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Morbidades e associações com autoavaliação de saúde e capacidade funcional em idosos

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Objetivos investigar a relação entre número de doenças crônicas e autoavaliação de saúde/capacidade funcional em relação a sexo e diferentes níveis educacionais. Métodos foi realizado um estudo transversal com 419 idosos que haviam participado do estudo FIBRA, o qual investiga fragilidade em indivíduos idosos. Foram avaliadas variáveis sociodemográficas, doenças crônicas não transmissíveis, autoavaliação de saúde e capacidade funcional. Foi utilizado o teste qui-quadrado ou exato de Fisher para testar as associações entre número de doenças e autoavaliação de saúde e capacidade funcional, com nível de significância de 5%. Resultados A autoavaliação de saúde negativa foi significativamente associada com número de doenças crônicas na amostra geral, no sexo feminino e em ambas as categorias de escolaridade. Por outro lado, relatar dependência parcial ou total para realizar uma ou mais atividades instrumentais de vida diária (AIVDs) apresentou associação significativa para número de doenças crônicas na amostra completa, sexo feminino e 0 a 4 anos de escolaridade. Conclusão as doenças crônicas possuem um impacto negativo na autoavaliação de saúde, especialmente em mulheres e em relação aos anos de escolaridade; e na dependência funcional para AIVDs, especialmente em mulheres e pessoas com 0 a 4 anos de escolaridade.
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RESUMO Objetivos: descrever as características sociodemográficas e de saúde dos idosos com morbidade, identificar as práticas de autocuidado e verificar a associação das variáveis sociodemográficas com as relacionadas à saúde e às práticas de autocuidado. Métodos: inquérito domiciliar quantitativo, analítico e transversal, desenvolvido na zona urbana no interior de Minas Gerais, de 2017 a 2018. Avaliados 796 idosos por instrumentos validados, como Escala de Depressão Geriátrica abreviada, Questionário Brasileiro de Avaliação Funcional e Multidimensional, Questionário Internacional de Atividade Física, Instrumento de Avaliação da Atitude Frente à Tomada de Remédios. Utilizou-se regressão logística múltipla (p<0,05). Resultados: a autopercepção de saúde negativa associou-se às baixas renda e escolaridade. Quanto ao autocuidado em saúde, ser ativo fisicamente associou-se à faixa etária 60 |-| 79 anos e à maior escolaridade. Conclusões: as variáveis sociodemográficas, como sexo, faixa etária, renda, escolaridade, estado conjugal, arranjo de moradia, relacionaram-se à condição de saúde e à prática de autocuidado.
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Objectives: to describe sociodemographic and health characteristics of older adults with morbidity, identify self-care practices and verify the association of sociodemographic variables with those related to health and self-care practices. Methods: a quantitative, analytical and cross-sectional household survey, developed in the urban area in the countryside of Minas Gerais, from 2017 to 2018. A total of 796 older adults were assessed using validated instruments, such as Geriatric Depression Scale: short form, Brazilian Questionnaire for Functional and Multidimensional Assessment, International Physical Activity Questionnaire, Instrument for Assessing Attitude Towards Taking Medications. Multiple logistic regression (p<0.05) was used. Results: negative self-perceived health was associated with low income and education. As for self-care in health, being physically active associated with the age group 60 |-| 79 years and higher education. Conclusions: sociodemographic variables such as sex, age group, income, education, marital status, housing arrangement were related to health status and self-care practice.
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Objectives Poor self-rated health (SRH) is a strong predictor of premature mortality in older adults. Trajectories of poor SRH are associated with multimorbidity and unhealthy behaviours. Whether trajectories of SRH are associated with deviating physiological markers is unclear. This study identified trajectories of SRH and investigated the associations of trajectory membership with chronic diseases, health risk behaviours and physiological markers in community-dwelling older adults. Study design and setting Prospective general population cohort. Participants Trajectories of SRH over 5 years were identified using data of 11 600 participants aged 65 years and older of the Lifelines Cohort Study. Outcome measures Trajectories of SRH were the main outcome. Covariates included demographics (age, gender, education), chronic diseases, health-risk behaviour (physical activity, smoking, drinking) and physiological markers (body mass index, cardiovascular function, lung function, glucose metabolism, haematological condition, endocrine function, renal function, liver function and cognitive function). Results Four stable trajectories were identified, including excellent (n=607, 6%), good (n=2111, 19%), moderate (n=7677, 65%) and poor SRH (n=1205, 10%). Being women (OR: 1.4; 95% CI: 1.0 to 1.9), low education (OR: 2.1; 95% CI: 1.5 to 3.0), one (OR: 10.4; 95% CI: 7.4 to 14.7) or multiple chronic diseases (OR: 37.8; 95% CI: 22.4 to 71.8), smoking (OR: 1.8; 95% CI: 1.0 to 3.2), physical inactivity (OR: 3.1; 95% CI: 1.8 to 5.2), alcohol abstinence (OR: 2.2; 95% CI: 1.4 to 3.2) and deviating physiological markers (OR: 1.5; 95% CI: 1.1 to 2.0) increase the odds for a higher probability of poor SRH trajectory membership compared with excellent SRH trajectory membership. Conclusion SRH of community-dwelling older adults is stable over time with the majority (65%) having moderate SRH. Older adults with higher probabilities of poor SRH often have unfavourable health status.
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Background: More than 80% of elderly Americans have at least one chronic disease. While past studies have shown that hierarchical patterns of functional loss may differ by gender and institutional settings, little is known about whether such patterns differ in relation to chronic health condition. The aim of this study is to investigate the pattern of functional loss among older adults with major chronic illnesses, and to compare their onset and ordering of incident ADL disability with those of persons without such conditions. Methods: We use a nationally representative sample of persons aged 80+ from the 1998-2014 Asset and Health Dynamics of the Oldest Old survey. The group with major noncommunicable diseases (including cardiovascular disease, cancer, chronic respiratory disease, and diabetes) comprises 3,514,052 subjects, while the comparison group comprises 1,073,263 subjects. Self-reports of having difficulty with six distinct ADLs are used to estimate disability incidence rate. Nonparametric statistical methods are used to derive median onset ages and ADL loss sequence separately for each group. Results: Older adults with major chronic diseases have higher rates of incident disability across all ADL items. Estimated median onset ages of ADL disabilities for the full sample range from 91.5 to 95.6. Disability occurs earlier for chronically ill persons (onset ages 91.1-95.0) than for those in the comparison group (onset ages 93.5-98.1). Among those with major chronic diseases, the ADL loss sequence ordered by median ages of disability onset is bathing, walking, dressing, toileting, transferring and eating. The activities are also distinctly separated into an early-loss cluster and a late-loss cluster. Although the loss sequence derived for the comparison group is largely similar, disability progression for those with major chronic diseases is compressed within a shorter timeframe and the timing gaps between adjacent disabilities are smaller. Conclusions: Older Americans with major noncommunicable diseases face an earlier and steeper slope of functional decline. Chronic care delivery programs should adapt to dynamic changes in older patients' functional status. Health interventions to help patients delay disability onset and optimize functional autonomy within emerging models of chronic care should especially target early-loss activities such as bathing, dressing, and walking.
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Background Functional difficulty assessment has been proven as a key factor in the health evaluation of adults. Previous studies have shown a reduction in health and functional difficulties with increasing age. This analysis was conducted to quantify the effect of poor self-rated health on functional difficulty among older adults in Ghana. Method This analysis was based on the World Health Organization Study on Global AGEing and Adult Health in Ghana for older adults 50 years and above. Fifteen standard functioning difficulty tools were extracted and used for the analysis. Three predictive models with the Coarsened Exact Matching method involving Negative Binomial, Logistics and Ordered logistic regression were performed using Stata 14. Results Overall, the prevalence of poor Self-rated health was 34.9% and that of functional difficulties among older adults in Ghana was 69.4%. Female sex, increasing age, being separated, having no religious affiliation, not currently working and being underweight were associated with and significantly influence poor Self-rated health [AOR(95%CI)p-value = 1.41(1.08–1.83)0.011, 3.85(2.62–5.64)0.000, 1.45(1.08–1.94)0.013, 2.62(1.68–4.07)0.000, 2.4(1.85–3.12)0.000 and 1.39(1.06–1.81)0.017 respectively]. In addition, poor Self-rated health and geographical location (rural vs. urban)significantly influence functioning difficulties among older adults in Ghana as predicted by the three models [Negative Binomial: PR(95%CI) = 1.62(1.43–1.82), Binary logistic: AOR(95%CI) = 3.67(2.79–4.81) and ordered logistic: AOR(95%CI) = 2.53(1.14–2.03)]. Conclusion Poor SRH is more pronounced among older adult females in Ghana. Some determinants of poor SRH include; age, geographical location (urban vs. rural), marital status, religion, and employment status. This provides pointers to important socio-demographic determinants with implications on the social function of older adults in line with the theme of the national aging policy of 2010, ‘ageing with security and dignity’ and ultimately in the national quest to achieve the Sustainable Development Goals by 2030.
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Aims To know the prevalence, associated factors and temporal trends of disabilities for basic and instrumental activities of daily living in older people in Spain from 2009 to 2017. Background Disability in older people is associated with health problems, increased health costs and low quality of life. There are no updated data in Spain with a representative sample about disability. Methods Cross-sectional study with 25,465 non-institutionalized older people who participated in the European Health Survey in 2009 and 2014 and the National Health Survey in 2011/12 and 2017 in Spain. The prevalence rates of disability were evaluated using the Katz Scale and Lawton and Brody Scale. Logistic regression was used to determine if there was an association between basic and instrumental activities of daily living and sociodemographic characteristics. Results More individuals had disability for instrumental activities of daily living (31.9%) than disability for basic activities of daily living (11.1%). The most predominant disability for instrumental activities of daily living was performing severe housework (34%). The prevalence of disabilities decreased from 2009 to 2017. In general, disability was associated with female gender, advanced age, lower education, restricted daily activity, being bedridden and higher pain levels. Conclusion There is a considerable prevalence of disabilities for basic and instrumental activities of daily living in older people in Spain. Although the disability prevalence has decreased slowly from 2009 to 2017, it continues to remain a health problem. Gender may influence the disabilities for basic and instrumental activities of daily living. Health policymakers should establish prevention strategies and effective interventions (e.g., physical exercise) for prevention and reduction of the disabilities for basic and instrumental activities of daily living, particularly in older females.
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Objectives. To investigate the association of functional incapacity and the number of morbidities with sociodemographic, economic and health variables. Methods. This is a household survey, quantitative and transversal approach, conducted with 1,693 elderly in Uberaba-MG in 2012. We used the Mini-Mental State Examination, Katz Scale, Lawton and Brody Scale; Geriatric Depression Scale abbreviated and semi-structured instrument for evaluation of demographic data, economic and morbidities. Results. Functional incapacity in basic activities of daily living was associated with older age, a greater number of morbidities and presence of indicative of depression. Regarding the instrumental activities of daily living, functional incapacity was related to age, lower education and income, the greater number of morbidities and have indicative of depression. The largest number of comorbidities was associated with female sex, older age, lower income and indicative of depression. Conclusion. This study highlights the need for health actions directed to the oldest old, with less education and income, and indicative of depression to minimize the dependency on the performance of functional capacity and impact on morbidities.
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Introduction: In Poland, the number of the oldest-old people is increasing. The prevalence of health problems increases with age, which expands the cost of medical and social care. Therefore, there is a need to assess factors affecting the level of disability and quality of life in order to modify them. Material and methods: The study was carried out in a group of 498 people aged 80 and over who live in community in south-eastern Poland. The researchers collected socio-demographic and health data, the WHODAS 2.0 questionnaire was used to assess disability and functioning. Quality of life was studied using the WHOQOL-BREF questionnaire. Results: The general average level of disability was 37.41, with women having a higher level of general disability than men (38.94 vs. 33.94). The highest levels of disability occurred in areas such as mobility, life activity and participation. Statistically, a significantly higher level of disability develops in women who are older, with lower education, social involvement, not able to get help from other people and having more chronic diseases. In men, disability increased with age and greater number of chronic illnesses. The general quality of life of the study group was average (62.53) and comparable for both genders. The lowest quality of life was found in the domain of physical health. A significantly lower quality of life appeared in lonely people, with more chronic diseases, lower education, physical and social inactivity, as well as a lack of help from other people and non-adjustment to the environment. Conclusions: Factors affecting the disability and quality of life of the oldest-old people should be considered in developing senior health policy in Poland.
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The classical portrayal of poor health in tropical countries is one of infections and parasites, contrasting with wealthy Western countries, where unhealthy diet and behaviours cause non-communicable diseases (NCDs) such as heart disease and cancer. Using international mortality data, we show that most NCDs cause more deaths at every age in low- and middle-income tropical countries than in high-income Western countries. Causes of NCDs in low- and middle-income countries include poor nutrition and living environment, infections, insufficient taxation and regulation of tobacco and alcohol, and under-resourced and inaccessible healthcare. We identify a comprehensive set of actions across health, social, economic and environmental sectors that could confront NCDs in low- and middle-income tropical countries and reduce global health inequalities.
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Multimorbidity has been recognized as a major public health issue that is prevalent among older adults, affecting objective and subjective health, and health care utilization. For instance, in Canadian and Australian population health surveys, self-reported multimorbidity is estimated between 50% and 65% among persons 65 and over. This exploratory study examines selected health outcomes associated with multimorbidity across older age groups/cohorts and gender, comparing Canada and Australia. Data were drawn from the 2008/09 Canadian Community Health Survey and the 2009 Australian HILDA survey. Seven major chronic illnesses were identical across the two data sets, and were combined into an additive measure of multimorbidity. OLS and logistic regression models were performed within age group (45–54, 55–64, 65–74, 75+) and gender to estimate associations between multimorbidity and several health outcomes, including: loneliness, life satisfaction, perceived health, mobility restriction, and hospital stays, adjusting for marital status, education and foreign born status. Overall, country-level differences were identified for perceptions of loneliness, life satisfaction, and perceived health. Australians tended to experience a greater risk of loneliness and lower self-rated health in the face of multimorbidity than Canadians, especially among older men. Canadians tended to experience lower life satisfaction associated with multimorbidity than Australians. No country-level differences were identified for the effects of multimorbidity on hospital stays or mobility limitations. The effects of multimorbidity on health is variable depending on population, age group/cohort, and gender. The strongest country-level associations are for indicators of health-related quality of life, rather than health care or mobility limitation outcomes.
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Objectives To evaluate, among the elderly, the association of self-rated health (SRH) with mortality, and to identify determinants of self-rating health as “at-least-good”. Study Design Individual data on SRH and important covariates were obtained for 424,791 European and Unites States residents, ≥60 years at recruitment (1982-2008), in eight prospective studies in the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). In each study, adjusted mortality ratios (hazard ratios, HRs) in relation to SRH were calculated and subsequently combined with random-effect meta-analyses. Main outcome measures All-cause, cardiovascular and cancer mortality. Results Within the median 12.5 years of follow-up, 93,014 (22%) deaths occurred. SRH “fair” or “poor” vs. “at-least-good” was associated with increased mortality: HRs 1.46 (95% CI 1·23-1.74) and 2.31 (1.79-2.99), respectively. These associations were evident: for cardiovascular and, to a lesser extent, cancer mortality, and within-study, within-subgroup analyses. Accounting for lifestyle, sociodemographic, somatometric factors and, subsequently, for medical history explained only a modest amount of the unadjusted associations. Factors favourably associated with SRH were: sex (males), age (younger-old), education (high), marital status (married/cohabiting), physical activity (active), body mass index (non-obese), alcohol consumption (low to moderate) and previous morbidity (absence). Conclusion SRH provides a quick and simple tool for assessing health and identifying groups of elders at risk of early mortality that may be useful also in clinical settings. Modifying determinants of favourably rating health, e.g. by increasing physical activity and/or by eliminating obesity, may be important for older adults to “feel healthy” and “be healthy”.