Funcionalidade, condições crônicas e mortalidade entre idosos: resultados da pesquisa por amostras de domicílios (PNAD) e estudo de coorte de Bambuí

O envelhecimento populacional leva a um aumento nas condições crônicas, como hipertensão arterial e diabetes, que estão relacionadas com a incapacidade funcional. Além disso, a incapacidade é um importante indicador de saúde e preditor de mortalidade entre idosos, mas essa associação tem sido pouco estudada em países de média e baixa renda. A presente tese é composta por dois estudos, sendo que o primeiro, de corte transversal, objetivou investigar a associação entre a mobilidade física e o relato de hipertensão arterial e diabetes, em idosos brasileiros, entre 1998 e 2008, utilizando os dados da Pesquisa Nacional de Amostra de Domicílios (PNAD). A variável dependente foi o índice de mobilidade física (IMF) construído com base na Teoria de Resposta ao Item (TRI) a partir de cinco indicadores de mobilidade física.

A associação foi verificada por meio de regressão logística multinomial, que mostrou redução da força de associação entre mobilidade e as condições estudadas no primeiro período (1998 a 2003), mas não no período mais recente. A diminuição da magnitude da associação nos primeiros cinco anos, apesar dos aumentos observados na prevalência da hipertensão arterial e diabetes, talvez possa ser explicada por melhorias nos serviços de saúde e tratamento dos idosos, chamando atenção para a não redução no período mais recente. O segundo estudo, do tipo longitudinal, visou investigar o efeito da incapacidade funcional (ABVD, AIVD e mobilidade) avaliada na linha de base, sobre a mortalidade geral em quinze anos de seguimento dos idosos da coorte de Bambuí, Minas Gerais. Foram utilizados dados de 1.342 idosos (83,6%), estimando-se o “Hazard ratio” pelo modelo de riscos proporcionais de Cox e as curvas de sobrevida, pelo método de Kaplan Meier. Considerando a população total, a incapacidade foi associada ao risco de morte nos três domínios investigados. No entanto, enquanto entre os homens a associação foi significativa para os três domínios, na população feminina o risco foi significativo apenas para as ABVD e mobilidade. Portanto, os domínios de incapacidade considerados foram preditores de mortalidade entre os idosos da coorte, sendo mais forte entre os homens. Estratégias de promoção e prevenção voltadas para esse grupo são fundamentais para manutenção da função física e redução do risco de morte

Prevalência e fatores associados ao diabetes em idosos no município de Viçosa, Minas Gerais / Prevalence and associated factors of diabetes in the elderly population in Viçosa, Minas Gerais, Brazil

RESUMO: Objetivo: Avaliar a prevalência e os fatores associados ao diabetes em idosos, bem como verificar a concordância entre o uso de medicamentos para diabetes e a informação referida sobre a doença. Métodos: Estudo epidemiológico transversal realizado na cidade de Viçosa, Minas Gerais, com 621 idosos com 60 anos ou mais, selecionados a partir de amostragem aleatória simples. Utilizou-se como instrumento de pesquisa um questionário semiestruturado que constava de perguntas sobre condições sociodemográficas, estilo de vida, condições de saúde e estado nutricional. Foram aferidos peso e altura, além do perímetro da cintura. A variável dependente do estudo foi o diabetes autorreferido. A análise da associação entre as diversas variáveis explicativas e a presença de diabetes foi feita por meio da regressão de Poisson com variância robusta simples e múltipla. Nas análises bivariadas foi utilizado o valor p < 0,25 para inclusão das variáveis na análise de regressão múltipla hierarquizada e, no modelo final, permaneceram as associações cujas variáveis apresentaram associação com o desfecho com valor p < 0,05. Resultados: A prevalência de diabetes foi de 22,4%. A análise múltipla hierarquizada evidenciou como fatores independentemente e positivamente associados ao diabetes: gênero, autopercepção da saúde, história de hipertensão e/ou dislipidemias, polifarmácia e obesidade abdominal. A escolaridade se manteve negativamente associada à presença de diabetes. Conclusão: Os resultados obtidos são similares aos de outros estudos conduzidos no país, sugerindo que os fatores associados ao diabetes entre idosos são semelhantes em todo o país. Ainda, observou-se moderada concordância entre o uso de medicamentos para diabetes e a informação referida sobre a doença, o que sugere o uso da última como método alternativo de investigação quando não se dispuser de outra forma de avaliação.

ABSTRACT: Objectives: To assess the prevalence and factors associated with diabetes in the elderly population and verify the correlation between the use of medications for diabetes and information about the disease. Methods: This epidemiological cross-sectional study was conducted in Viçosa, Minas Gerais, Brazil, with 621 elderly people aged 60 years or older selected by simple random sampling. A semi-structured questionnaire was used as a research tool and included questions about socioeconomic conditions, lifestyle, health conditions, and nutritional status. The weight, height, and waist circumference were measured. The dependent variable was the self-reported diabetes. In the association analysis between explanatory variables and self-reported diabetes, the Poisson regression analysis with robust variance was used. In the bivariate analysis, a p value < 0.25 was used to include the variables for the multivariate modeling, and in the final model, the variables with p value < 0.10 association were included. Results: The prevalence of diabetes was 22.4%. The multivariate hierarchical analysis showed the following factors independently and positively associated with diabetes: gender, self-reported health, history of hypertension/dyslipidemia, polypharmacy, and waist circumference. The elderly schooling was negatively associated with diabetes. Conclusion: The results showed the need for implementation of educational public policies to promote behavior changes of the population to prevent and control diabetes and its complications.

Diabetes, hypertension and mobility among Brazilian older adults: findings from the Brazilian National Household Sample Survey (1998, 2003 and 2008).

BACKGROUND: The rapid population ageing has been accompanied by a growing number of older adults experiencing chronic conditions, especially diabetes and hypertension, which are conditions associated to the decline in physical functioning. The aim of this study was to investigate changes in the strength of the association between mobility and two chronic conditions (hypertension and diabetes) in a large representative sample of Brazilian older adults over a ten year period. METHODS: The data came from the Brazilian National Household Sample Survey (PNAD) of 1998, 2003 and 2008. The sample comprised 28,943 participants aged 60 years and older investigated in 1998, 35,042 in 2003 and 41,269 in 2008, totalling 105,254 older adults. The dependent variable was the physical mobility index (PMI) constructed based on the Item Response Theory (IRT) using five physical mobility indicators. The chronic conditions were self-reported and the confounders included: age, sex, schooling, ethnicity, family income, household composition, other co-morbidities and use of health services. The association between physical mobility (three different groups) and chronic conditions (hypertension and diabetes) was performed using multinomial logistic regression. RESULTS: Over the ten year period the prevalence of hypertension increased from 44 % (1998), 49 % (2003) to 53 % (2008) (p < 0.001). Similar pattern was observed for the prevalence of diabetes: 10 % in 1998, 13 % in 2003 and 16 % in 2008 (p < 0.001). Overall, physical mobility showed a statistical significant association with both chronic diseases studied even after adjusting for potential confounders. The time-disease interaction term was significant (p < 0.05) for the two chronic conditions studied, and the strength of the associations decreased over the first five years, but it was not sustained between 2003 and 2008. CONCLUSIONS: Despite the increases observed in the prevalence of the hypertension and diabetes over the ten year period, the decrease in strength of the association with physical mobility during the first period could be explained by improvements in health services and treatment of older adults. Special attention should be given to the treatment and management of diabetes in order to avoid declines in physical mobility levels.

Prevalence and associated factors of diabetes in the elderly population in Viçosa, Minas Gerais, Brazil.

OBJECTIVES: To assess the prevalence and factors associated with diabetes in the elderly population and verify the correlation between the use of medications for diabetes and information about the disease. METHODS: This epidemiological cross-sectional study was conducted in Viçosa, Minas Gerais, Brazil, with 621 elderly people aged 60 years or older selected by simple random sampling. A semi-structured questionnaire was used as a research tool and included questions about socioeconomic conditions, lifestyle, health conditions, and nutritional status. The weight, height, and waist circumference were measured. The dependent variable was the self-reported diabetes. In the association analysis between explanatory variables and self-reported diabetes, the Poisson regression analysis with robust variance was used. In the bivariate analysis, a p value < 0.25 was used to include the variables for the multivariate modeling, and in the final model, the variables with p value < 0.10 association were included. RESULTS: The prevalence of diabetes was 22.4%. The multivariate hierarchical analysis showed the following factors independently and positively associated with diabetes: gender, self-reported health, history of hypertension/dyslipidemia, polypharmacy, and waist circumference. The elderly schooling was negatively associated with diabetes. CONCLUSION: The results showed the need for implementation of educational public policies to promote behavior changes of the population to prevent and control diabetes and its complications.

Factors associated with functional ability in Brazilian elderly.

The purpose of this observational study, designed as a cross-sectional sample of 621 elderly residents in Viçosa, Minas Gerais state, Brazil was to evaluate the prevalence of inadequate functional ability and associated factors in Brazilian elderly. Interviews were conducted at study subjects' houses using a questionnaire focused on socio demographic information and health conditions. Elderly who reported some difficulty in performing six or more activities, or total inability to carry out at least three activities identified on the scale developed by Katz et al. (1963) and Lawton and Brody (1969) were considered to have inadequate functional ability. Data analysis included frequency distribution, bivariate and multivariate Poisson regression. The prevalence of inadequate functional ability was of 16.2% (95% CI: 13-19%) in the sample analyzed. With aging, there was a significant trend of inadequate functional ability increasing in men (χ(2) for trend=8.481; p=0.003) and women (χ(2) trend=13.667; p<0.001). Factors positively associated with inadequate functional ability were age over 80 years, low monthly income, poor self-health perception, history of hospitalization in the last year, use of 5 or more medicines in the last 15 days; history of depression, history of osteoporosis, and negatively associated to physical activity. Factors associated with inadequate functional ability highlighted in this study demonstrate the importance of health programs in Brazil focused on adults and the elderly in preventing or delaying functional decline and promote healthy aging.

Estado nutricional e fatores associados em idosos do Município de Viçosa, Minas Gerais, Brasil / Nutritional status and associated factors among the elderly in Viçosa, Minas Gerais State, Brazil

Investigaram-se as prevalências de baixo peso e excesso de peso, bem como os fatores associados em idosos. Trata-se de um estudo transversal, com 621 idosos residentes no Município de Viçosa, Minas Gerais, Brasil, realizado em 2009. As informações foram obtidas por meio de entrevistas domiciliares e se referiam à avaliação do estado nutricional, condições sociodemográficas e de saúde. Do total de pessoas estudadas, 53,3 por cento eram do gênero feminino. A mediana do IMC foi de 26,40kg/m² (mínima 15,20 e máxima 46,82) e foi menor para os homens do que para as mulheres. A prevalência de excesso de peso foi elevada (45 por cento; IC95 por cento: 40 por cento-49 por cento), diminuiu com a idade, associou-se positivamente ao gênero feminino e história de artrite/artrose, e negativamente à faixa etária de 80 anos ou mais e ao tabagismo. A prevalência de baixo peso foi maior no gênero masculino (18,2 por cento), aumentou com o avanço da idade e associou-se positivamente à pior percepção de saúde. O conjunto dos resultados salientam a importância de estratégias em saúde que favoreçam mudanças no estilo de vida e hábitos alimentares saudáveis.

This cross-sectional study in 2009 focused on the prevalence of underweight and overweight and associated factors in a sample of 621 elderly individuals in Viçosa, Minas Gerais State, Brazil. Data were obtained through home interviews on nutritional status and socio-demographic and health conditions. Of the total sample, 53.3 percent were females. Median BMI was 26.40kg/m² (range = 15.20-46.82) and was lower for men than for women. Prevalence of overweight was high (45 percent; 95 percentCI: 40 percent-49 percent), decreased with age, was positively associated with female gender and history of arthritis/arthrosis, and was negatively associated with age 80 years or older and smoking. Prevalence of underweight was high in men (18.2 percent), increased with age, and was positively associated with worse self-rated health. The findings highlight the importance of health strategies that favor lifestyle changes and healthy eating habits.

Estado nutricional e condições de saúde da população idosa brasileira: revisão da literatura

O estado nutricional tem implicações significativas em relação ao processo de envelhecimento e importante relação com a morbimortalidade de idosos. Este trabalho objetiva realizar revisão da literatura sobre as condições de saúde e o estado nutricional da população idosa brasileira. As bases de dados pesquisadas foram PubMed, LILACS e Scielo. Observa-se elevada prevalência de doenças crônicas entre idosos brasileiros, sendo as cardiovasculares responsáveis pelas principais causas de mortalidade. As doenças também se associam à incapacidade funcional, dependência e perda de autonomia. Observa-se ainda tendência ao estado nutricional dos idosos brasileiros apresentarem aumento de sobrepeso e obesidade e redução do baixo peso. Essas alterações, associadas ao envelhecimento e aos hábitos de vida, podem levar a doenþas crônicas e à incapacidade anatomofuncional. São escassos os estudos nacionais que investigam as associações entre condições de saúde e nutrição de idosos.

Nutritional state has significant implications on the ageing process and important relationship with morbi-mortality among elderly people. Building on PubMed, LILACs and Sciolo databanks, this paper provides a review of the literature on the nutritional state and health conditions of the Brazilian elderly population. Literature reports high prevalence of chronic disease among this population, and cardiovascular diseases are reported to be the main causes of mortality. The diseases are also reported to be associated to functional incapacity, dependence, and loss of autonomy. Brazilian elderly people are also reported to have a tendency to increased overweight and obesity, or else reduced weight. Such alterations, when associated with ageing and life styles, can lead to chronic diseases and anatomo-functional incapacity. Few students were found that investigated the associations between the elderly people?s nutrition and health conditions.

[Nutritional status and associated factors among the elderly in Viçosa, Minas Gerais State, Brazil]. / Estado nutricional e fatores associados em idosos do Município de Viçosa, Minas Gerais, Brasil.

This cross-sectional study in 2009 focused on the prevalence of underweight and overweight and associated factors in a sample of 621 elderly individuals in Viçosa, Minas Gerais State, Brazil. Data were obtained through home interviews on nutritional status and socio-demographic and health conditions. Of the total sample, 53.3% were females. Median BMI was 26.40 kg/m² (range = 15.20-46.82) and was lower for men than for women. Prevalence of overweight was high (45%; 95%CI: 40%-49%), decreased with age, was positively associated with female gender and history of arthritis/arthrosis, and was negatively associated with age 80 years or older and smoking. Prevalence of underweight was high in men (18.2%), increased with age, and was positively associated with worse self-rated health. The findings highlight the importance of health strategies that favor lifestyle changes and healthy eating habits.