;
	Female	177 (38.2)	104 (59.8)	1.14	0.96–1.34	0.130
	Male	286 (61.8)	150 (52.6)	1.00	0.96–1.34	0.130
Age group^* * up to 5 respondents;
	70 and older	202 (43.6)	130 (65.0)	1.36	1.15–1.60	0.001^‡ ‡ p≤0.05, statistically significant.
	60 to 69 years	261 (56.4)	124 (47.9)	1.00	1.15–1.60	0.001^‡ ‡ p≤0.05, statistically significant.
Marital status^* * up to 5 respondents;
	Without partner	212 (45.8)	123 (58.6)	1.11	0.95–1.31	0.200
	With partner	251 (54.2)	131 (52.6)	1.00	0.95–1.31	0.200
Ethnicity/skin color^† † 17 respondents;
	Multiracial/Black	288 (64.0)	153 (53.3)	0.90	0.76–1.07	0.230
	White/Asian/Indigenous	162 (36.0)	94 (59.1)	1.00	0.76–1.07	0.230
Schooling^* * up to 5 respondents;
	Up to 8 years	333 (72.1)	198 (59.8)	1.38	1.11–1.72	0.004^‡ ‡ p≤0.05, statistically significant.
	9 and over	129 (27.9)	55 (43.3)	1.00	1.11–1.72	0.004^‡ ‡ p≤0.05, statistically significant.
ABEP classification^* * up to 5 respondents;
	Classes C1, C2, D-E	388 (83.8)	216 (56.3)	1.11	0.87–1.41	0.394
	Classes A, B1, B2	75 (16.2)	38 (50.7)	1.00	0.87–1.41	0.394
Currently working^* * up to 5 respondents;
	No	372 (80.5)	216 (58.5)	1.39	1.07–1.80	0.013^‡ ‡ p≤0.05, statistically significant.
	Yes	90 (19.5)	38 (42.2)	1.00	1.07–1.80	0.013^‡ ‡ p≤0.05, statistically significant.
Municipality of residence^* * up to 5 respondents;
	Inland	282 (61.3)	159 (56.4)	1.05	0.89–1.25	0.573
	Cuiabá and Várzea Grande	179 (38.7)	95 (53.7)	1.00	0.89–1.25	0.573

Variables		Total	Functional disability (IADL)
		n (%)	Prevalence	PR	95%CI	p-value
		n (%)	n (%)	PR	95%CI	p-value
Regular alcohol consumption^* * up to 5 respondents.
	Yes	61 (13.2)	26 (42.6)	0.75	0.55–1.01	0.058
	No	401 (86.8)	227 (57.2)	1.00	0.55–1.01	0.058
Smokes and/or smoked tobacco products^* * up to 5 respondents.
	Yes	269 (58.1)	152 (53.1)	1.07	0.90–1.27	0.423
	No	194 (41.9)	102 (56.9)	1.00	0.90–1.27	0.423
Passive smoker — home^* * up to 5 respondents.
	Yes	53 (11.5)	35 (66.0)	1.22	0.98–1.51	0.063
	No	410 (88.5)	219 (53.9)	1.00	0.98–1.51	0.063
Leisure-time physical activity^* * up to 5 respondents.
	Inactive	392 (84.5)	219 (56.6)	1.18	0.67–1.11	0.240
	Active	72 (15.5)	35 (48.6)	1.00	0.67–1.11	0.240
Excessive screen time (TV, tablet, computer, mobile phone)^* * up to 5 respondents.
	Yes	229 (49.5)	121 (53.1)	0.92	0.78–1.09	0.333
	No	234 (50.5)	133 (57.7)	1.00	0.78–1.09	0.333
Connected to the mobile phone for more than 3 h/day^* * up to 5 respondents.
	Yes	48 (10.4)	21 (44.7)	0.79	0.57–1.10	0.161
	No	415 (89.6)	233 (56.6)	1.00	0.57–1.10	0.161

Variables		Total	Functional disability (IADL)
		n (%)	Prevalence	PR	95%CI	p-value
		n (%)	n (%)	PR	95%CI	p-value
Organizational religiosity^* * 4 to 8;
	Rarely/never	128 (27.9)	77 (60.6)	1.14	0.96–1.35	0.148
	Often	331 (72.1)	175 (53.4)	1.00	0.96–1.35	0.148
Non-organizational religiosity^* * 4 to 8;
	Rarely/never	66 (14.3)	33 (50.0)	0.90	0.69–1.15	0.370
	Often	397 (85.7)	221 (56.2)	1.00	0.69–1.15	0.370
Tangible support^† † 10 to 19 respondents;
	Low	18 (3.9)	7 (38.9)	0.69	0.39–1.25	0.227
	Moderate	48 (10.6)	29 (60.4)	1.08	0.85–1.38	0.530
	High	389 (85.5)	215 (55.8)	1.00
Informational and emotional support^† † 10 to 19 respondents;
	Low	25 (5.6)	13 (52.0)	0.99	0.67–1.46	0.953
	Moderate	114 (25.5)	71 (62.8)	1.19	1.01–1.43	0.050^‡ † 10 to 19 respondents;
	High	309 (68.9)	161 (52.6)	1.00
Affectionate support^† † 10 to 19 respondents;
	Low	23 (5.0)	15 (65.2)	1.23	0.90–1.68	0.204
	Moderate	45 (9.9)	30 (66.7)	1.25	0.99–1.57	0.052
	High	389 (85.1)	205 (53.3)	1.00
Positive social interaction^† † 10 to 19 respondents;
	Low	41 (9.1)	20 (48.8)	0.91	0.65–1.26	0.565
	Moderate	71 (15.7)	47 (66.2)	1.23	1.01–1.50	0.035^‡ † 10 to 19 respondents;
	High	339 (75.2)	180 (53.7)	1.00

Variables		Total	Functional disability (IADL)
		n (%)	Prevalence	PR	95%CI	p-value
		n (%)	n (%)	PR	95%CI	p-value
Family history of cancer^* * 4;
	Yes	192 (42.0)	104 (54.7)	1.02	0.86–1.21	0.808
	No	265 (58.0)	147 (55.9)	1.00	0.86–1.21	0.808
Staging^* * 4;
	III and IV	214 (46.2)	116 (54.7)	1.02	0.84–1.24	0.841
	No information	111 (24.0)	64 (58.7)	1.09	0.87–1.37	0.422
	0, I, and II	138 (29.8)	74 (53.6)	1.00
Self-rated health^† † 8 to 18;
	Regular, poor, and very poor	243 (52.9)	141 (58.5)	1.13	0.96–1.35	0.132
	Good and very good	216 (47.1)	110 (51.4)	1.00	0.96–1.35	0.132
Health insurance^* * 4;
	No	287 (62.0)	171 (60.2)	1.27	1.05–1.53	0.010^‡ ‡ 44 respondents; ‡ p≤0.05, statistically significant.
	Yes	176 (38.0)	83 (47.4)	1.00	1.05–1.53
Comorbidities^* * 4;
	2 or more	146 (31.5)	90 (61.6)	1.31	1.50–1.64	0.016^‡ ‡ 44 respondents; ‡ p≤0.05, statistically significant.
	1	180 (38.9)	101 (56.4)	1.20	0.96–1.50	0.106
	0	137 (29.6)	63 (47.0)	1.00
Depressive symptoms^† † 8 to 18;
	Yes (score ≥9)	104 (23.2)	76 (73.8)	1.50	1.28–1.76	<0.001^‡ ‡ 44 respondents; ‡ p≤0.05, statistically significant.
	No (score 0 to 8)	345 (76.8)	168 (49.1)	1.00	1.28–1.76
BMI^‡ ‡ 44 respondents; ‡ p≤0.05, statistically significant.
	<22 (malnutrition)	67 (15.9)	47 (71.2)	1.38	1.11–1.71	0.004^‡ ‡ 44 respondents; ‡ p≤0.05, statistically significant.
	>27 (obesity)	204 (48.3)	105 (51.5)	0.99	0.81–1.22	0.969
	≥22 to ≤27 (normal weight)	151 (35.8)	77 (51.7)	1.00
Having a companion to health services^† † 8 to 18;
	Yes	367 (79.4)	218 (60.1)	1.58	1.21–2.08	0.001^‡ ‡ 44 respondents; ‡ p≤0.05, statistically significant.
	No	95 (20.6)	36 (37.9)	1.00	1.21–2.08

Variables		Adjusted PR	95%CI	p-value
Gender
	Male	1.00	0.86–1.22	0.757
	Female	1.03	0.86–1.22	0.757
Age group
	60 to 69 years	1.00	0.97–1.37	0.114
	70 years or older	1.15	0.97–1.37	0.114
Currently working
	Yes	1.00	1.03–1.78	0.028^* * p≤0.05, statistically significant.
	No	1.36	1.03–1.78	0.028^* * p≤0.05, statistically significant.
Affectionate support
	High	1.00
	Moderate	1.30	1.04–1.64	0.020^* * p≤0.05, statistically significant.
	Low	1.49	1.10–2.03	0.010^* * p≤0.05, statistically significant.
Depressive symptoms
	No	1.00	1.10–1.56	0.003^* * p≤0.05, statistically significant.
	Yes	1.31	1.10–1.56	0.003^* * p≤0.05, statistically significant.
Nutritional status
	≥22 to ≤27 (normal weight)	1.00
	>27 (obesity)	1.01	0.81–1.23	0.996
	<22 (malnutrition)	1.28	1.03–1.59	0.027^* * p≤0.05, statistically significant.
Comorbidities
	0	1.00
	1	1.20	0.96–1.52	0.110
	2 or more	1.30	1.03–1.64	0.027^* * p≤0.05, statistically significant.
Having a companion to health services
	No	1.00	1.05–1.83	0.020^* * p≤0.05, statistically significant.
	Yes	1.39	1.05–1.83	0.020^* * p≤0.05, statistically significant.

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[1] Corresponding author: Juliana Fernandes Cabral. Avenida das Palmeiras, 436, Jardim Imperial, CEP 78.075-905, Cuiabá (MT), Brazil. E-mail: julianacabral@unemat.br