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INTRODUCTION AND HYPOTHESIS: This study aimed to estimate the incidence of fecal incontinence (FI) and identify risk factors in a cohort of older individuals. METHODS: In 2006, individuals aged ≥ 60 years were selected from the SABE study. The dependent variable was FI in 2010. FI was assessed using the question: "In the last 12 months, have you ever lost control of bowel movements or stools?" Incidence was measured in units of per 1000 person-years. Multivariate analysis was used to assess risk factors for FI. RESULTS: This study was the first to examine the incidence of FI in older Brazilian individuals. In total, 1413 individuals were included; mean age was 74.5 years, and 864 (61.8%) participants were women. FI prevalence rates were 4.7% for men and 7.3% for women. Incidence rate of FI was 16.3 and 22.2 per 1000 person-years for men and women, respectively. The risk of FI was greater among women aged ≥ 75 years, with severe symptoms of depression, cancer (other than skin) and chronic obstructive pulmonary disease (COPD). In men, the risk of FI was greater among those with poor literacy (up to 3 years of schooling), an Instrumental Activities of Daily Living (IADL) category of 1-4 and those who self-reported "bad/very bad" health status. CONCLUSIONS: The FI incidence rate was high. The identified risk factors were age ≥ 75 years, with severe symptoms of depression, cancer and COPD (women); having up to 8 years of schooling; IADL category of 1-4 and self-reported health status (men).
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Incontinência Fecal , Neoplasias , Doença Pulmonar Obstrutiva Crônica , Atividades Cotidianas , Idoso , Envelhecimento , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Incidência , Masculino , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Fatores de RiscoRESUMO
BACKGROUND: Populational ageing has been increasing in a remarkable rate in developing countries. In this scenario, preventive strategies could help to decrease the burden of higher demands for healthcare services. Machine learning algorithms have been increasingly applied for identifying priority candidates for preventive actions, presenting a better predictive performance than traditional parsimonious models. METHODS: Data were collected from the Health, Well Being and Aging (SABE) Study, a representative sample of older residents of São Paulo, Brazil. Machine learning algorithms were applied to predict death by diseases of respiratory system (DRS), diseases of circulatory system (DCS), neoplasms and other specific causes within 5 years, using socioeconomic, demographic and health features. The algorithms were trained in a random sample of 70% of subjects, and then tested in the other 30% unseen data. RESULTS: The outcome with highest predictive performance was death by DRS (AUC-ROC = 0.89), followed by the other specific causes (AUC-ROC = 0.87), DCS (AUC-ROC = 0.67) and neoplasms (AUC-ROC = 0.52). Among only the 25% of individuals with the highest predicted risk of mortality from DRS were included 100% of the actual cases. The machine learning algorithms with the highest predictive performance were light gradient boosted machine and extreme gradient boosting. CONCLUSION: The algorithms had a high predictive performance for DRS, but lower for DCS and neoplasms. Mortality prediction with machine learning can improve clinical decisions especially regarding targeted preventive measures for older individuals.
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Doenças Cardiovasculares , Aprendizado de Máquina , Idoso , Algoritmos , Brasil/epidemiologia , Causas de Morte , HumanosRESUMO
Excessive weight (overweight and obesity) is a common disorder involving genetic and environmental factors, associated with cardiovascular diseases, type-2 diabetes, and others. NOTCH1 is critical for the maintenance of stem cells and adult tissues, being reported as a key player in metabolism and adipogenesis in animals. Thus, we test the hypothesis that NOTCH1 Single Nucleotide Polymorphisms (SNPs) are associated with excessive weight. Participants from the census-based cohort SABE (Saúde, Bem Estar e Envelhecimento-Health, Well-Being, and Aging), carried out in the city of São Paulo-Brazil, were stratified into cases and controls according to BMI. We filter the SNPs located at the start and end positions of NOTCH1 and 50 Kb on both sides. We selected SNPs with minor allelic frequency (MAF) greater than or equal to 0.01 and Hardy-Weinberg equilibrium (p > 0.05) and r2 ≥ 0.8. We performed an association study with genotypes and haplotypes, as well as in silico functional analysis of the identified SNPs. We observed an association of the SNP rs9411207 with the risk of excessive weight, under log-additive model, and the genotype distribution showed an increased frequency of homozygous TT (OR 1.50, CI 1.20-1.88; p = 0.0002). The haplotype GAT constructed from this and other SNPs in high Linkage Disequilibrium was more frequent in excessive-weight individuals (p = 0.003). In silico analyses suggested that these SNPs are likely to affect the transcription of NOTCH1 and other genes involved in adipogenesis and metabolism. This is the first study reporting association between NOTCH1 SNPs and the risk of excessive weight. Considering the possibility of NOTCH1 modulation, additional population studies are important to replicate these data and confirm the usefulness of risk genotypes for management strategies of excessive weight.
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Obesidade , Sobrepeso , Polimorfismo de Nucleotídeo Único , Receptor Notch1 , Receptor Notch1/genética , Humanos , Brasil/epidemiologia , Masculino , Obesidade/genética , Feminino , Idoso , Sobrepeso/genética , Predisposição Genética para Doença , Pessoa de Meia-Idade , Haplótipos , Frequência do Gene , Estudos de Casos e Controles , Genótipo , Índice de Massa CorporalRESUMO
Stress during aging is not uncommon and dysfunctional family relationships are important sources of stress in the elderly. Considering the potential stressor that family dysfunction represents, it is questioned whether prolonged exposure to dysfunctional family arrangements can contribute to cognitive decline in aging. Objective: To verify whether family dysfunction is a predictive factor of cognitive decline in aging. Methods: Secondary study with analysis of existing data from the longitudinal, population-based study "Health, Wellbeing and Aging" (SABE). Data from 791 elderly people from two cohorts of the SABE study between 2006 and 2015 were analyzed. Family dysfunction was assessed using the Apgar family instrument, while cognitive performance was assessed using the Mini-Mental State Examination (MMSE), verbal fluency (animals) and digit length in reverse order. Cognitive decline was measured by the difference in scores in the period between 2006 and 2015. Results: Approximately 10% of the sample had family dysfunction. The familial Apgar score was not associated with decline on MMSE (p=0.732), verbal fluency (p=0.852) and digit span scores (p=0.718). Scores related to cognition and family functionality, such as age, education, living alone, depression and family Apgar, do not explain cognitive decline. Conclusion: The findings indicate that family functioning is not associated with cognitive decline in community-dwelling elderly. New studies will be needed to analyze the qualitative characteristics of family relationships in the cognitive performance of the elderly.
O estresse ao longo do envelhecimento não é incomum, e as relações familiares disfuncionais constituem fontes importantes de estresse nos idosos. Considerando-se o potencial estressor que a disfunção familiar representa, questiona-se se a exposição prolongada a arranjos familiares disfuncionais pode contribuir para o declínio cognitivo no envelhecimento. Objetivo: Verificar se a disfunção familiar é um fator preditivo de declínio cognitivo no envelhecimento. Métodos: Estudo secundário com análise de dados provenientes do estudo longitudinal de base populacional "Saúde, Bem-estar e Envelhecimento" (SABE). Foram analisados dados de 791 idosos de duas coortes do estudo SABE no período entre 2006 e 2015. A disfunção familiar foi avaliada pelo instrumento Apgar familiar, enquanto o desempenho cognitivo foi avaliado pelo Miniexame do Estado Mental (MEEM), fluência verbal (animais) e extensão de dígitos na ordem inversa. O declínio cognitivo foi medido pela diferença dos escores entre 2006 e 2015. Resultados: Aproximadamente 10% da amostra apresentou disfunção familiar. O escore Apgar familiar não foi associado ao declínio cognitivo pelo MEEM (p=0,732), fluência verbal (p=0,852) e extensão de dígitos ao longo do tempo (p=0,718). Escores relacionados à cognição e funcionalidade familiar, como idade, escolaridade, morar sozinho, depressão e Apgar de família, não explicam o declínio cognitivo. Conclusão: Os achados mostram que a funcionalidade familiar não está associada ao declínio cognitivo de idosos da comunidade. Novos estudos serão necessários para analisar as características qualitativas das relações familiares no desempenho cognitivo de idosos.
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BACKGROUND: A better understanding of performance in functional mobility tasks related to the mortality patterns for the different causes of death for the Brazilian older population is still a challenge. OBJECTIVE: To analyze if gait speed and chair stand test performance are associated with mortality in older adults, and if the overall mobility status changes the effect of other mortality risk factors. METHODS: The data were from SABE (Health, Well-being and Aging Study), a multiple-cohort study conducted in São Paulo, Brazil, with a representative sample of people aged 60 and more. Cox regression models were used to analyze 10-year all-cause and cause-specific mortality with consideration for gait speed and the chair stand test. RESULTS: Of the 1411 participants, 26% died during the follow-up. The performance in the chair stand test had a more consistent association with mortality (hazard ratio (HR)=1.03, 95%CI: 1.00, 1.05) than gait speed. Being unable to perform the test also increased the risk to die by all-cause (HR=1.71, 95%CI: 1.21, 2.42) and by diseases of the circulatory system (HR=2.14, 95%CI: 1.25, 3.65). The stratified analysis of mobility performance changed the effects of some of the mortality risk factors, such as cognitive impairment and multimorbidity. CONCLUSIONS: The chair stand test could be a better choice than 3-meters walking test as a mortality predictor. In addition, the impact of cognitive decline and multimorbidity were greater among those with reduced mobility, supporting the development of preventive interventions and public policies targeted at more vulnerable groups of older adults.
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Velocidade de Caminhada , Idoso , Brasil , Causas de Morte , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: The early identification of individuals at risk of mobility decline can improve targeted strategies of prevention. AIMS: To evaluate the predictive performance of machine learning (ML) algorithms in identifying older individuals at risk of future mobility decline. METHODS: We used data from the SABE Study (Health, Well-being and Aging Study), a representative sample of people aged 60 years and more, living in the Municipality of São Paulo, Brazil. Mobility decline was assessed 5 years after admission in the study by self-reported difficulty to walk a block, climb steps, being able to stoop, crouch and kneel, or lifting or carrying weights greater than 5 kg. Popular machine learning algorithms were trained in 70% of the sample with 10-fold cross-validation, and predictive performance metrics were obtained from applying the trained algorithms to the other 30% (test set). RESULTS: Of the 1,615 individuals, 48% developed difficulty in at least one of the four tasks, 32% in stooping, crouching and kneeling, and 30% in carrying weights. The random forest algorithm had the best predictive performance for most outcomes. The tasks that the algorithm was able to predict with better performance were crouching and kneeling (AUC-ROC: 0.81[0.76-0.85]), and lifting or carrying weights (AUC-ROC: 0.80[0.75-0.84]). Age was the most important variable for the algorithms, followed by education and back pain, according to the SHAP (SHapley Additive exPlanations) values. CONCLUSION: Applications of ML algorithms are a promising tool to identify older patients at risk of mobility decline, with the potential of improving targeted preventive programs.
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Algoritmos , Aprendizado de Máquina , Idoso , Envelhecimento , Brasil , Humanos , Pessoa de Meia-Idade , Medição de RiscoRESUMO
Background: Social networks can modulate physiological responses, protects against the detrimental consequences of prolonged stress, and enhance health outcomes. Family ties represent an essential source of social networks among older adults. However, the impact of family support on cognitive performance and the biological factors influencing that relationship is still unclear. We aimed to determine the relationship between family support, cognitive performance and BDNF levels. Methods: Cross-sectional data from three-hundred, eight-six individuals aged on average 60 years enrolled in the Health, Wellbeing and Aging Study (SABE), a population-cohort study, were assessed for family support, community support and cognitive performance. Structural and functional family support was evaluated based on family size and interactions allied to scores in the Family APGAR questionnaire. Community assistance (received or provided) assessed the community support. Cognitive performance was determined using the Mini-Mental State Examination (MMSE), verbal fluency (animals per minute) and backward digital span. Blood samples were obtained to determine BDNF levels. Results: Multivariate analysis showed that functional family support, but not structural, was associated with higher MMSE, verbal fluency and digit span scores, even controlling for potential cofounders (p < 0.001). Providing support to the community, rather than receiving support from others, was associated with better cognitive performance (p < 0.001). BDNF concentration was not associated with community support, family function, or cognitive performance. Conclusion: These findings suggest that emotional components of functional family and community support (e.g., loving and empathic relationship) may be more significant to cognitive health than size and frequency of social interactions.
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This study evaluated influenza vaccine coverage among elderly individuals (≥ 60 years) living in the city of São Paulo, Brazil, in 2015, and analyzed associated factors. This was a cross-sectional population-based study of data from the SABE Study (Health, Well-Being, and Aging). The dependent variable was influenza vaccination in the 12 months prior to the interview, and the independent variables were sociodemographic and behavioral characteristics, self-reported health status, and use of health services. Data analysis considered the complex study sample, respecting the sampling weight. Poisson's regression was used, with significance set at 5%. Vaccine coverage was 79.7% (95%CI: 76.8-82.5). Influenza vaccination was associated with marital status (PR single/without partner = 0.84; 95%CI: 0.77-0.93), physical activity (PR yes = 1.08; 95%CI: 1.01-1.17), and medical appointment in the previous 12 months (PR yes = 1.22; 95%CI: 1.07-1.39). There were no differences between sociodemographic strata. Influenza vaccination in the elderly had already reached the target for universal coverage in the city of São Paulo. The results are relevant for planning the immunization program, pointing to priority groups to motivate for vaccination and valuing interaction between the elderly and health services.
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Vacinas contra Influenza , Influenza Humana , Idoso , Brasil , Estudos Transversais , Humanos , Influenza Humana/prevenção & controle , Fatores Socioeconômicos , VacinaçãoRESUMO
The scope of this study was to analyze the difference in the prevalence of cardiovascular disease (CVD) between 2000 and 2010 and its association with socio-economic and risk factors among the elderly. Bayesian multilevel models were applied to analyze the difference in the prevalence of CVD, and the association between individual characteristics and the presence of CVD was analyzed by logistic regression models with complex samples separately for 2000, 2006 and 2010. This research is part of the Health, Welfare and Aging (SABE) study, performed in Sao Paulo, Brazil, and used the samples collected in 2000, 2006 and 2010. An increase in the prevalence of cardiovascular disease among the elderly was observed during the period, from 17.9% in 2000, to 22.2% in 2006, attaining 22.9% in 2010. In reference to the prevalence observed in 2000, the multilevel analysis indicated a significant increase in the presence of cardiovascular disease in 2006 (OR = 3.20 95%CI = 1.93-5.31) and 2010 (OR = 2.98 95%CI = 1.51-5.89), even after statistical adjustment for individual factors. The presence of CVD was associated with older age, smoking history, the presence of diabetes and hypertension, and an inverse association was observed between the presence of CVD and alcohol intake.
O objetivo do estudo foi analisar a mudança na prevalência de doença cardiovascular (DCV) entre 2000 e 2010 e sua associação com os fatores socioeconômicos e fatores de risco em idosos. A diferença da prevalência de DCV ao longo do período foi analisada por meio de modelos multinível bayesianos e a análise da associação entre a presença de DCV e os fatores individuais utilizou modelos de regressão logística para amostras complexas nos três períodos separadamente (2000, 2006 e 2010). A presente pesquisa utilizou os dados do Estudo de Saúde, Bem-Estar e Envelhecimento (SABE), realizada no município de São Paulo, referente às amostras de 2000, 2006 e 2010. Foi observado um aumento geral na prevalência de DCV em idosos no município de São Paulo na última década, apresentando prevalências iguais a 17,9% em 2000, 22,2% em 2006 e 22,9% em 2010. Em relação à prevalência em 2000, foi observado o aumento estatisticamente significativo da presença de DCV em 2006 (OR = 3,20 IC95% = 1,93-5,31) e 2010 (OR = 2,98 IC95% = 1,51-5,89), mesmo após o ajuste estatístico para características individuais. A presença de DCV apresentou associação com maior faixa etária, histórico de tabagismo e presença de diabetes e hipertensão arterial, sendo observada uma associação inversa entre a presença de DCV e a ingestão de álcool.
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Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Fumar/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Teorema de Bayes , Brasil/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores SocioeconômicosRESUMO
OBJECTIVE: To describe the prevalence of the self-rated poor and very poor health status among elderly people who were not in nursing homes and were living in São Paulo, Brazil, in 2010, and to identify whether the social inequalities previously reported for this condition persist. METHODS: We carried out a cross-sectional study, with a representative sample of 1,344 people aged 60 years or more living in the city, who participated in the SABE Study (Health, Well-Being, and Aging). We applied a questionnaire about sociodemographic characteristics, which included three questions on self-rated health status: a direct question about the current condition, a comparison with the condition of the other people of the same age, and a comparison with oneself a year before. The comparative analysis used Poisson regression models, reporting the prevalence ratio as a measure of association between variables. RESULTS: Only 7.8% of the elderly individuals reported a negative self-rated health status in 2010, similar proportion to those that consider themselves to be in worse health condition than the other people of the same age (8.7%). However, the prevalence of elderly people that reported worsening in comparison with the previous year was higher, of 29.2%. Regardless of the question used, the prevalence of negative self-rated health was directly associated with worse indicators of income, educational status, and consumer classes. Significant differences between genders, age groups, and skin color categories were also observed. CONCLUSION: Differences in the prevalence of self-rated negative health status continue to affect the sociodemographic groups. The knowledge already available about social inequalities in health did not eliminate or attenuate social injustice in this outcome.
OBJETIVO: Descrever a prevalência da autoavaliação de saúde ruim e muito ruim em idosos não asilados vivendo na cidade de São Paulo em 2010 e identificar se persistem as desigualdades sociais anteriormente relatadas para esta condição. MÉTODOS: Foi realizado um estudo transversal, com amostra representativa de 1.344 pessoas com 60 anos ou mais vivendo na cidade, participantes do Estudo SABE (Saúde, Bem-Estar e Envelhecimento). Foi aplicado questionário sobre características sociodemográficas, incluindo três questões de autoavaliação de saúde: uma pergunta direta sobre a condição atual, uma comparação com a condição das demais pessoas da mesma idade, e uma comparação consigo mesmo há um ano. A análise comparativa utilizou modelos de regressão de Poisson, relatando a razão de prevalências como medida de associação entre variáveis. RESULTADOS: Apenas 7,8% dos idosos relataram autoavaliação negativa de saúde em 2010, proporção análoga à dos que se consideraram em pior condição de saúde que as demais pessoas de mesma idade (8,7%). No entanto, foi mais elevada a prevalência de idosos que relataram piora em relação ao ano anterior: 29,2%. Independentemente da questão utilizada, a prevalência de autoavaliação negativa de saúde associou-se diretamente com piores indicadores de renda, escolaridade e classes de consumo. Também foram observadas diferenças significativas entre os sexos, grupos etários e categorias de cor da pele. CONCLUSÃO: Diferenças na prevalência de autoavaliação negativa de saúde persistem afetando os grupos sociodemográficos. O conhecimento já disponível sobre desigualdades sociais de saúde não propiciou suprimir ou atenuar a injustiça social neste desfecho.
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Autoavaliação Diagnóstica , Disparidades nos Níveis de Saúde , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Envelhecimento Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Distribuição por Sexo , Fatores SocioeconômicosRESUMO
INTRODUCTION: The use of dental prosthesis and the tooth loss in elderly people are associated with significant impact on the overall health and quality of life. Continuous assessment of oral health profile in this population is important for planning the actions and policies of the area. OBJECTIVES: The aims of this study were to assess the prevalence of tooth loss and use of dental prosthesis among the elderly people in different periods, to evaluate the association between functional dentition (20 teeth or more) and socioeconomic factors, and to evaluate the impact of tooth loss and use of dental prosthesis on self-rated oral health. METHODS: Thesample consisted of people aged 60 years and older who participated in the Health, Well-Being, and Aging Study (SABE). Data from the years 2000, 2006, and 2010 were used to assess the prevalence of tooth loss and use of dental prosthesis. Analysis of the factors associated with the functional dentition and self-rated oral health was based on the data collected in 2010. Comparison of oral health profile over the 3 years was done through descriptive analysis and comparison of confidence intervals. Multiple logistic regression models were used to assess the factors associated with functional dentition and self-rated oral health. RESULTS: The prevalence of tooth loss and use of dental prosthesis remained constant over the three periods analyzed. Functional dentition was significantly associated with education, sex, and race/gender. Individuals in need of dental prosthesis and with periodontal pocket were more likely to report poor oral health. CONCLUSION: There was no reduction in the prevalence of tooth loss and in the use of dental prosthesis over 10 years. Functional dentition is associated with socioeconomic inequalities. Self-rated oral health is associated with the need of dental prosthesis.
INTRODUÇÃO: O uso de prótese e a perda dentária em idosos estão associados a impactos significativos na saúde geral e na qualidade de vida. A avaliação contínua do perfil de saúde bucal dessa população é importante para o planejamento das ações e políticas da área. OBJETIVO: Foram objetivos deste trabalho avaliar a prevalência de perda dentária e uso de próteses entre idosos em diferentes períodos, verificar as características sociodemográficas associadas à dentição funcional (mais de 20 dentes) e avaliar o impacto do uso de prótese e da perda dentária na autoavaliação da saúde bucal. MÉTODOS: A amostra foi composta por pessoas de 60 anos ou mais, participantes do Estudo Saúde, Bem-Estar e Envelhecimento (SABE). A avaliação da prevalência de perda dental e uso de próteses foi feita a partir da comparação dos dados coletados nos anos de 2000, 2006 e 2010. As análises dos fatores associados à dentição funcional e autoavaliação de saúde bucal foram realizadas com base nos dados coletados no ano de 2010. A comparação do perfil de saúde bucal ao longo dos três períodos foi feita por meio de análises descritivas e comparação de intervalos de confiança. Realizou-se análise de regressão logística múltipla para avaliar os fatores associados à dentição funcional e à autoavaliação da saúde bucal. RESULTADOS: A prevalência de perda dental e uso de próteses se manteve constante ao longo dos três anos analisados. A dentição funcional foi significativamente associada à escolaridade, sexo e cor/gênero. Idosos com necessidade de próteses e bolsa periodontal apresentaram mais chances de autoavaliação ruim. CONCLUSÃO: Não houve redução da prevalência de perda dentária e uso de próteses ao longo de dez anos na população estudada. A dentição funcional está associada a desigualdades sociodemográficas. A autoavaliação de saúde bucal está associada à necessidade de próteses.
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Prótese Dentária/estatística & dados numéricos , Autoavaliação Diagnóstica , Vida Independente/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Perda de Dente/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Inquéritos de Saúde Bucal/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Perfil de Impacto da Doença , Fatores Socioeconômicos , Fatores de TempoRESUMO
The changes that occur during aging are accompanied by limitations in functional performance that impair elderly people's social participation and consequently harm their quality of life. In the SABE Study (São Paulo, Brazil), the results indicated relationships between life expectancy without disabilities and demographic and social variables. This article sought to evaluate these and other variables together as explanatory factors for the presence or absence of difficulties in instrumental activities of daily living (IADL), directly related to the possibility of more efficient community participation. Five of the eight questions relating to IADL that were applied to the sample of 2,143 elderly individuals in the municipality of São Paulo in 2000 were considered. Odds ratios were calculated using logistic regression. All the socio-demographic variables analyzed (age, income, ethnicity, schooling, and gender) were significant, with the exception of "sufficient money". All the variables in the "health" group (one or two or more diseases reported, and depression) were also significant. The two other variables that entered the model were physical activity and alcohol consumption.
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Atividades Cotidianas , Avaliação Geriátrica , Qualidade de Vida , Idoso , Brasil , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To describe factors associated to inequalities in access to health care services and utilization for the elderly. METHODS: Study part of the Health, Well-being and Aging in Latin America and the Caribbean ("SABE") Survey that included 2,143 elderly individuals aged 60 or older in the city of São Paulo, southeastern Brazil, in 2000. A two-step sampling procedure with probability proportional to size was carried out using census tracts with replacement. To achieve the desired number of respondents aged 75 or older, additional households close to the selected census tracts were sampled. Access to health services and utilization were measured for outpatient and hospital services during a 4-month period prior to the interview, and correlated to factors related to ability, need and predisposition (total income, schooling, health insurance, reported medical condition, self-perception, gender and age).Multivariate logistic regression was performed in the analysis. RESULTS: Of all respondents, 4.7% reported being hospitalized and 64.4% seeking outpatient care in the four months prior to the study. As for public outpatient care provided, 24.7% were in hospital clinics and 24.1% in other public outpatient services. As for private care, 14.5% received care in hospitals and 33.7% in health clinics. The multivariate analysis showed an association between health service utilization and sex, medical condition, self-perceived health, income, schooling, and health insurance. However, an inverse effect was found for the variable "schooling". CONCLUSIONS: The study results show inequalities in access to health services and utilization as well as a deficient health care system. Public policies should take into account the specific needs of the elderly population to facilitate access to health care services and reduce inequalities.
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Avaliação Geriátrica , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Nível de Saúde , Idoso , Idoso de 80 Anos ou mais , Brasil , Métodos Epidemiológicos , Feminino , Humanos , Planos de Pré-Pagamento em Saúde , Encaminhamento e Consulta , Fatores Sexuais , Previdência Social , Fatores SocioeconômicosRESUMO
OBJECTIVE: To investigate the prevalence of demand and provision of care for the Brazilian population with functional disabilities in activities of daily living. METHODS: This is a quantitative and descriptive study using baseline data from ELSI-Brazil (Brazilian Longitudinal Study of Aging), a cohort study with a representative sample of the Brazilian population aged 50 years or older (n = 9,412). We considered the demand for care from the self-report of having some difficulty to perform at least one activity of daily life (eating, bathing, going to the toilet, dressing, moving in a room [ambulation], and transferring from chair [transfer]). Care supply was measured by having some help to perform the activity of daily living. RESULTS: Approximately a quarter of the individuals evaluated (23.2%) reported difficulty in at least one activity of daily living, especially regarding transfer and dressing. Age, schooling, and number of chronic diseases were significantly associated with the difficulty in activities of daily living. Among those who reported difficulty, 35.1% received help of others and 11.8% did not receive (lack of care). The activities with greater lack of care were bathing (13.3%) and transfer (11.7%), which reveals an undignified survival condition. Care remains a family (94.1%) and female (72.1%) issue; despite the important changes that have taken place in society, there is still a lack of care policies. Of the total caregivers, 25.8% reported stopping working or studying to perform this role and only 9.2% were paid (hired ones or family members). CONCLUSIONS: The ELSI-Brazil results reveal the expressive care demand of the Brazilian population aged 50 years or older with functional disabilities on activities of daily living and the lack of care policies aimed at this public.
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Atividades Cotidianas , Cuidadores/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil , Pessoas com Deficiência , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores SocioeconômicosRESUMO
OBJECTIVE: To identify socioeconomic and contextual factors associated with functional mobility and falls in elderly residents of São Paulo, Brazil. METHOD: We used data from the Health, Well-Being, and Aging ( Saúde, Bem-estare Envelhecimento [SABE]) Study. The dependent variables were falling in the last year and functional mobility impairment. Individual (marital status, race, education, and perception of income sufficiency) and contextual (green area and violence) factors were analyzed by multilevel logistic models. RESULTS: Having 8 or more years of schooling was a protective factor for mobility impairment. Neighborhoods with moderate homicide rate were associated with higher odds of falling. Moderate green spaces were associated with higher odds of falling and lower odds to have mobility impairment for individuals 80 years and older. DISCUSSION: Our findings support the concern that neighborhood characteristics are associated with falls and mobility impairment. Strategies to prevent these outcomes should consider contextual aspects.
Assuntos
Acidentes por Quedas , Envelhecimento , Limitação da Mobilidade , Características de Residência , Fatores Socioeconômicos , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Brasil/epidemiologia , Escolaridade , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multinível , Avaliação das Necessidades , Desempenho Físico Funcional , Serviços Preventivos de Saúde/métodosRESUMO
ABSTRACT. Stress during aging is not uncommon and dysfunctional family relationships are important sources of stress in the elderly. Considering the potential stressor that family dysfunction represents, it is questioned whether prolonged exposure to dysfunctional family arrangements can contribute to cognitive decline in aging. Objective: To verify whether family dysfunction is a predictive factor of cognitive decline in aging. Methods: Secondary study with analysis of existing data from the longitudinal, population-based study "Health, Wellbeing and Aging" (SABE). Data from 791 elderly people from two cohorts of the SABE study between 2006 and 2015 were analyzed. Family dysfunction was assessed using the Apgar family instrument, while cognitive performance was assessed using the Mini-Mental State Examination (MMSE), verbal fluency (animals) and digit length in reverse order. Cognitive decline was measured by the difference in scores in the period between 2006 and 2015. Results: Approximately 10% of the sample had family dysfunction. The familial Apgar score was not associated with decline on MMSE (p=0.732), verbal fluency (p=0.852) and digit span scores (p=0.718). Scores related to cognition and family functionality, such as age, education, living alone, depression and family Apgar, do not explain cognitive decline. Conclusion: The findings indicate that family functioning is not associated with cognitive decline in community-dwelling elderly. New studies will be needed to analyze the qualitative characteristics of family relationships in the cognitive performance of the elderly.
RESUMO. O estresse ao longo do envelhecimento não é incomum, e as relações familiares disfuncionais constituem fontes importantes de estresse nos idosos. Considerando-se o potencial estressor que a disfunção familiar representa, questiona-se se a exposição prolongada a arranjos familiares disfuncionais pode contribuir para o declínio cognitivo no envelhecimento. Objetivo: Verificar se a disfunção familiar é um fator preditivo de declínio cognitivo no envelhecimento. Métodos: Estudo secundário com análise de dados provenientes do estudo longitudinal de base populacional "Saúde, Bem-estar e Envelhecimento" (SABE). Foram analisados dados de 791 idosos de duas coortes do estudo SABE no período entre 2006 e 2015. A disfunção familiar foi avaliada pelo instrumento Apgar familiar, enquanto o desempenho cognitivo foi avaliado pelo Miniexame do Estado Mental (MEEM), fluência verbal (animais) e extensão de dígitos na ordem inversa. O declínio cognitivo foi medido pela diferença dos escores entre 2006 e 2015. Resultados: Aproximadamente 10% da amostra apresentou disfunção familiar. O escore Apgar familiar não foi associado ao declínio cognitivo pelo MEEM (p=0,732), fluência verbal (p=0,852) e extensão de dígitos ao longo do tempo (p=0,718). Escores relacionados à cognição e funcionalidade familiar, como idade, escolaridade, morar sozinho, depressão e Apgar de família, não explicam o declínio cognitivo. Conclusão: Os achados mostram que a funcionalidade familiar não está associada ao declínio cognitivo de idosos da comunidade. Novos estudos serão necessários para analisar as características qualitativas das relações familiares no desempenho cognitivo de idosos.
RESUMO
PURPOSE OF THE STUDY: To analyze a representative sample of older individuals of São Paulo, Brazil, according to outdoor fallers, indoor fallers and non-fallers, and to identify biological and socioeconomic (individual and contextual) factors associated with the occurrence and place of falls. MATERIALS AND METHODS: A cross-sectional study was conducted using data (n = 1345) from the 2010 wave of the Health, Wellbeing and Aging (SABE) Study, a representative sample of older residents (60 years and older) of São Paulo, Brazil. Multinomial logistic analysis was performed to identify individual factors associated with the occurrence and place of falls, and multilevel multinomial analysis to identify contextual effects (green areas, violence, presence of slums and income inequality). RESULTS: 29% had a fall in the last 12 months, with 59% occurring in indoor spaces. Individuals who had outdoor falls were overall not statistically different from non-fallers; on the other hand, those who had the last fall indoor had worse health status. Moderate homicide rate was a factor associated with increased presence of indoor falls, compared with non-fallers. IMPLICATIONS: Our results describe the importance of falls, a common problem in active and community-dwelling older adults of São Paulo, Brazil. Transforming outdoor spaces into walk-friendly areas is essential to allow socialization and autonomy with safety. Creating strategies that take into account the most vulnerable populations, as those who live in violent areas and the oldest older adults, will be a growing challenge among developing countries.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Características de Residência , Fatores de Risco , Fatores SocioeconômicosRESUMO
The Pan-American Health Organization coordinated a survey called SABE - acronym for Health, Wellbeing and Aging carried out in seven Latin America and Caribbean countries. In Brazil, it was developed in the city of São Paulo in 2000. On a sample of 2,143 elderly people was applied an instrument, made up of eleven sections, in two parts. The present study was aimed at characterizing and analyzing the death causes of the elderly people during the period of the SABE data collection. From the total deaths, 55.3% were of very old males. Most elderly people didn't live alone and needed no help in answering the questionnaire. Regarding death causes, the diseases that had most incidences were circulatory system, neoplasias and respiratory system. It is hoped that the results of this study may contribute to the adoption of preventive measures aimed at reducing risks related to death among elderly people.
Assuntos
Causas de Morte/tendências , Geriatria , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Analyze the use of antihypertensives among seniors and the association with socioeconomic and behavioral characteristics. METHODS: In this seriate cross-sectional study, we used data from the Saúde, Bem Estar e Envelhecimento study (SABE - Health, Well-being, and Aging), conducted in 2000, 2006, and 2010 in the city of São Paulo. Association between the use of antihypertensives and the demographic, behavioral, and socioeconomic characteristics and risk factors was analyzed by using multilevel logistic regression models. RESULTS: We observed increased proportion of use of antihypertensive, from 48.7% in 2000 to 61.3% in 2006, reaching 65.7% in 2010. Among the seniors who made use of this type of medicine, we also observed increased adoption of combined therapy in the period, from 69.9% to 82.6% from 2000 to 2006 and reaching 91.6% in 2010. Multilevel analysis indicated statistically significant increase in use of antihypertensives, even after control by socioeconomic and behavioral characteristics, both in 2006 and in 2010 (OR = 1.90; 95%CI 1.60-2.24 and OR = 1.94; 95%CI 1.62-2.33, respectively). Use of antihypertensives showed positive association with females, higher age group, black skin color, overweight, and smoking history. CONCLUSIONS: High use of antihypertensives and its association with sociodemographic and behavioral characteristics can help guide the discussion of strategies to improve the epidemiological situation, the quality of life, and the distribution of medicines to the elderly population. OBJETIVO: Analisar o uso de medicamentos anti-hipertensivos em idosos e a associação com características socioeconômicas e comportamentais. MÉTODOS: Neste estudo transversal seriado, foram utilizados dados do estudo SABE (Saúde, Bem Estar e Envelhecimento), realizado em 2000, 2006 e 2010 no município de São Paulo. A associação entre o uso de medicamentos anti-hipertensivos e as características demográficas, socioeconômicas comportamentais e fatores de risco foi analisada por meio de modelos de regressão logísticos multinível. RESULTADOS: Foi observado aumento da proporção do uso de anti-hipertensivo, de 48,7% em 2000 para 61,3% em 2006, chegando à 65,7% em 2010. Entre os idosos que faziam uso desse tipo de medicamento, também foi observado aumento da adoção da terapia combinada no período, passando de 69,9% para 82,6% de 2000 a 2006 e alcançando 91,6% em 2010. A análise multinível indicou aumento estatisticamente significativo do uso de anti-hipertensivos, mesmo após controle pelas características socioeconômicas e comportamentais, tanto em 2006 como em 2010 (OR = 1,90; IC95% 1,60-2,24 e OR = 1,94; IC95% 1,62-2,33, respectivamente). O uso de anti-hipertensivos apresentou associação positiva com sexo feminino, maior faixa etária, cor da pele preta, sobrepeso e histórico de tabagismo. CONCLUSÕES: O uso elevado de anti-hipertensivos e sua associação com as características sociodemográficas e comportamentais podem ajudar a orientar a discussão de estratégias para a melhoria do quadro epidemiológico, da qualidade de vida, e da distribuição de medicamentos para a população idosa.
Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Brasil , Estudos Transversais , Feminino , Humanos , Hipertensão/psicologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Fatores SocioeconômicosRESUMO
Resumo: O presente estudo avaliou a cobertura da vacina contra influenza entre pessoas idosas (idade de 60 anos ou mais) residentes no Município de São Paulo, Brasil, em 2015, bem como verificou os fatores associados. Trata-se de um estudo transversal de base populacional com dados do Estudo Saúde, Bem-estar e Envelhecimento. A variável dependente foi a vacinação contra influenza nos últimos 12 meses anteriores à entrevista, e as variáveis independentes compreenderam características sociodemográficas, comportamentais, situação de saúde autorreferida e uso de serviços de saúde. Para a análise de dados, considerou-se a amostragem complexa do estudo, respeitando-se o peso amostral. Utilizou-se a regressão de Poisson, com nível de 5% de significância. A cobertura vacinal foi de 79,7% (IC95%: 76,8-82,5). A vacinação contra influenza foi associada a situação conjugal (RP sem companheiro = 0,84; IC95%: 0,77-0,93), prática de atividade física (RP sim = 1,08; IC95%: 1,01-1,17) e consulta médica nos últimos 12 meses (RP sim = 1,22; IC95%: 1,07-1,39). Não houve diferença entre os estratos sociodemográficos. A vacinação de idosos contra influenza já atingiu uma meta de universalidade no Município de São Paulo. Os resultados são relevantes para o planejamento do programa de imunizações, apontando grupos prioritários para motivar a vacinação, e valorizam a interação dos idosos com o serviço de saúde.
Resumen: Este estudio evaluó la cobertura de la vacuna de la gripe entre personas ancianas (edad de 60 años o más), residentes en el Municipio de São Paulo, Brasil, en 2015, así como verificó los factores asociados. Se trata de un estudio transversal de base poblacional con datos del Estudio Salud, Bienestar y Envejecimiento. La variable dependiente fue la vacunación contra la gripe en los últimos 12 meses anteriores a la entrevista y las variables independientes comprendieron características sociodemográficas, comportamentales, situación de salud autoinformada y uso de servicios de salud. Para el análisis de datos, se consideró la muestra compleja del estudio, respetando el peso de la muestra. Se utilizó la regresión de Poisson, con un nivel de significancia de un 5%. La cobertura de la vacunación fue de un 79,7% (IC95%: 76,8-82,5). La vacunación contra la gripe estuvo asociada a la situación conyugal (RP sin compañero = 0,84; IC95%: 0,77-0,93), práctica de actividad física (RP sí = 1,08; IC95%: 1,01-1,17) y consulta médica en los últimos 12 meses (RP sí = 1,22; IC95%: 1,07-1,39). No hubo diferencia entre los estratos sociodemográficos. La vacunación de ancianos contra la gripe ya alcanzó una meta de universalidad en el municipio de São Paulo. Los resultados son relevantes para la planificación del programa de inmunizaciones, apuntando grupos prioritarios para la motivación respecto a la vacunación, así como valora la interacción de los ancianos con el servicio de salud.
Abstract: This study evaluated influenza vaccine coverage among elderly individuals (≥ 60 years) living in the city of São Paulo, Brazil, in 2015, and analyzed associated factors. This was a cross-sectional population-based study of data from the SABE Study (Health, Well-Being, and Aging). The dependent variable was influenza vaccination in the 12 months prior to the interview, and the independent variables were sociodemographic and behavioral characteristics, self-reported health status, and use of health services. Data analysis considered the complex study sample, respecting the sampling weight. Poisson's regression was used, with significance set at 5%. Vaccine coverage was 79.7% (95%CI: 76.8-82.5). Influenza vaccination was associated with marital status (PR single/without partner = 0.84; 95%CI: 0.77-0.93), physical activity (PR yes = 1.08; 95%CI: 1.01-1.17), and medical appointment in the previous 12 months (PR yes = 1.22; 95%CI: 1.07-1.39). There were no differences between sociodemographic strata. Influenza vaccination in the elderly had already reached the target for universal coverage in the city of São Paulo. The results are relevant for planning the immunization program, pointing to priority groups to motivate for vaccination and valuing interaction between the elderly and health services.