RESUMEN
BACKGROUND: Oral health has been associated with general health conditions, but few longitudinal studies evaluated the effect of dentition status on gait speed. OBJECTIVE: This study aimed to investigate the longitudinal association between different time-varying measures of dentition status (i.e., number of teeth, the presence of periodontal pockets and the functional impact of oral health) and gait speed (outcome) in older Brazilian adults. MATERIALS AND METHODS: This was a prospective study using data from the Health, Well-being and Aging cohort study (SABE) from 2006, 2010 and 2015. The gait speed was the dependent variable and the independent variables of interest were dentition status evaluated using the number of teeth, use of dental prostheses, presence of periodontal pocket, clinical attachment loss and self-perceived poor functional oral health. Dentition status measures were obtained through clinical oral examinations, performed by trained dentists using standardized criteria proposed by the World Health Organization. Self-perceived poor functional oral health was evaluated using the functional domain of the Geriatric Oral Health Assessment Index. The longitudinal effect of dentition status on gait speed was evaluated using mixed-effects linear models. The effect of the number of teeth/periodontal pocket/attachment loss on gait speed change over time was evaluated by including an interaction term between these variables. The effect of periodontal pocket was tested only among dentate individuals. RESULTS: Data for the complete sample included 3,306 observations from 1,964 individuals. The analyses for dentate individuals included 1,883 observations from 1,149 individuals. There was a positive association between the number of teeth and mean gait speed. Individuals using dental prostheses also had higher means of gait speed than those without dental prostheses. Gait speed was lower among individuals with periodontal pockets and with attachment loss. No interaction was found between any of the indicators of dentition status and time. CONCLUSION: Gait speed was associated with dentition status and this association was constant over time.
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Dentición , Salud Bucal , Velocidad al Caminar , Humanos , Masculino , Brasil/epidemiología , Femenino , Anciano , Velocidad al Caminar/fisiología , Estudios Prospectivos , Estudios Longitudinales , Estudios de Cohortes , Anciano de 80 o más Años , Persona de Mediana EdadRESUMEN
OBJECTIVE: Investigate the association between potentially inappropriate medication (PIM) use and the risk of death among community-dwelling older Brazilian adults. METHODS: Participants from the Health, Well-Being, and Aging Cohort Study (SABE) in São Paulo, Brazil, between 2000 and 2016 were included. The dependent variable was all-cause mortality, measured as the time elapsed until death. The exposure of interest was the use of PIM according to the Beers Criteria 2019 version. All covariates, except for sex and education, were considered time-varying. RESULTS: PIM use was not associated with mortality after adjusting for covariates (HR = 0.99; 95 % CI: 0.88-1.12). There was a significant interaction between PIM use and age (HR = 0.98; 95 % CI: 0.96-0.99). CONCLUSION: The association between PIM use and the risk of death was moderated by age. Future studies should consider the impact of necessary medication omissions when assessing the mortality risk associated with PIM use.
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Lista de Medicamentos Potencialmente Inapropiados , Humanos , Brasil , Masculino , Femenino , Anciano , Estudios de Cohortes , Vida Independiente , Anciano de 80 o más Años , Prescripción Inadecuada , Mortalidad , Factores de RiesgoRESUMEN
BACKGROUND: Patterns of cognitive change and modifiable factors for cognitive decline versus stable cognitive trajectories have rarely been described in lower-educated older adults. OBJECTIVES: We aimed to identify long-term trajectories of cognitive functioning and possible factors associated with cognitive decline. DESIGN AND PARTICIPANTS: We used data from 1,042 adults aged ≥ 60 participating in the Health, Welfare and Aging Study (SABE), São Paulo, Brazil, without cognitive impairment at baseline. Data were collected across four waves (2000-2015). Group-based trajectory modelling was used to identify cognitive trajectories. Associations with socioeconomic variables, childhood background, lifestyle, and cardiovascular risk factors were explored using weighted multinomial logistic regressions. MEASUREMENTS: The abbreviated Mini-Mental State Examination was used to measure cognition. RESULTS: Three cognitive trajectories were identified: stable (n= 754, 68.6%), mild-decline (n= 183, 20.8%), and strong-decline (n= 105, 10.7%). At baseline, respondents in the strong-decline group were more likely to be older than those with stable and mild-decline trajectories. Furthermore, participants in both the mild and strong-decline groups were more likely to have no schooling, be divorced/separated, receive less than 4 monthly wages, and be underweight (BMI < 18.5) compared to the stable group. Finally, the mild-decline group was more likely to have lived in rural areas during childhood than participants located in a stable trajectory. CONCLUSIONS: Our findings suggest that interventions to reduce cognitive decline for low-educated older adults might include strategies addressing inequalities and improving modifiable risk factor burden.
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Disfunción Cognitiva , Escolaridad , Factores Protectores , Humanos , Masculino , Disfunción Cognitiva/epidemiología , Femenino , Brasil/epidemiología , Anciano , Factores de Riesgo , Estudios de Seguimiento , Persona de Mediana Edad , Factores Socioeconómicos , Anciano de 80 o más Años , Pruebas de Estado Mental y DemenciaRESUMEN
BACKGROUND: Vision and hearing impairments can reduce participation in social activities. Given the prominent role of the mouth in face-to-face interactions, this study evaluated the associations of tooth loss, vision, and hearing impairments with social participation among older adults. METHODS: This analysis included 1947 participants, aged 60+ years, who participated in three waves (2006, 2010, and 2015) of the Health, Wellbeing and Aging Study (SABE) in Brazil. Social participation was measured by the number of formal and informal social activities (requiring face-to-face interaction) participants were regularly involved in. Teeth were counted during clinical examinations and categorized as 0, 1-19, and 20+ teeth. Reports on vision and hearing impairments were classified into three categories (good, regular, and poor). The associations of each impairment with the 9-year change in the social participation score were tested in negative binomial mixed-effects models adjusting for time-variant and time-invariant covariates. RESULTS: Each impairment was associated with the baseline social participation score and the annual rate of change in the social participation score. Participants with 1-19 (incidence rate ratio: 0.96, 95% CI: 0.91-1.01) and no teeth (0.92, 95% CI: 0.87-0.97), those with regular (0.98, 95% CI: 0.95-1.01) and poor vision (0.86, 95% CI: 0.81-0.90), and those with regular (0.94, 95% CI: 0.91-0.98) and poor hearing (0.91, 95% CI: 0.87-0.95) had lower baseline social participation scores than those with 20+ teeth, good vision, and good hearing, respectively. Furthermore, participants with 1-19 (0.996, 95% CI: 0.990-1.002) and no teeth (0.994, 95% CI: 0.987-0.999), those with regular (0.996, 95% CI: 0.992-0.999) and poor vision (0.997, 95% CI: 0.991-1.003), and those with regular (0.997, 95% CI: 0.992-1.001) and poor hearing (0.995, 95% CI: 0.990-0.999) had greater annual declines in the social participation score than those with 20+ teeth, good vision and good hearing, respectively. CONCLUSION: This 9-year longitudinal study shows that tooth loss, vision, and hearing impairments are associated with reduced social participation among older adults.
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Pérdida Auditiva , Pérdida de Diente , Humanos , Anciano , Participación Social , Brasil/epidemiología , Estudios Longitudinales , Trastornos de la Visión/complicaciones , Pérdida de Diente/epidemiología , Pérdida de Diente/complicaciones , Pérdida Auditiva/epidemiología , Pérdida Auditiva/complicacionesRESUMEN
Objectives: Although the majority of older adults experience sexual satisfaction regardless of their sexual activity, there are few studies that address sexuality in aging, especially in Latin America. The objective of this study was to assess the prevalence of sexual activity and satisfaction among older adults in two time-points, as well as their sociodemographic and health predictors.Method: We analyze data from 1,464 older adults aged 60 years or over from the Health, Well-Being, and Aging (SABE) cohort study conducted in Brazil. Multivariable regression models were used to determinate the factors associated with sexual activity and sexual satisfaction, stratified by gender. Results: Among older adults, the prevalence of sexual activity was 48%, while the vast majority reported feeling sexually satisfied (80%). Men had more sexual activity than women, while women presented greater sexual satisfaction than men. After the follow-up, older adults that were married were more likely to have sexual activity. In women, being older than 71 years was associated with lower sexual activity. In men, those with mobility problems and depression were less likely to have sexual activity. Regarding sexual satisfaction, having depression remained a leading factor for lower sexual satisfaction in men.Conclusion: Despite beliefs, a high percentage of older adults reported being sexually active and feeling sexually satisfied. Our results highlight the gender difference in the predictors of sexual activity and sexual satisfaction. Since sexuality is important for well-being throughout life, preventing factors that decrease sexual activity and sexual satisfaction in aging could help improve the quality of life of older adults.
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Calidad de Vida , Conducta Sexual , Masculino , Humanos , Femenino , Anciano , Brasil/epidemiología , Estudios de Cohortes , Envejecimiento , Satisfacción PersonalRESUMEN
BACKGROUND: Few studies have explored regional asymmetries and their implications for health policies regarding episodes of falls among the population of ≥80 years old in continental and developing countries like Brazil with deep inequalities and sociocultural differences. OBJECTIVE: To evaluate the occurrence of falls and their association with functional capacity and nutritional status in the longest oldest-old living in two municipalities in the Northeast and Southeast of Brazil. METHODS: This is a cross-sectional study, with primary data collection in which were included in the research seniors aged 80 years or more, of both sexes, belonging to two Brazilian municipalities of discrepant socioeconomic aspects. The dependent variable was the occurrence of falls in the last year. The independent variables were grouped into demographic aspects, functional capacity and nutritional status. To identify variables that contribute to the occurrence of falls, the multiple logistic regression model, adopts a significance level of 5%. RESULTS: The sample was composed of 415 oldest-old adults. From the total, 32.3% reported having fallen in the last year, 24.7% in Brejo dos Santos and 37.8% in São Paulo. Among the former population, the mean value of walking speed for those who had falls was 0.27 m/s and for those who had no occurrence of falls was 0.33 m/s; and, among the seniors from São Paulo, the mean values were 0.51 m/s and 0.58 m/s, respectively. Significant correlations between walking speed and falls were verified for both populations, showing that the lower the walking speed, the higher the predisposition to falls. In the final regression model, the occurrence of falls was associated with moderate balance (OR = 5.28; CI: 1.11-25.18) among the longevous people Brejo dos Santos and with very poor functional performance (OR = 16.09; CI:1.46-177.06) among those from São Paulo. CONCLUSION: The results pointed out a lower prevalence of falls in longevous people from Brejo dos Santos than in those from São Paulo and differences regarding the associated factors, showing heterogeneity between the two populations; indicating the need for public policies and effective programmes aimed at preventing falls based on the maintenance or increase of functional capacity.
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Longevidad , Femenino , Masculino , Humanos , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Recolección de Datos , GenotipoRESUMEN
BACKGROUND: Anemia is the most common hematological abnormality among older adults, and it is associated with decreased physical performance. But the role of hemoglobin in the absence of anemia remains unclear. Thus, this study aimed to assess the impact of hemoglobin levels on physical performance in Brazilian older adults without anemia. METHODS: The study is longitudinal in that it relies on two waves of the Saúde, Bem-Estar e Envelhecimento (SABE; Health, Well-being, and Aging) study: 2010 and 2015-2016. Mixed-effects linear regression was used to determine the effects of the hemoglobin concentrations on the Short Physical Performance Battery-SPPB over time among the 1,023 who had complete data and did not have anemia in 2010. In the follow-up, there were 567 without anemia. RESULTS: In analyses adjusted for age, education, comorbidities, body mass index, and physical inactivity, we found a differential association between hemoglobin concentration and SBBP by sex, with a positive interaction (ß Hb*female= 0.20, 95% CI 0.04,0.37). At lower levels of hemoglobin, women have lower levels of SPPB than men, but at higher levels of hemoglobin concentration, there are no sex differences in physical performance. In addition, higher age was negatively associated with SPPB levels and cardiometabolic diseases, other diseases, and physical inactivity. Education was positively associated with physical performance. CONCLUSION: Our study demonstrates that higher hemoglobin levels were associated with better physical performance among older adults without anemia in Brazil. However, there were sex differences in this association. This finding is important because, in clinical practice, most health professionals focus on the World Health Organization definition of anemia. Our study suggests the importance of hemoglobin levels among older adults, even those without anemia, and highlights sex differences.
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Anemia , Anciano , Envejecimiento , Anemia/diagnóstico , Anemia/epidemiología , Brasil/epidemiología , Femenino , Hemoglobinas/análisis , Humanos , Masculino , Rendimiento Físico FuncionalRESUMEN
BACKGROUND: Among the oldest old, aged 80 years and over, the prevalence of disability is higher than in other age groups and can be considered a predictor of mortality. OBJECTIVE: To evaluate how psychosocial aspects and support networks influence the disability of these oldest-old individuals, performing a comparison between two longevous populations, one living in one of the poorest regions of Brazil, in the backlands of Paraíba, and another living in one of the largest urban centres in Latin America. METHOD: A cross-sectional study in which 417 oldest-old persons aged 80 years and older were interviewed, with data collected through the "Health, Welfare and Ageing" survey conducted in two Brazilian cities. Disability was assessed by reporting the need for assistance in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Bivariate and multiple analyses were performed using R statistical software. RESULTS: Food insufficiency in the first years of life had negative repercussions on the disability of oldest old people living in the northeast. On the other hand, in this region, older people have a higher rate of support and live longer with their peers, which may contribute to reducing feelings of loneliness, depressive symptoms, and worse self-perception of health. In the Southeast, financial constraints, subjective poverty, and unmet needs may favour the development of functional limitations between long-lived people. CONCLUSION: Our findings indicate that regional differences in Brazil may influence the disability of older people aged 80 and older. In northeast Brazil, having no partner may contribute to disability for ADLs and IADLs; while, in the longevous population of São Paulo, having a worse self-rated health may contribute to disability for IADLs.
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Actividades Cotidianas , Personas con Discapacidad , Anciano , Anciano de 80 o más Años , Envejecimiento , Brasil/epidemiología , Estudios Transversales , HumanosRESUMEN
INTRODUCTION: Decreases in prevalence of cognitive impairment and dementia over the last two decades have been observed in different countries for cohorts entering older age. This study aimed to assess the cognitive impairment prevalence and explore associated factors among subjects aged >60 living in São Paulo, Brazil. METHOD: Data came from a population-based Health, Welfare and Aging survey conducted in 2000, 2006, 2010, and 2015. Cognitive impairment was detected using the abbreviated Mini-Mental State Exam corrected by formal education years. In total, there were 5922 respondents in the statistical analyses. RESULTS: Logistic regression models adjusted for age group, income, race, cardiovascular risk factors, and depression were used to estimate cognitive impairment prevalence. Between 2015 and 2000, respondents were more likely to report formal education, hypertension, diabetes, and overweight/obesity. Moreover, the weighted analyses showed that cognitive impairment prevalence was higher in 2015, even adjusting for sociodemographic and socioeconomic characteristics, cardiovascular risk factors, and depression. CONCLUSION: In contrast to decreases in cognitive impairment prevalence in other countries and despite increases in educational years, our findings suggest no secular improvements in cognitive health for the 2015 wave of older adults residing in São Paulo.
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Disfunción Cognitiva , Anciano , Envejecimiento , Brasil/epidemiología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Humanos , Prevalencia , Factores de Riesgo , Factores SocioeconómicosRESUMEN
AIM: To investigate the within- and between-person longitudinal effects of tooth loss and the use of dentures, clinically assessed by dentists, on cognitive decline in a representative sample of community-dwelling older Brazilian adults. METHODS: Data came from 1265, 1112 and 1021 individuals aged ≥60 years who participated in the second (2006), third (2010) and fourth (2015) waves, respectively, of the Health, Well-being and Aging study (SABE). Cognitive performance was evaluated with the abbreviated version of the Mini-Mental State Examination (MMSE). The number of natural teeth was classified according to three categories: none, 1-19 and ≥20 teeth. The presence of removable full or partial dentures in each dental arch (yes/no) was recorded. Hybrid regression models, adjusted for sociodemographic, behavior and health-related covariates, were used to estimate the between- and within-person effects of the longitudinal association between cognitive performance and oral health. RESULTS: Participants with 1-19 and no teeth had, respectively, 1.15 (95% CI 0.65-1.66) and 1.54 (95% CI 0.99-2.09) units lower MMSE score than those with ≥20 teeth. Denture wearers had 1.54 (95% CI 1.13-1.95) units greater MMSE score than non-denture wearers, and those who started wearing dentures during the follow up had 0.83 (95% CI 0.21-1.45) units greater MMSE score after the transition. CONCLUSION: Our main findings showed that the use of dental prostheses might be a protective factor for cognitive decline. Geriatr Gerontol Int 2021; 21: 1093-1098.
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Prótesis Dental , Boca Edéntula , Pérdida de Diente , Anciano , Cognición , Estudios de Cohortes , Humanos , Pérdida de Diente/epidemiologíaRESUMEN
OBJECTIVES: To investigate the longitudinal association between frailty and health-related quality of life (HRQoL) in older adults and to examine whether family functionality moderates the association between frailty and HRQoL. METHODS: It's a longitudinal observational study. The sample was drawn from three waves (2006, 2010, and 2015) of the Health, Well-Being, and Aging Study (Saúde, bem-estar e envelhecimento; SABE) collected in São Paulo, Brazil with adults aged 60 years and older. HRQoL was based on the Short Form (SF-12) Health Survey, from which the physical component score (PCS) and mental component score (MCS) were obtained. Frailty status was determined according to the Fried frailty criteria. Family support was measured using the family APGAR instrument. Mixed effects linear regression was used to determine the associations of frailty on longitudinal changes in HRQoL and to examine whether family functionality attenuates this association. RESULTS: Being frail was negatively associated with MCS and PCS scores. Familiar functionality was found to be a protective factor for MCS only. CONCLUSIONS: These findings are innovative and make an important contribution to the study of HRQoL among older adults in developing countries.
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Anciano Frágil/psicología , Fragilidad/psicología , Estado de Salud , Calidad de Vida/psicología , Anciano , Anciano de 80 o más Años , Envejecimiento/psicología , Brasil , Estudios Transversales , Países en Desarrollo/estadística & datos numéricos , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: To analyze the agreement between self-reported race and race reported on death certificates for older (≥ 60 years) residents of São Paulo, Brazil (from 2000 to 2016) and to estimate weights to correct mortality data by race. METHODS: We used data from the Health, Well-Being and Aging Study (SABE) and from Brazil's Mortality Information System. Misclassification was identified by comparing individual self-reported race with the corresponding race on the death certificate (n = 1012). Racial agreement was analyzed by performing sensitivity and Cohen's Kappa tests. Multinomial logistic regressions were adjusted to identify characteristics associated with misclassification. Correction weights were applied to race-specific mortality rates. RESULTS: Total racial misclassification was 17.3% (13.1% corresponded to whitening, and 4.2% to blackening). Racial misclassification was higher for self-reported pardos/mixed (63.5%), followed by blacks (42.6%). Official vital statistics suggest highest elderly mortality rates for whites, but after applying correction weights, black individuals had the highest rate (45.85/1000 population), followed by pardos/mixed (42.30/1000 population) and whites (37.91/1000 population). CONCLUSIONS: Official Brazilian data on race-specific mortality rates may be severely misclassified, resulting in biased estimates of racial inequalities.
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Causas de Muerte , Certificado de Defunción , Mortalidad , Grupos Raciales/clasificación , Grupos Raciales/estadística & datos numéricos , Registros/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Brasil , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Few studies have specifically investigated the inverse relationship between reduced quality of life in different domains and elevated C-reactive protein (CRP) serum levels in older adults. Therefore, this study investigates the cross-sectional association between quality of life and inflammation in older Brazilian adults. METHODS: Data were collected from 1255 participants from the third wave (2010) of the Brazilian Health, Well-being and Aging study (SABE), a community-based cohort study of aging. Inflammation was assessed using CRP serum levels and quality of life (QoL) was measured using the 12-item Short-Form Health Survey (SF-12) questionnaire. The covariates included age, sex, education level, financial sufficiency, number of non-communicable diseases, self-reported doctor diagnosed diseases, Activity of Daily Living (ADL) difficulties, Body Mass Index (BMI), and waist circumference. RESULTS: The fully adjusted models showed that older adults with low scores in the physical domain of the SF12 (OR 1.34, 95%CI 1.02;1.77) and high BMI values (> 30) (OR 2.05, 95%CI 1.50;2.81) were more likely to present high CRP serum levels. CONCLUSION: Our findings suggest a significant association of lower scores in the physical domain of quality of life and the presence of obesity with high CRP serum levels.
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Actividades Cotidianas , Inflamación/diagnóstico , Calidad de Vida , Anciano , Índice de Masa Corporal , Brasil , Proteína C-Reactiva/análisis , Estudios de Cohortes , Comorbilidad , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Inflamación/epidemiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Encuestas y Cuestionarios , Circunferencia de la CinturaRESUMEN
OBJECTIVES: To investigate the differences in life expectancy with and without cognitive impairment (CI) by educational levels and sex in Brazil. DESIGN: Longitudinal observational study. SETTING: The sample was drawn from three waves (2000, 2006, and 2010) of the Health, Well-Being, and Aging Study (Saúde, bem-estar e envelhecimento; SABE) collected in São Paulo, Brazil. PARTICIPANTS: Adults aged 60 years and older (N = 2116). MEASUREMENTS: Educational levels were estimated in the baseline wave (2000), cognition was assessed in all waves, and mortality data were obtained through the state and municipal mortality system in Brazil. Interpolation of Markov chain methods was used to estimate life expectancy with and without CI by education and sex. RESULTS: Life expectancy without CI at the age of 60 years was 13.0 years among men with no education and 17.6 years among their counterparts with 8 years of schooling. On the other hand, life expectancy with CI was higher among men with no education than those with more education (3.2 and 0.6 years, respectively). Among 60-year-old women without education, life expectancy without CI reached 16.2 years, but it was considerably higher among more educated women (22.7 years). Life expectancy with CI reached 4.5 years among women aged 60 years with no education, vs 1.0 year among women with 8 years of schooling. CONCLUSIONS: Adults older than 60 years with no education live shorter lives and with longer periods of CI than those with education. Women in São Paulo live longer lives than men, but they live with CI for a greater number of years.
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Cognición , Disfunción Cognitiva/epidemiología , Escolaridad , Esperanza de Vida/tendencias , Anciano , Brasil/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To conduct a survival analysis according to age at natural menopause (NM) in a representative sample of elderly women from the municipality of São Paulo, Brazil. STUDY DESIGN: We analyzed data from the Health, Well-Being and Aging study (SABE), a cohort that started in 2000. Mortality data up to September 2016 were obtained by linkage from the Program for Mortality Information of São Paulo (PRO-AIM). MAIN OUTCOME MEASURES: We used Cox regression to analyze all-cause and cause-specific mortality rates for cardiovascular diseases, respiratory diseases and cancer, according to age at menopause, categorized as <40, 41-44, 45-49, 50-54 (reference) and ≥55. RESULTS: After 16 years of follow-up, there were 444 deaths, of which 199 were from cardiovascular diseases, 73 from respiratory diseases and 65 from cancer. After adjustment for socioeconomic, reproductive and lifestyle factors, having an early menopause (at age 41-44) was associated with an increased risk of all-cause mortality (HR = 1.48, 95% IC: 1.03, 2.14) relative to NM at 50-54 years. Women aged 41-44 and 45-49 at NM had twice the risk of cancer mortality of the reference group. We did not find significant associations between age at NM and cause-specific mortality for respiratory and cardiovascular diseases. CONCLUSIONS: Our findings suggest that early menopause is associated with all-cause mortality in the largest city of Latin America. In addition, earlier age at NM was associated with cancer mortality. These results suggest that age at NM may be a biomarker for mortality, irrespective of country of residence.
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Enfermedades Cardiovasculares/mortalidad , Menopausia , Neoplasias/mortalidad , Enfermedades Respiratorias/mortalidad , Adulto , Anciano , Brasil/epidemiología , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Análisis de SupervivenciaRESUMEN
BACKGROUND: The age is a variable positively related to healthcare expenditures on diabetes (DM), however other factors could also be associated. Physical activity, normal weight and walking habit could be inversely associated to healthcare expenditures related to DM control. The aim of this study was to describe healthcare diabetic-related expenditures and analyze the associations with Body Mass Index (BMI), Physical Activity Level (PAL), and walking habit among the elderly Brazilians. METHODS: A cross-sectional analysis was carried out on a population-based study (SABE Study) in Brazil. Healthcare expenditures were estimated for the medicine prescriptions, outpatient service and hospitalization. The sample was classified according to BMI, the PAL, and according to weekly frequency of walking habit.The annual healthcare expenditures were estimated, and the multiple logistic regression was used to analyze the associations between variables. RESULTS: The sample included 295 elderly diabetics, with a mean age 70 years. The excess weight group presented significantly higher annual expenditures with medicine prescriptions, hospitalization, and outpatient services. Absence of walking habit was related to higher costs and inversely associated to higher expenditures to medicine prescriptions (OR 2.82, IC95% 1.48 - 5.40) and hospitalizations (OR 5.79, IC95% 1.10 - 10.93), independent of BMI, sex, age and the presence of hypertension. CONCLUSION: BMI and insufficient PAL were associated to higher public expenditures related to DM control in elderly people. Walking habit was inversely associated to healthcare expenditures on behalf of the diabetes control among Brazilian elderly population.
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Índice de Masa Corporal , Diabetes Mellitus/economía , Diabetes Mellitus/terapia , Ejercicio Físico , Costos de la Atención en Salud , Gastos en Salud , Caminata , Factores de Edad , Anciano , Atención Ambulatoria/economía , Brasil , Ahorro de Costo , Estudios Transversales , Diabetes Mellitus/diagnóstico , Costos de los Medicamentos , Femenino , Hábitos , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Costos de Hospital , Humanos , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Modelos Logísticos , Masculino , Oportunidad Relativa , Factores de Riesgo , Conducta de Reducción del RiesgoRESUMEN
AIMS: To estimate the prevalence and incidence of urinary incontinence (UI) and identify the associated risk factors in a cohort of elderly individuals in Brazil. METHODS: In 2006, individuals aged ≥60 years were selected from the SABE Study (Health, Well-being, and Aging). The dependent variable was reported UI in 2009. UI was assessed using the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form (ICIQ-UI SF). Incidence was measured in units of 1000 person-years, and Cox regression was applied for data analysis. Multivariate analysis was used to assess risk factors for UI. Incidence risk ratio (IRR) was used for comparison. RESULTS: This is the first study to examine the incidence of UI in Brazilian elderly individuals. In total, 1413 individuals were included; the mean age was 74.5 years, and 864 (61.8%) participants were female. The risk of UI was greater among women with cancer (other than skin) and among those with diabetes. In men, the risk of UI was greater for those in Instrumental Activities of Daily Living (IADL) category "5-8" and those who self-reported a "fair" health status. The prevalence of UI was 14.2% and 28.2% for men and women, respectively. The incidence rate of UI was 25.6 and 39.3 (×1000 person-years) for men and women, respectively. CONCLUSIONS: The incidence rate of UI among older adults in the Brazilian community was high for elderly individuals. The identified risk factors were diabetes and IADL category 5-8 (women) as well as cancer (other than skin) and self-reported health status (male).
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Incontinencia Urinaria/epidemiología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios de Cohortes , Complicaciones de la Diabetes/epidemiología , Femenino , Estado de Salud , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/epidemiología , Población , Prevalencia , Factores de Riesgo , Factores Sexuales , Encuestas y CuestionariosRESUMEN
AIM: The aim of the present study was to analyze the impact of anemia and hypoalbuminemia on mortality in a 5-year period. METHODS: This was longitudinal population-based observational survey part of the Saúde, Bem-Estar e Envelhecimento study (Health, Well-being and Aging), carried out with 1256 older adults from the third wave of the cohort, followed for 5 years, when they were contacted for the fourth wave, in Sao Paulo, Brazil. Anemia was defined when hemoglobin was <12 g/dL for women and <13 g/dL for men, and hypoalbuminemia when serum albumin was <3.5 g/dL. Survival functions were estimated according to nutritional status in four groups: (i) without nutritional alteration; (ii) anemia only; (iii) hypoalbuminemia only; and (iv) anemia and hypoalbuminemia. Hazard ratios were calculated, following the Cox proportional hazards model, controlling for baseline covariates. All analyses considered sample weights, and were carried out using the Stata 12. RESULTS: After the 5-year period, 12.3% of the participants died, and 8.2% were lost to follow up. Those who died had lower hemoglobin and albumin concentrations (13.4 g/dL and 3.7 g/dL) compared with survivors (14.3d/dL and 3.9 g/dL; P < 0.001). The crude death rate was 27.6/1000 person-years for participants in group i, 124.3 in group ii, 116.0 in group iii and 222.8 in group iv (P < 0.001). In the final Cox models, group 2 and 3 had a similar effect (hazard ratio 2.23, P = 0.020; 2.53, P = 0.005; respectively) and group 4 had a higher risk (hazard ratio 3.36; P = 0.004). CONCLUSIONS: Anemia and hypoalbuminemia are important markers for death in older adults, and have an additive effect on mortality. Because they are common and cost-effective biomarkers, their use should be encouraged in geriatric evaluation for all health professionals and in population settings, such as primary care. Geriatr Gerontol Int 2018; 18: 177-182.
Asunto(s)
Anemia/sangre , Hipoalbuminemia/sangre , Mortalidad , Estado Nutricional , Anciano , Biomarcadores/sangre , Brasil/epidemiología , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: The literature shows the inverse association between physical activity level (PAL) and chronic diseases that have a significant burden over health care costs. However, in upper-middle income countries and in elderly population this information are scarce. OBJECTIVE: To describe the annual drug expenditures for the hypertensive and diabetic elderly population in Brazil and to analyze the association with PAL and engagement in walking. METHODS: This cross sectional study is part of SABE Survey and comprised 806 hypertensive and/or diabetic elderly (≥60 years old). The annual expenditures of medicine use was estimated for all medications for hypertension and/or diabetes they were taking. The PAL was considered insufficient when moderate physical activity was <150 min/week or vigorous physical activity was < 75 min/week. Engagement in walking was considered by at least 1 day a week. All expenditures were presented through the descriptive values (in American Dollars US$) according PAL and engagement in walking. The association analysis between annual expenditures, PAL and engagement in walking were performed by multiple logistic regression models adjusted for gender, age and body mass index. RESULTS: The average annual cost was higher in diabetic and insufficient physically activity elderly. The 1-year estimated.cost was US$ 73386,09 and 295% higher in insufficiently physically active. Older people who reported not walking had a higher risk to higher annual expenditures of medicine use (OR = 1.57, 95% CI 1.03-2.40). CONCLUSIONS: The annual expenditures of medicine use for controlling hypertension and diabetes of Brazilian elderly were higher and inversely associated with physical activity level and engagement in walking.
Asunto(s)
Diabetes Mellitus/fisiopatología , Costos de los Medicamentos , Ejercicio Físico , Gastos en Salud , Hipertensión/fisiopatología , Anciano , Brasil , Enfermedad Crónica , Estudios Transversales , Diabetes Mellitus/tratamiento farmacológico , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Research using questionnaires has shown that physical activity level (PAL) is associated with healthcare costs. The purpose of this study was to examine the association between objectively measured PAL and healthcare costs among hypertensive and diabetic noninstitutionalized Brazilian older people. The method consisted of a cross-sectional study forming part of the SABE Study, composed of 377 older people interviewed in 2010. Expenditures were estimated taking into account self-reported medicine prescription, outpatient service, and hospitalizations, with the highest quartile of expenditures considered as a risk category. PAL was estimated using an Actigraph accelerometer. Associations were expressed as odds ratios and 95% confidence intervals, adjusted for covariates. Overall expenditures were higher in the sedentary group. The insufficiently active group presented greater odds for higher total, outpatient, and hospitalization expenditure. It was concluded that healthcare expenditures were lower in more active hypertensive and diabetic older people. The promotion of physical activity could be relevant in the attenuation of the burden of chronic diseases in economic losses.