Epidemiology of disability in Brazilian older people

INTRODUCTION:  In Brazil the major phenomena observed in the last 40 years is the population aging which occurs extremely quickly. This is a country with huge inequalities and many older adults come to very old age with severe disability despite regular medical monitoring or health promotion actions. Objectives: To identify the determinants factors of the elderly aging considered more fragile (with severe functional impairment and need of caregiver’s help).

METHODS:  The study is part of Longitudinal SABE Study (Health, Wellbeing and Aging) that began in 2000 (first wave) with a multistage, clustered, probabilistic sample (n=2143) of older adults (≥ 60 years) in Sao Paulo, Brazil. The second wave was carried out in 2006 when 1115 elders were re-interviewed and a new probabilistic cohort (60 to 64 years) was included (n=298). The same occurred (third wave) in 2010 (978 elders were re-interviewed and a new cohort (n=355) was included). The sample here is composed by elders interviewed in 2006 and 2010 (n=978). The variable dependent was elders without functional or cognitive impairment in 2006 who developed severe disability in 2010 (reported of difficult on ≥1 ADL and needs caregiver’s help). 

RESULTS:  In the multiple logistic regression analysis adjusted for baseline variables (hypertension, osteoporosis and gender the fragile aging was associated with oldest-old elderly (OR=2.13; p=0.014); low education (p=0.001); presence of self reported Diabetes (OR=1.72;p=0.016) and self reported Chronic Lung Disease (OR=2.20;p=0.015), Stroke (OR=2.32; p=0.036) and less active social contact (p=0.025). 

CONCLUSIONS:  The fragile aging is directly related to social inequality and elders’ behavior  and, due to Brazilian social reality, adequacy of public policies aimed at better conditions in old age are urged be implemented.