Date Published: May 31, 2019
Publisher: Public Library of Science
Author(s): Valéria Teresa Saraiva Lino, Nádia Cristina Pinheiro Rodrigues, Mônica Kramer de Noronha Andrade, Inês Nascimento de Carvalho Reis, Lucília Almeida Elias Lopes, Soraya Atie, Peter F.W.M. Rosier.
Disability follows the rapid rate of population ageing, imposing a huge burden on society. Functional assessment in older people can identify predictors of disability.
Analyze the incidence and the risk factors for disability in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults over six years.
Six year-follow up study initiated in 2010. The baseline non-probabilistic sample consisted of 180 independent community dwelling individuals aged 60 and over. The procedures comprised an interview with sociodemographic data, questions about falls, urinary incontinence, self-rated health, and assessment of ADL, IADL, mobility, depression, vision, hearing, cognition, nutrition, grip strength and social support. The second research was carried out by telephone and assessed ADL and IADL. Logistic regression models calculated the odds of disability in ADL and IADL according to the age, sex and all other variables.
At six-year follow-up, 118 participants were still alive (65.6%), 31 died (17%) and other 31 were missed (17%). The incidence of disability to performADL and IADL were 25.4% and 32.3%, respectively. The regression logistic models revealed thaturinary incontinence (OR = 3.2; P = 0.03) and insufficient emotional support (OR = 3.8; P = 0.04) were associated with ADL disability, while visual problems (OR: 2.9; P = 0.03) and insufficient emotional support (OR: 5.6; P = 0.01) were associated with IADL disability.
The current study has identified that insufficient emotional support, visual problems and urinary incontinence are associated with disability in older adults. The routine assessment of these problems in the primary care clinics enable the implementation of strategies aimed at reducing or postponing disability. Educating patients and families will also enable better choices to reduce the risk of functional decline.
The demographic transition that has taken place in many countries has produced an aging population that is growing in size and proportion. In Latin America, the accelerated aging process associated with high poverty rates and inefficient health and social security systems imposes to families the most responsibility for the elderly care . The Gini index of income measures the inequality of its distribution, and its value ranges from zero (equality) to one (maximum inequality). In 2015, the Gini index of real average monthly household income per capita in Brazil was 0.485, revealing the inequalities in the income distribution and the concentration of wealth in a small part of the population.
In the group of 180 participants examined in 2010, the average age was 73.1 (SD 7.0) and the overall majority were women (73.3%). At six-year follow-up, 118 participants accepted to participate (65.6%), 31 were dead (17%) and other 31 had been missed (17%). Reasons for non-participation in the follow-up were the change of address (16.1%) and lack of interest (1.1%). There were no statistically significant differences between the characteristics of the studied population and the missing group, except for a higher proportion of individuals who reported insufficient social interaction in the missinggroup.
This study identified a high incidence of ADL/IADL disability in poor elderly over six years, mainly due to insufficient emotional support, UI and visual problems. The incidence of ADL/IADL disability was 25% and 32%, respectively. These high rates of disability align with previous findings. Among older Brazilians, reduced disability is associated with higher income as evidenced in a study that examined income-disability relationships with more than 63,000 older adults. There was a strong and predominantly linear relationship between higher income and lower prevalence of disability. For those in the 50th percentile or under this level, the prevalence of disability was around 21% and 33% for men and women, respectively. For those between the 86-90th percentiles the prevalence rates decreased to 11% and 26% for men and women, respectively.
The rapid rate of population ageing will bring a tremendous social and financial impact upon society and the health system. Disability follows the rhythm of the ageing process, making the oldest ones more prone to functional decline. This imposes a huge burden on families and caregivers. The challenge for the health system is to propose strategies to postpone or prevent functional decline. The current study has identified risk factors associated with increased disability incidence in the elderly, which may be modifiable. Insufficient emotional support, visual problems and UI are easily measured predictors for disability. The periodic screening of these problems during routine visits to the primary care clinics will probably enable the implementation of strategies and treatments aimed at reducing or postponing disability. Educating patients and families will also allow better choices to reduce the risk of functional decline. Studies with poor populations are necessary to verify the effects of interventions that reduce the impacts of insufficient emotional support, visual problems, and UI on the high incidence of disability in the elderly.