Aging in a rural area in southern Brazil: designing a prospective cohort study.

INTRODUCTION: This article presents the methods used to design a prospective cohort study with older adults from a rural area in the far south of Brazil (EpiRural Cohort Study), as well as to describe the cohort profile. METHODS: The cohort study began in 2017 and evaluated older adults (≥60 years) living in rural area. The first follow-up of the cohort was carried out between September 2018 and March 2019. Data collection at baseline and first follow-up was performed through an electronic questionnaire containing demographic, socioeconomic and health-related questions, such as alcohol and cigarette consumption, morbidities and self-perceived health status. RESULTS: At baseline, 1130 older adults were sampled, 1029 of whom were interviewed (91.1%). The age of almost 17% was 80 years or more, and 55.2% were male. At first follow-up, 862 individuals were followed (83.8%) and the characteristics of the older adults interviewed compared to those not interviewed at follow-up were similar. Between baseline and follow-up, the proportion of individuals aged 70-79 years increased, as well as the proportion of those who had consumed alcoholic beverages in the previous week and who had hypertension. The male-to-female ratio, those who were living alone, working, smokers, diabetics, who had stroke and who reported their health as being very good/good were comparable between the baseline and follow-up. CONCLUSION: With a reasonable follow-up rate, it was possible to transform a cross-sectional study into a prospective cohort study. However, new strategies will be needed to help locate participants more successfully and ensure a good response rate in future follow-ups.

Functional dependence among older adults: a cross-sectional study with a rural population of southern Brazil.

INTRODUCTION: Brazil has a rapidly aging population, yet little is known about the occurrence of functional dependence in the rural older adult population. The objective of this study was to estimate the prevalence of functional dependence and its associated factors among community-dwelling older adults in the rural area of the municipality of Rio Grande, Rio Grande do Sul state, Brazil. METHODS: This was a cross-sectional, population-based study. A systematic random sampling of households was used. Eighty percent of households in the rural area were selected, which included 1131 older adults. The outcome analyzed in this study was functional dependence. This was measured by and data were collected using the Katz Index for Activities of Daily Living (ADL) and Lawton and Brody's Scale for Instrumental Activities of Daily Living (IADL). Descriptive analysis was used to estimate the prevalence of functional dependence in ADL and IADL and to describe the sample. Crude and adjusted analysis was performed by Poisson regression with robust adjustment of variance. Prevalence ratios (PRs) and 95% confidence intervals (95%CIs) were reported. RESULTS: A total of 1029 older adults took part in this study, corresponding to an 8.9% rate of losses and refusals. Prevalence of functional dependence in ADL was 8.1% (95%CI 6.4-9.7), while prevalence of functional dependence in IADL was 32.4% (95%CI 29.5-35.2). The occurrence of functional dependence in one or more of ADL or IADL was 6.7% (95%CI 5.2-8.2). The following categories were associated with functional dependence in ADL: female sex (PR=1.70; 95%CI 1.10-2.62), age group 80 years or more (PR=3.68; 95%CI 2.20-6.16), no schooling (PR=2.61; 95%CI 1.26-5.37) and 1-4 years of schooling (PR=2.49; 95%CI 1.28-4.84), having diabetes (PR=1.85; 95%CI 1.21-2.83), depression in the previous year (PR=1.90; 95%CI 1.09-3.31), urinary incontinence (PR=3.26; 95%CI 2.06-5.16), history of stroke (PR=2.26; 95%CI 1.35-3.76) and poor/very poor self-rated health (PR=2.36; 95%CI 1.29-4.32). The following categories were associated with functional dependence in IADL: female sex (PR=1.40; 95%CI 1.19-1.65), age groups of 70-79 years (PR=1.92; 95%CI 1.51-2.43) and 80 years or more (PR=3.80; 95%CI 3.07-4.72), no schooling (PR=1.87; 95%CI 1.46-2.41) and 1-4 years of schooling (PR=1.55; 95%CI 1.22-1.96), medical diagnosis of diabetes (PR=1.33; 95%CI 1.10-1.60), urinary incontinence (PR=1.40; 95%CI 1.17-1.68), history of stroke (PR=1.41; 95%CI 1.10-1.81) and regular self-rated health (PR=1.27; 95%CI 1.06-1.52) or poor/very poor self-rated health (PR=1.80; 95%CI 1.41-2.30). CONCLUSION: Older adults in rural areas have a high prevalence of functional dependence. Knowledge of functional dependence and associated factors in rural populations is necessary for the planning and developing actions, especially in the routine of primary care, which promote health and prevent or postpone the decline in functional capacity.