Activity Limitation in the Elderly People and Inequalities in Brazil

André Luiz Barbosa de Lima^*, Kenio Costa de Lima

Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil.

DOI: 10.4236/oalib.1100739                

Abstract

Functional status decline in elderly individuals can compromise home life and lead to social isolation. Therefore, we aimed to determine the influence of income inequality on the limitation of activities among elderly people in Brazil. The present study included 18,484 individuals aged 60 years old or more from data of the Health Supplement of the National Household Sample Survey (PNAD), conducted in 2008. Random effects ordinal regression was proposed for multilevel analysis of the Global Activity Limitation Index (GALI), and its association among independent variables on two levels. With regards to socio-demographic status, the factors most commonly associated with activity limitation were as follows: 75 years old or more; female; living with others; living in urban areas; earning less than two minimum wages and having completed three or less years of study. With regards to health status: poor or very poor self-perceived health, hospitalization in the last 12 months, continued use of medication and depression. On a contextual level, income inequality exerted a major influence on activity limitations in elderly individuals. Analysis of these results should also consider the limitations of the data. The rural sample is not complete, because the rural north was excluded due the logistical complexity required to conduct a survey in this area. In addition, it was not possible to use any measures of cognitive disability or mental health. We concluded that the limitations in activities among elderly individuals are reflected widely in the worsening self-rated health and condition of depression. Chronic diseases should be associated with increased activity limitations, especially chronic kidney disease, arthritis, tendinitis and cancer. The effective preventive and rehabilitation strategies for reducing the activity limitations in the elderly population should be implemented, considering the social determinants and the determinants of disability.

Keywords

Multilevel Analysis, Aged, Activities of Daily Living

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Tas U., Verhagen, A.P., Bierma-Zeinstra, S.M., et al. (2007) Incidence and Risk Factors of Disability in the Elderly: The Rotterdam Study. Preventive Medicine (Baltim), 44, 272-278. http://dx.doi.org/10.1016/j.ypmed.2006.11.007
[2]	Mollaoglu, M., Tuncay, F.Ö. and Fertelli, T.K. (2010) Mobility Disability and Life Satisfaction in Elderly People. Archives of Gerontology and Geriatrics, 51, 115-119. http://dx.doi.org/10.1016/j.archger.2010.02.013
[3]	Serraino, D., Fratino, L. and Zagonel, V. (2001) Prevalence of Functional Disability among Elderly Patients with Cancer. Critical Reviews in Oncology/Hematology, 39, 269-273. http://www.ncbi.nlm.nih.gov/pubmed/11500267 http://dx.doi.org/10.1016/S1040-8428(00)00130-X
[4]	Nikolova, R., Demers, L., Béland, F., et al. (2011) Transitions in the Functional Status of Disabled Community-Living Older Adults over a 3-Year Follow-Up Period. Archives of Gerontology and Geriatrics, 52, 12-17. http://dx.doi.org/10.1016/j.archger.2009.11.003
[5]	Alves, L.C., Leite, I.D.C. and Machado, C.J. (2010) Factors Associated with Functional Disability of Elderly in Brazil: A Multilevel Analysis. Revista de Saúde Pública, 44, 468-478. http://www.ncbi.nlm.nih.gov/pubmed/20464262 http://dx.doi.org/10.1590/S0034-89102010005000009
[6]	Channon, A.A., Andrade, M.V., Noronha, K., et al. (2012) Inpatient Care of the Elderly in Brazil and India: Assessing Social Inequalities. Social Science & Medicine, 75, 2394-2402. http://dx.doi.org/10.1016/j.socscimed.2012.09.015
[7]	Costa, A.J.L. (2006) Metodologias e indicadores para avaliação da capacidade funcional: Análise preliminar do Suplemento Saúde da Pesquisa Nacional por Amostra de Domicílios PNAD, Brasil, 2003. Ciência & Saúde Coletiva, 11, 927-940. http://dx.doi.org/10.1590/S1413-81232006000400015
[8]	Bodde, A.E., Seo, D.-C. and Frey, G. (2009) Correlation between Physical Activity and Self-Rated Health Status of Non-Elderly Adults with Disabilities. Preventive Medicine (Baltim), 49, 511-524. http://dx.doi.org/10.1016/j.ypmed.2009.10.004
[9]	Beckett, L.A., Brock, D.B., Lemke, J.H., et al. (1996) Analysis of Change in Self-Reported Physical Function among Older Persons in Four Population Studies. American Journal of Epidemiology, 143, 766-778. http://www.ncbi.nlm.nih.gov/pubmed/8610686 http://dx.doi.org/10.1093/oxfordjournals.aje.a008814
[10]	Castro, M., Camargos, S., Helena, I., et al. (2005) Expectativa de vida com incapacidade funcional em idosos em São Paulo, Brasil. Revista Panamericana de Salud Pública, 17, 379-386. http://dx.doi.org/10.1590/S1020-49892005000500010
[11]	Leveille, S.G., Penninx, B.W., Melzer, D., Izmirlian, G. and Guralnik, J.M. (2000) Sex Differences in the Prevalence of Mobility Disability in Old Age: The Dynamics of Incidence, Recovery, and Mortality. The Journals of Gerontology: Series B, 55, S41-S50. http://www.ncbi.nlm.nih.gov/pubmed/10728129 http://dx.doi.org/10.1093/geronb/55.1.S41
[12]	Murtagh, K.N. and Hubert, H.B. (2004) Gender Differences in Physical Disability among an Elderly Cohort. American Journal of Public Health, 94, 1406-1411. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1448463&tool=pmcentrez&rendertype=abstract http://dx.doi.org/10.2105/AJPH.94.8.1406
[13]	Yeom, H.A., Fleury, J. and Keller, C. (2008) Risk Factors for Mobility Limitation in Community-Dwelling Older Adults: A Social Ecological Perspective. Geriatric Nursing, 29, 133-140. http://dx.doi.org/10.1016/j.gerinurse.2007.07.002
[14]	Rantanen, T. and Avela, J. (1997) Leg Extension Power and Walking Speed in Very Old People Living Independently. The Journals of Gerontology: Series A, 52, M225-M231. http://www.ncbi.nlm.nih.gov/pubmed/9224434 http://dx.doi.org/10.1093/gerona/52A.4.M225
[15]	Parahyba, M.I., Veras, R. and Melzer, D. (2005) Incapacidade funcional entre as mulheres idosas no Brasil. Revista de Saúde Pública, 39, 383-391. http://dx.doi.org/10.1590/S0034-89102005000300008
[16]	Sundsli, K., Espnes, G.A. and Söderhamn, O. (2013) Lived Experiences of Self-Care among Older Physically Active Urban-Living Individuals. Clinical Interventions in Aging, 8, 123-130. http://dx.doi.org/10.2147/CIA.S39689
[17]	Clarke, P.J., Ailshire, J.A., Nieuwenhuijsen, E.R. and Vrankrijker, M.W. (2011) Participation among Adults with Disability: The Role of the Urban Environment. Social Science & Medicine, 72, 1674-1684.
[18]	Virués-Ortega, J., de Pedro-Cuesta, J., del Barrio, J.L., Almazan-Isla, J., Bergareche, A., Bermejo-Pareja, F., et al. (2011) Medical, Environmental and Personal Factors of Disability in the Elderly in Spain: A Screening Survey Based on the International Classification of Functioning. Gaceta Sanitaria, 25, 29-38.
[19]	Hairi, N.N., Bulgiba, A., Mudla, I. and Said, M.A. (2011) Chronic Diseases, Depressive Symptoms and Functional Limitation amongst Older People in Rural Malaysia, a Middle Income Developing Country. Preventive Medicine, 53, 343-346. http://dx.doi.org/10.1016/j.ypmed.2011.07.020
[20]	Gallegos-Carrillo, K., García-Peña, C., Duran-Muñoz, C., Reyes, H. and Durán-Arenas, L. (2006) Autopercepción del estado de salud: Una aproximación al los ancianos en México. Revista de Saúde Pública, 40, 792-801. http://dx.doi.org/10.1590/S0034-89102006000600008
[21]	Alexandre, T.D.S., Corona, L.P., Nunes, D.P., Santos, J.L.F., Duarte, Y.A.O. and Lebrão, M.L. (2012) Gender Differences in Incidence and Determinants of Disability in Activities of Daily Living among Elderly Individuals: SABE Study. Archives of Gerontology and Geriatrics, 55, 431-437. http://dx.doi.org/10.1016/j.archger.2012.04.001
[22]	Almeida, O.P. and Almeida, S. (1999) Short Versions of the Geriatric Depression Scale: A Study of Their Validity for the Diagnosis of a Major Depressive Episode According to ICD-10 and DSM-IV. International Journal of Geriatric Psychiatry, 14, 858-865. http://www.ncbi.nlm.nih.gov/pubmed/10521885
[23]	Wu, C.Y., Hu, H.Y., Li, C.P., Fang, Y.T., Huang, N. and Chou, Y.J. (2013) The Association between Functional Disability and Acute Care Utilization among the Elderly in Taiwan. Archives of Gerontology and Geriatrics, 57, 177-183. http://dx.doi.org/10.1016/j.archger.2013.04.011
[24]	Elias, P.E.M. and Cohn, A. (2003) Health Reform in Brazil: Lessons to Consider. American Journal of Public Health, 93, 44-48. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1447689&tool=pmcentrez&rendertype=abstract http://dx.doi.org/10.2105/AJPH.93.1.44
[25]	Szwarcwald, C.L., Souza-Júnior, P.R.B. and Damacena, G.N. (2010) Socioeconomic Inequalities in the Use of Outpatient Services in Brazil According to Health Care Need: Evidence from the World Health Survey. BMC Health Services Research, 10, 217. http://dx.doi.org/10.1186/1472-6963-10-217
[26]	Petti, S. and Polimeni, A. (2011) Inverse Care Law. British Dental Journal, 210, 343.
[27]	Hubbard, R.E., O’Mahony, M.S. and Woodhouse, K.W. (2013) Medication Prescribing in Frail Older People. European Journal of Clinical Pharmacology, 69, 319-326. http://dx.doi.org/10.1007/s00228-012-1387-2
[28]	Jäntti, P.O., Pyykkö, V.I. and Laippala, P. (1993) Falls among Elderly Nursing Home Residents. Public Health, 107, 89-96. http://www.ncbi.nlm.nih.gov/pubmed/7599243
[29]	Feng, Z., Wang, W.W., Jones, K. and Li, Y. (2012) An Exploratory Multilevel Analysis of Income, Income Inequality and Self-Rated Health of the Elderly in China. Social Science & Medicine, 75, 2481-2492. http://dx.doi.org/10.1016/j.socscimed.2012.09.028
[30]	Filho, A.D.P.C., Lebrão, M.L. and Kawachi, I. (2012) Income Inequality and Elderly Self-Rated Health in São Paulo, Brazil. Annals of Epidemiology, 22, 863-867. http://dx.doi.org/10.1016/j.annepidem.2012.09.009
[31]	dos Santos, A.A. and Pavarini, S.C.I. (2011) Functionality of Elderly People with Cognitive Impairments in Different Contexts of Social Vulnerability. Acta Paulista de Enfermagem, 24, 520-526.