Fatores associados à capacidade funcional em pessoas idosas no contexto brasileiro

Abstract

Activity limitations are difficulties an individual may have to perform certain tasks of daily life and determines part of the individual's disability status. In Brazil, the prevalence of activity limitation reaches 32% of the population of elderly people. Knowing the prevalence of activity limitations in terms of functional capacity of the elderly and to examine the associations between functional capacity and socio-demographic and economic characteristics of individuals, as well as the social gender inequality and socioeconomic characteristics within the Brazilian Federative Units are fundamental to the structure of assistance actions and health surveillance. Therefore, the aim of this study was to create the functional capacity index and thus able to estimate the magnitude of gender differences in functional capacity among the elderly and examine whether these differences could be associated with social gender inequality and socioeconomic contextual factors in terms of Federative Units. This is a cross-sectional and ecological population-based study that included residents aged 60 years old participating in the National Health Survey, conducted in 2013, in Brazil. The functional capacity index was developed and validated from a generalized partial credit model of item response theory, provided the assumptions of dimensionality of the latent space and stochastic local independence. Gender differences were estimated in functional capacity in each Federative Unit. To determine if the social gender inequality and socioeconomic contextual variables were associated with gender differences in functional capacity were adjusted multilevel linear regression models with cross-level interaction, controlled by individual- and contextual-level variables, which yielded coefficients and their 95% confidence intervals. For Brazil, the results indicated that 17% of the elderly had some limitation in activities of daily living and 29% in instrumental activities of daily living. Women had higher functional capacity disadvantages than men and was found in the group of octogenarians a prevalence of 70% in activity limitations. The smallest functional capacity indexes were found among older people with older age, especially the group of octogenarians and illiterate. It was noted that the North and Northeast Region had greater disadvantages in functional capacity, especially among women. Amazonas, Rio Grande do Norte, Paraiba and Alagoas detained the worst conditions of functional capacity among the elderly. Moreover, in Alagoas, Pernambuco and Maranhao the magnitude of gender differences, in disadvantage for women, were higher. Based on these results, the hypothesis of this study was confirmed by demonstrating that the Brazilian Federative Units with the largest gender differences in functional capacity were those with the greatest social inequalities of gender, being largely influenced by higher income inequality.