Active ageing among elderly community members: structural equation modeling analysis

doi:10.1590/0034-7167-2020-0110

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (suppl 3) • 2020 • https://doi.org/10.1590/0034-7167-2020-0110 copy

Active ageing among elderly community members: structural equation modeling analysis

Envejecimiento activo entre ancianos comunitarios: análisis del modelado de ecuación estructural

About the SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to propose a structural model of active ageing among elderly community members based on the World Health Organization’s theoretical framework and to identify the most relevant determinants of active ageing to the proposed model.

Methods:

a cross-sectional and analytical study conducted with 957 elderly community members. Confirmatory factor analysis and structural equation modeling were performed.

Results:

the final measurement model was composed of the six determinants of active ageing: behavioral (R²=0.66); personal (R²=0.74); physical environment (R²=0.70); social (R²=0.77); economic (R²=0.44); and social and health services (R²=0.95). The last one showed good quality of adjustment: χ²/gl=3.50; GFI=0.94; CFI=0.92; TLI=0.90; RMSEA=0.05. By analyzing the trajectories between determinants and active ageing, the most representative was social and health services  active ageing (λ=0.97; p<0.001).

Conclusion:

satisfaction with access to health services and positive self-assessment of health status were the factors that most contributed to active ageing in this population.

Descriptors:
Health of the Elderly; Ageing; Elderly Statistical Factor Analysis; Geriatric Nursing

Determinants	Measured determinants	Instruments	Code in Structural Equation Modeling (SEM)
Behavioral	Anthropometric profile	BMI⁽¹⁹19 American Dietetic Association, American Academy of Family Physicians, National Council on the Aging . Nutrition interventions manual for professionals caring for older Americans. Washington (US): Nutrition Screening Initiative; 1992.⁾; AC⁽²⁰20 World Health Organization (WHO). Obesity: preventing and managing the global epidemic [Internet]. Geneva: WHO, 2000[cited 2020 Feb 17]. Available from: https://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/ https://www.who.int/nutrition/publicatio... ⁾; CC⁽²¹21 Pagotto V, Santos KF, Malaquias SG, Bachion MM, Silveira EA. Calf circumference: clinical validation for evaluation of muscle mass in the elderly. Rev Bras Enferm. 2019; 71(2):343-50. doi: 10.1590/0034-7167-2017-0121 https://doi.org/10.1590/0034-7167-2017-0... ⁾; and BC⁽²²22 Burr ML, Phillips KM. Anthropometric norms in the elderly. Br J Nutr. 1984; 51(1):165-9. doi: 10.1079/bjn19840020 https://doi.org/10.1079/bjn19840020... ^-²³23 Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. Michigam Press; 1990.⁾.	Number of suitable items (0 to 4).
	Physical activity	IPAQ⁽²⁴24 Benedetti TRB, Mazo GZ, Barros MVG. Aplicação do questionário internacional de atividades físicas (IPAQ) para avaliação do nível de atividades físicas de mulheres idosas: validade concorrente e reprodutibilidade teste-reteste. Rev Bras Ciên Movimento. 2004; 12(1):25-33.⁾.	Number of healthy life habits (0 to 4).
	Alcohol consumption	Do you usually consume alcoholic beverages?
	Smoking	Do you smoke?
	Sleep quality	Do you have any trouble sleeping?
	Routine consultation	Have you undergone a routine check-up last year?	Number of self-care practices (0 to 5).
	Preventive examinations	Have you undergone a preventive examination last year?
	Attitude towards taking medicines	IAAFTR⁽²⁵25 Strelec MAAM, Pierin AMG, Mion Jr DA. Influência do conhecimento sobre a doença e atitude frente à tomada de remédios no controle da hipertensão arterial. Arq Bras Cardiol. 2003; 8(4):343-8. Available from: http://publicacoes.cardiol.br/abc/2003/8104/8104002.pdf http://publicacoes.cardiol.br/abc/2003/8... ⁾.
	Vaccination status	Assessment of the vaccination card of elderly individuals⁽²⁶26 Ministério da Saúde (BR). Calendário Nacional de Vacinação 2017 [Internet]. Brasília (DF), 2017. [cited 2020 Feb 17]. Available from: ortalarquivos.saude.gov.br/images/pdf/2017/outubro/03/Calendario-2017-atualizado.pdf ortalarquivos.saude.gov.br/images/pdf/20... ⁾.
	Oral health	When was the last time you went to the dentist?
Personal	Resilience	CD-RISC-25BRAZIL⁽²⁷27 Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003; 18(2):76-82. doi: 10.1002/da.10113 https://doi.org/10.1002/da.10113... ^-²⁸28 Solano JPC, Bracher ESB, Faisal-Cury A, Ashmawi HA, Carmona MJC, Lotufo Neto, et al. Factor structure and psychometric properties of the Connor-Davidson resilience scale among Brazilian adult patients. São Paulo Med J. 2016; 134(5):400-6. doi: 10.1590/1516-3180.2015.02290512 https://doi.org/10.1590/1516-3180.2015.0... ⁾.	Resilience score.
	Depression, Emotional	GDS-15⁽²⁹29 Almeida OP, Almeida SA. Reliability of the Brazilian version of the Geriatric Depression Scale (GDS) short form. Arq Neuropsiquiatr. 1999;57(2-B):421-26. doi: 10.1590/S0004-282X1999000300013 https://doi.org/10.1590/S0004-282X199900... ⁾.	Number of depressive symptoms.
	Family history for CNCDs	BOMFAQ⁽³⁰30 Ramos LR, Perracini M, Rosa TE, Kalache A. Significance and management of disability among urban elderly residents in Brazil. J Cross-Cultural Gerontol. 1993; 8(4):3313-23. doi: 10.1007/BF00972560 https://doi.org/10.1007/BF00972560... ⁾.	No (1); Yes (0).
	Functioning of the senses	How would you assess the functioning of hearing, vision, taste, smell, touch?	Very bad (1); Bad (2); Neither bad nor good (3); Good (4) and Very good (5).
	Morbidities	BOMFAQ⁽³⁰30 Ramos LR, Perracini M, Rosa TE, Kalache A. Significance and management of disability among urban elderly residents in Brazil. J Cross-Cultural Gerontol. 1993; 8(4):3313-23. doi: 10.1007/BF00972560 https://doi.org/10.1007/BF00972560... ⁾.	Number of morbidities.
	Cognitive ability	MMSE⁽¹⁵15 Bertolucci PHF, et al. The Mini-Mental State Examination in an outpatient population: influence of literacy. Arq Neuro-Psiquiatr. 1994; 52(1):1-7. doi: 10.1590/S0004-282X1994000100001 https://doi.org/10.1590/S0004-282X199400... ⁾.	No (1); Yes (0).
Physical Environment	Physical security and protection; physical environment; means of transport; and environment in the home.	Do you feel safe in your daily life? Is your physical environment (climate, noise, pollution) healthy? Are you satisfied with your means of transport? Are you satisfied with the conditions of your place of residence?	Nothing (1); Very little (2); So-so (3); Quite (4); Extremely (5).
Social	Social network	Network and social support scale⁽³¹31 Griep RH, Chor D, Faerstein E, Werneck GL, Lopes CS. Construct validity of the Medical Outcomes Study’s social support scale adapted to Portuguese in the Pró-Saúde Study. Cad Saúde Pública. 2005; 21(3):703-14. doi: 10.1590/S0102-311X2005000300004 https://doi.org/10.1590/S0102-311X200500... ⁾.	Number of relatives and friends.
	Social support	Network and social support scale⁽³¹31 Griep RH, Chor D, Faerstein E, Werneck GL, Lopes CS. Construct validity of the Medical Outcomes Study’s social support scale adapted to Portuguese in the Pró-Saúde Study. Cad Saúde Pública. 2005; 21(3):703-14. doi: 10.1590/S0102-311X2005000300004 https://doi.org/10.1590/S0102-311X200500... ⁾.	Social support score.
	Personal relationships	How satisfied are you with your personal relationships?	Very dissatisfied (1); Dissatisfied (2); Neither dissatisfied nor satisfied (3); Satisfied (4); Very satisfied (5).
	AADL	Thirteen questions of a social nature⁽³²32 Dias EN, Silva JV, Pais-Ribeiro JL, Martins T. Validation of the advanced activities of daily living scale. Geriatr Nurs. 2019; 40(1):7-12. doi: 10.1016/j.gerinurse.2018.05.008 https://doi.org/10.1016/j.gerinurse.2018... ⁾.	Number of activities performed.
	Community activities	Are you satisfied with the opportunities you have to participate in community activities?	Very dissatisfied (1); Dissatisfied (2); Neither dissatisfied nor satisfied (3); Satisfied (4); Very satisfied (5).
	Out-of-school activities	To what extent do you have opportunities for leisure activities?	Nothing (1); Very little (2); So-so (3); Quite (4); Extremely (5).
	Education years	How many full years of study do you have?	Full years of study.
Economic	Monthly individual income	What is your individual monthly income?	<1 (1); 1┤3 and ≥3.
	Assessment of economic condition	How do you assess your economic condition?	Good (1); Bad (0).
	Money to meet basic needs	Do you have enough money to meet your needs?	Nothing (1); Very little (2); So-so (3); Quite (4); Extremely (5).
	Retirement and pension	Are you a retiree and/or pensioner?	Yes (1); No (0).
	Paid work	Do you have paid work?	Yes (1); No (0).
Social and health services	Access to health care services	Are you satisfied with your access to health services?	Very dissatisfied (1); Dissatisfied (2); Neither dissatisfied nor satisfied (3); Satisfied (4); Very satisfied (5).
	Link with the health service	Do you usually seek the same health service when you need care?	Yes (1); No (0).
	Access to continuous-use medicines	Do you have access to continuous medicines?	Yes (1); No (0).
	Self-assessment of the course of health status	Comparing your health today with that of a year ago, would you say that your health is worse, equal or better? ⁽³⁰30 Ramos LR, Perracini M, Rosa TE, Kalache A. Significance and management of disability among urban elderly residents in Brazil. J Cross-Cultural Gerontol. 1993; 8(4):3313-23. doi: 10.1007/BF00972560 https://doi.org/10.1007/BF00972560... ⁾.	Worse (1); Equal (2); Best (3).
	Assessment of current health status	How do you assess your health? ⁽³⁰30 Ramos LR, Perracini M, Rosa TE, Kalache A. Significance and management of disability among urban elderly residents in Brazil. J Cross-Cultural Gerontol. 1993; 8(4):3313-23. doi: 10.1007/BF00972560 https://doi.org/10.1007/BF00972560... ⁾.	Terrible (1); Bad (2); Regular (3); Good (4); Great (5).

Variables	n	%
Sex
Male	317	33.1
Female	640	66.9
Age group (years)
60 - 70	358	37.4
70 - 80	396	41.4
80 and older	203	21.2
Marital Status
Single	63	6.6
Common-law marriage	410	42.8
Widow(er)	377	39.4
Separated/divorced	107	11.2
Education (years)
None	171	17.9
1├5	501	52.4
5 or more	285	29.7
Individual monthly income (minimum wages)
<1	80	8.4
1┤3	821	85.8
≥3	56	5.8
Housing arrangement
Living alone	181	18.9
Living with other people	776	81.1

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[1] Corresponding author: Darlene Mara dos Santos Tavares. E-mail: darlenetavares@enfermagem.uftm.edu.br