RESUMO
BACKGROUND: The association between social isolation and cognitive performance has been less investigated in low-to-middle-income countries (LMIC) and the presence of depression as a moderator on this association has not been examined. The authors examined the associations of social isolation and perceived loneliness with cognitive performance in the Brazilian Longitudinal Study of Aging. METHODS: In this cross-sectional analysis, social isolation was evaluated by a composite score including marital status, social contact, and social support. The dependent variable was global cognitive performance, which considered memory, verbal fluency, and temporal orientation tests. Linear and logistic regressions were adjusted for sociodemographic and clinical variables. The authors added interaction terms of depressive symptoms with social isolation and loneliness to examine whether depression, measured through the Center for Epidemiologic Studies-Depression Scale, modified these associations. RESULTS: Among 6,986 participants (mean age = 62.1 ± 9.2 years), higher levels of social connections were associated with better global cognitive performance (B = 0.02, 95%CI: 0.02; 0.04). Perceived loneliness was associated with worse cognition (B = -0.26, 95%CI = -0.34; -0.18). Interactions of depressive symptoms with social connections scores were found on memory z-score and with loneliness on global and memory z-scores, suggesting a weaker association between social isolation or loneliness and cognition among those with depressive symptoms. CONCLUSION: In a large sample from an LMIC, social isolation and loneliness were associated with worse cognitive performance. Surprisingly, depressive symptoms decrease the strength of these associations. Future longitudinal studies are important to assess the direction of the association between social isolation and cognitive performance.
Assuntos
Solidão , Isolamento Social , Humanos , Idoso , Solidão/psicologia , Brasil/epidemiologia , Estudos Longitudinais , Estudos Transversais , Isolamento Social/psicologia , CogniçãoRESUMO
Background: While efforts have been made to validate intrinsic capacity (IC) as a multidimensional indicator of healthy aging in high-income countries, we still need evidence from lower-income countries. We examined associations of IC with wide ranges of activities of daily living in a nationally representative sample of Brazilians aged≥50 years. Methods: This cross-sectional analysis included 7175 participants from the Brazilian Longitudinal Study of Aging. IC domains (cognitive, psychological, sensory, locomotor, and vitality) were determined using self-reported and physical performance measures. IC was operationalized through factorial analysis. We investigated associations of IC and its domains with functional ability in basic, instrumental, and advanced activities of daily living (ADL, IADL, and AADL) using logistic regressions adjusted for sociodemographic, clinical, and modifiable risk factors. Findings: The IC bi-factorial model revealed satisfactory goodness-of-fit. Preserved ability in ADL and IADL, respectively, ranged from 69% and 29% to 89% and 74% across IC quartiles. In adjusted analyses, every standard deviation increment in IC composite score was associated with almost twice the odds of preserved ADL (OR=1·72; 95%CI=1·54-1·93), preserved IADL (OR=1·95; 95%CI=1·77-2·16), and high performance in AADL (OR=1·79; 95%CI=1·59-2·00). Similar results were reported using the IC domains as predictors. Although age, race/ethnicity, and education did not modify associations of IC with functional ability, we found sex differences with stronger relationships of IC with preserved ADL or IADL in females. Interpretation: Our results support IC validity and reliability to measure healthy aging in diverse socioeconomic and cultural settings. Incorporating IC in routine practices can promote holistic and person-centered care approaches in aging societies. Funding: The Brazilian Ministry of Health and Ministry of Science, Technology, Innovation, and Communication.
Assuntos
Expectativa de Vida , Qualidade de Vida , Fatores Etários , Idoso , Brasil/epidemiologia , HumanosRESUMO
OBJECTIVE: To analyse differences in the prevalence of prediabetes (PD), undiagnosed diabetes (UDD) and diagnosed diabetes (DD) and associated factors between Brazilian and English older adults. DESIGN: Cross-sectional study. SETTING: England and Brazil. PARTICIPANTS: 5301 participants of the English Longitudinal Study of Ageing study and 1947 participants of the Brazilian Longitudinal Study of Aging study classified as non-diabetics, PD, UDD and DD. RESULTS: The prevalence of PD, UDD and DD was 48·6, 3 and 9·6 % in England and 33, 6 and 20 % in Brazil. In England, the increase in age, non-white skin colour, smoking, general obesity and abdominal obesity were associated with PD, UDD and DD, whereas hypertriglyceridaemia, low HDL levels, hypertension and stroke were associated with UDD and DD. In Brazil, the increase in age was associated with DD and UDD, non-white skin colour and smoking were associated with UDD and abdominal obesity and hypertriglyceridaemia were associated with all three conditions. CVD in England and schooling in Brazil were associated with PD and DD. A sedentary lifestyle was associated with DD in both samples. CONCLUSIONS: The prevalence of diabetes was higher in the Brazilian sample. Different associated factors were found in the two samples, which may be related to differences in nutritional transition, access to healthcare services and the use of such services.
Assuntos
Diabetes Mellitus , Estado Pré-Diabético , Idoso , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Humanos , Estudos Longitudinais , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: To determine the extent to which racial inequities in tooth loss and functional dentition are explained by individual socioeconomic status, smoking status and frequency/reason for the use of dental services. METHODS: Data came from the Brazilian Longitudinal Study of Ageing, a nationally representative sample of community-dwelling people aged 50 years and over. Tooth loss and functional dentition (ie 20+ natural teeth) were the outcomes. The main explanatory variable was self-classified race. Covariates included dental visits in the past 12 months, dental visits for check-ups only, smoking status, self-reported chronic conditions, depression and cognitive function. Logistic regression and Blinder-Oaxaca decomposition analysis were used to estimate the share of each factor in race-related tooth loss inequities. RESULTS: The analytical sample comprised of 7126 respondents. While the prevalence of functional dentition in White Brazilians was 37% (95% CI: 33.5;40.9), it was 29% (95% CI: 26.4;31.6) among Browns and 30% (95% CI: 25.1;35.4) among Blacks. The average number of lost teeth among Whites, Browns and Blacks were 18.7 (95% CI: 17.8;19.6), 20.4 (95% CI: 19.7;21.1) and 20.8 (95% CI: 19.5;22.0), respectively. Decomposition analysis showed that the selected covariates explained 71% of the racial inequalities in tooth loss. Dental visits in the previous year and smoking status explained nearly half of race-related gaps. Other factors, such as per capita income, education and cognitive status, also had an important contribution to the examined inequalities. The proportion of racial inequities in tooth loss that was explained by dental visits (frequency and reason) and smoking status decreased from 40% for those 50-59 years of age to 22% among participants aged 70-79 years. CONCLUSIONS: Frequency and reason for dental visits and smoking status explained nearly half of the racial inequity in tooth loss among Brazilian older adults. The Brazilian Family Health Strategy Program should target older adults from racial groups living in deprived areas.
Assuntos
Perda de Dente , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Escolaridade , Humanos , Renda , Estudos Longitudinais , Pessoa de Meia-Idade , Fatores Socioeconômicos , Perda de Dente/epidemiologia , Adulto JovemRESUMO
Little is known about vitamin D status in older adults in South America, where exposures to ultra-violet radiation are high. We examined the distribution of serum 25-hydroxyvitamin D (25OHD) concentration and its determinants in a nationally representative sample of Brazilians aged 50 years and older. Explanatory variables included environment and individuals' characteristics from the ELSI baseline survey (2015-16). Among the 2,264 participants (mean age = 62.6 years), the geometric mean of 25OHD concentration was 66.8 nmol/L. The prevalence of vitamin D deficiency (< 30 nmol/L) and insufficiency (< 50 nmol/L) were 1.7% (95% CI 1.0, 2.8) and 16% (95% CI 12, 20), respectively. Mean concentrations were lower in those geographical regions situated at lower latitudes. Those at the oldest age, women, self-classified as Black and Brown, living in urban areas and current smokers were more likely to have vitamin D insufficiency, independent of each other and other relevant factors. In contrast, individuals who eat fish regularly were considerably less likely to present lower concentration. Based on these findings it is possible to estimate that about 875,000 older Brazilians have vitamin D deficiency and 7.5 million its insufficiency.
Assuntos
Envelhecimento/sangue , Vitamina D/sangue , Idoso , Brasil , Feminino , Humanos , Estudos Longitudinais , MasculinoRESUMO
BACKGROUND: Research on discrimination and health focused on older adults has been scarce, comparatively with younger and middle-aged adults. Considering where people live matters, accurate measures of perceived discrimination might consider how the place of residence interferes on discriminatory experiences. This study aimed to assess the association between perceived discrimination and urban/rural place of residence among a representative sample of older adults in Brazil. METHODS: Data came from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015/2016, with individuals aged 50 years and older. Perceived Discrimination was measured by means of the following question: "In the past 12 months have you felt a victim of any type of discrimination" with five possible answers: (1)"when you sought medical services or health care?", (2)"in social gatherings?", (3)"in the work place?", (4)"within the family?", (5)"due to where you live?". Participants who answered yes for any of the five domains were coded as having reported an experience of discrimination. The main exposure variable was the urban-rural classification of the households, carried out according to the methods employed by the Brazilian Institute of Geography and Statistics during the 2010 Population Census. Other covariates included: age, sex, skin color, household wealth and education. Multiple Poisson regression was used to estimate prevalence ratios and their respective 95% confidence interval for the association between discrimination and independent variables. RESULTS: Prevalence of any perceived discrimination among Brazilian older adults was 16.8%. Regardless the place of residence (either urban or rural), participants reported health care settings as the most common domain where discriminatory experiences occurred and the work place as the least common. According to the adjusted model, perceived discrimination was significantly higher among urban dwellers when compared to their rural counterparts, independent of sociodemographic characteristics, health status and neighborhood social environment. The outcome was significant associated with skin color, education and health status. CONCLUSIONS: Urban environment plays a core role in perceived discrimination and health care settings constitute the most common domain where discriminatory experiences occurred. Our findings may contribute to fulfill the knowledge gap on discrimination among older adults living in developing countries.
Assuntos
Envelhecimento/psicologia , Preconceito , População Rural , População Urbana , Idoso , Idoso de 80 Anos ou mais , Brasil , Emprego , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Meio Social , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Brazil is experiencing among the world's fastest demographic aging worldwide. This demographic transition is occurring in a context of few resources and great social inequalities. The Brazilian Longitudinal Study of Aging (ELSI-Brazil) is a nationally representative study of 9,412 people aged 50 years or older, residing in 70 municipalities across the 5 Brazilian regions. ELSI-Brazil allows investigations of the aging process, its health, psychosocial and economic determinants, and societal consequences. The baseline examination (2015-2016) included detailed household and individual interviews and physical measurements (blood pressure, anthropometry, grip strength, and timed walk and balance tests). Blood tests and sample storage were performed in a subsample of study participants. Subsequent waves are planned for every 3 years. The study adopts a conceptual framework common to other large-scale longitudinal studies of aging in the world, such as the Health and Retirement Study, allowing cross-national comparisons. The goal of ELSI-Brazil is not only to build an understanding of aging in a large, Western, middle-income country in a rapid demographic transition but also to provide scientific data to support and study policy changes that may affect older adults. We describe the methodology of the study and some descriptive results of the baseline survey.
Assuntos
Envelhecimento , Projetos de Pesquisa Epidemiológica , Transição Epidemiológica , Idoso , Idoso de 80 Anos ou mais , Antropometria , Pressão Sanguínea , Brasil/epidemiologia , Características da Família , Feminino , Força da Mão , Humanos , Renda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Aposentadoria , Fatores Socioeconômicos , Teste de CaminhadaRESUMO
BACKGROUND: This study aimed to estimate coverage and identify factors associated to vaccination against influenza in the elderly population. METHODS: The study design was cross-sectional and population based. Data was collected in 2010 by the Health, Well-Being and Aging Study. Sample consisted of 1,341 community-dwelling elderly, in São Paulo, Brazil. Association between vaccination and covariates was evaluated by means of prevalence ratios estimated by Poisson regression models. RESULTS: Self-reported vaccination coverage was 74.2% (95% confidence interval: 71.3-76.9). Remaining physically active and having had recent interaction with health services, mainly with public units of healthcare, were the main incentives to increase vaccination coverage among the elderly; whereas lower age, living alone and absent interaction with health services were the main constraints to influenza vaccination at the community level. These covariates had already been reported to influence influenza vaccination of elders in previous years. CONCLUSION: Previous knowledge already available on the main constraints to influenza vaccination has not allowed to remove them. Influenza campaigns should be strengthened to increase vaccination coverage, especially in the group more reticent to vaccination. Instructing healthcare providers to recommend vaccine uptake is an important piece of this puzzle.
Assuntos
Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Vacinação/estatística & dados numéricos , Idoso , Brasil , Estudos de Coortes , Estudos Transversais , Atenção à Saúde/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Classe SocialRESUMO
BACKGROUND: The authors conducted a study to evaluate the association between changes in weight and waist circumference (WC) and oral health status among older adults in Brazil. METHODS: The study sample consisted of community-dwelling people representing the population 60 years and older in the city of São Paulo who were enrolled in the Health, Well-being and Aging cohort study. Changes in weight and WC were classified as stable (within 5 percent of the second-wave weight and WC), loss (5 percent or more decrease since the second wave) and gain (5 percent or more increase since the second wave). The following baseline characteristics were the independent variables: sociodemographic variables (age, sex and education), general health data (number of self-reported chronic diseases, physical activity, weight, WC and smoking status) and oral health (edentulism, need for dental prostheses). RESULTS: The incidence of weight (33.2 percent) and WC (35.3 percent) gain was higher than that of loss (13.5 percent and 10.6 percent, respectively). Neither weight nor WC gains were associated with dental status. The risk of weight and WC loss was higher among edentulous participants than among dentate participants. CONCLUSION: The results of this study show that edentulism status was a significant predictor of weight and WC loss, independent of socioeconomic and general health status. PRACTICAL IMPLICATIONS: Edentulism has a significant impact on weight and WC, which highlights the importance of an integrated approach to health care among health care professionals.
Assuntos
Peso Corporal , Saúde Bucal , Circunferência da Cintura , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Indicadores Básicos de Saúde , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Perda de Dente/epidemiologiaRESUMO
OBJECTIVES: To test the hypothesis that clinical oral health conditions are associated with frailty independent of socioeconomic and general health status. DESIGN: Cross-sectional. SETTING: Population-based cohort study of health, well-being, and aging. PARTICIPANTS: One thousand three hundred seventy-four community-dwelling individuals representing 998,528 individuals aged 60 and older in the city of São Paulo, Brazil. MEASUREMENTS: Frailty was defined on the basis of five characteristics: weight loss, weakness, slowness, exhaustion, and low level of physical activity. Participants with three or more characteristics were classified as frail, with one or two as prefrail, and with zero as nonfrail. Oral health measures were number of teeth, use of dental prostheses, need for dental prostheses, presence of decayed teeth, clinical attachment loss of 4 mm or greater, and periodontal pocket of 4 mm or greater. Data on sociodemographic (age, sex, and schooling) and general health (number of self-reported chronic diseases and smoking status) data were assessed. RESULTS: The prevalence of frailty was 8.5%, with 50.8% considered nonfrail. Elderly individuals with a need for dental prostheses were significantly more likely to be prefrail and frail. Participants with 20 or more teeth had a lower chance of being frail than edentulous individuals. CONCLUSION: The need for dental prostheses was significantly associated with frailty, independent of socioeconomic and general health status.
Assuntos
Envelhecimento , Idoso Fragilizado , Avaliação Geriátrica/métodos , Saúde Bucal , Vigilância da População/métodos , Atividades Cotidianas , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores SocioeconômicosRESUMO
OBJECTIVES: To assess the impact of oral health on quality of life in elderly Brazilians and to evaluate its association with clinical oral health measures and socioeconomic and general health factors. DESIGN: Cross-sectional study. SETTING: Population-based cohort study on health, well-being, and aging. PARTICIPANTS: Eight hundred fifty-seven participants representing 588,384 community-dwelling elderly adults from the city of São Paulo, Brazil. MEASUREMENTS: Self-perceived impact of oral health on quality of life was measured using the Geriatric Oral Health Assessment Index (GOHAI), with scores categorized as good, moderate, or poor, indicating low, moderate, and high degrees of negative impact on quality of life, respectively. RESULTS: Nearly half of the individuals had good GOHAI scores (44.7% of overall sample, 45.9% of dentate participants, and 43.4% of edentulous participants). In the overall sample, those with poor self-rated general health and a need for dental prostheses were more likely to have poor and moderate GOHAI scores. Individuals with depression were significantly more likely to have poor GOHAI scores. No socioeconomic variables were related to the outcome, except self-perception of sufficient income, which was a protective factor against a poor GOHAI score in dentate participants. CONCLUSION: Moderate and high degrees of negative impact of oral health on quality of life were associated with general health and clinical oral health measures, independent of socioeconomic factors.
Assuntos
Nível de Saúde , Saúde Bucal , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Renda/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Identifying changes in the oral health status of older populations, and their predictors and explanations, is necessary for public health planning. The authors assessed patterns of change in oral health-related quality of life in a large cohort of older adults in Brazil during a five-year period and evaluated associations between baseline characteristics and those changes. METHODS: The sample consisted of 747 older people enrolled in a Brazilian cohort study called the Health, Well-Being and Aging (Saúde, Bem-estar e Envelhecimento [SABE]) Study. Trained examiners measured participants' self-perceived oral health by using the General Oral Health Assessment Index (GOHAI). The authors calculated changes in the overall GOHAI score and in the scores for each of the GOHAI's three dimensions individually by subtracting the baseline score from the score at follow-up. A positive difference indicated improvement in oral health, a negative difference indicated a decline and a difference of zero indicated no change. RESULTS: The authors found that 48.56 percent of the participants experienced a decline in oral health and 33.48 percent experienced an improvement. Participants with 16 or more missing teeth and eight or more years of education were more likely to have an improvement in total GOHAI score. Deterioration was more likely to occur among those with two or more diseases. Improvement and decline in GOHAI functional scores were related to the number of missing teeth. The authors found no significant model for the change in the psychosocial score, and self-rated general health was the only variable related to both improvement and decline in pain or discomfort scores. CONCLUSIONS: The authors observed a bidirectional change in self-perceived oral health, with deterioration predominating. The strongest predictor of improvement in the total GOHAI score was the number of missing teeth, whereas the number of diseases was the strongest predictor of deterioration. CLINICAL IMPLICATIONS: Dental professionals and policymakers need to know the directions of change in older adults' oral health to establish treatment priorities and evaluate the impact of services directed at this population.
Assuntos
Avaliação Geriátrica , Saúde Bucal , Qualidade de Vida , Autoavaliação (Psicologia) , Idoso , Envelhecimento/psicologia , Análise de Variância , Brasil , Distribuição de Qui-Quadrado , Estudos de Coortes , Assistência Odontológica para Idosos , Inquéritos de Saúde Bucal , Progressão da Doença , Educação Continuada em Odontologia , Feminino , Odontologia Geriátrica/educação , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Perfil de Impacto da Doença , Fatores Socioeconômicos , Perda de Dente/psicologiaRESUMO
The aim of this study was to investigate the relationship between inadequate nutrient intake, oral health and family cohesion. This was a cross-sectional study with a sample of 887 non-institutionalized elderly people from Vitória, Espírito Santo State, Brazil. Oral examination was performed by trained and calibrated examiners and three measurements were considered: number of posterior occluding pairs of natural teeth (POP), number of teeth and overall dental status. Nutrient intake was assessed by a 24-hour diet recall interview. The elderly person's perception of family cohesion was assessed using the family adaptability and cohesion scale. People with no POP were more likely than those with 5 or more POP to have inadequate intake of vitamin C (OR = 2.79; 95%CI: 1.16-6.71), calcium (OR = 3.74; 95%CI: 1.69-8.25), riboflavin (OR = 2.49; 95%CI: 1.10-5.64) and zinc (OR = 3.43; 95%CI: 1.07-10.94). There was no association between elderly people's perceptions of family cohesion and inadequate intakes. It was concluded that oral health is related to inadequate intake of important nutrients among non-institutionalized elderly people.
Assuntos
Ingestão de Alimentos/fisiologia , Ingestão de Energia/fisiologia , Relações Familiares , Avaliação Nutricional , Saúde Bucal , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Comportamento Alimentar , Humanos , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Prevalência , Apoio Social , Perda de DenteRESUMO
OBJECTIVE: To evaluate the relationship between the oral health condition, the nutrient intake and the body mass index (BMI) in elderly people. BACKGROUND: Impaired dentition has been associated with an inadequate consumption of key nutrients and with changes in nutritional status in elderly people. MATERIALS AND METHODS: The sample comprised 887 elderly people, aged 60 and over, of whom 816 underwent a clinical oral examination and were allocated into groups according to the numbers of teeth and number of posterior occluding pairs of natural teeth. Nutritional status was determined using the BMI. Dietary intake was assessed by a 24-h diet recall interview and the data from these records were converted to nutritional intake using DietPro software. Differences between means were evaluated using ANOVA, together with the Tukey test or Dunnet test, according to the normality of the data. Associations between categorical variables were tested using chi-square analysis. RESULTS: Ages ranged from 60 to 96 years (mean, 71.46 years), with 47% of the respondents in the 60-to 69-year-old group. A high DMFT index (mean, 27.81) was observed with the missing component accounting for 88.8% of the index. Significant differences were observed between the mean intake of nutrients and the number of posterior occluding pairs of natural teeth (p < 0.05). No significant differences were found between the number of teeth and BMI. CONCLUSION: Nutrient intake is associated with the oral health status as defined by clinical measures.