Silva Alexandre Moreira de Melo, Mambrini Juliana Vaz de Melo, Andrade Juliana Mara, Andrade Fabiola Bof de, Lima-Costa Maria Fernanda
Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.
Programa de Pós-graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
Cad Saude Publica. 2021 Sep 22;37(9):e00255420. doi: 10.1590/0102-311X00255420. eCollection 2021.
This study aimed to examine the association between frailty syndrome and the perception of problems in indicators of attributes in primary healthcare (PHC) among elderly Brazilians. This was a cross-sectional study with 5,432 participants 60 years or older in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in 2015 and 2016. Frailty, the independent variable, was defined according to the theoretical framework of the frailty phenotype, and the indicators of problems in PHC attributes, the dependent variables, were obtained from questions related to health services use. Access, longitudinal care, coordination, comprehensiveness, family orientation, and cultural adequacy were the target attributes. For the data analysis, logistic regression models were used, adjusted for predisposing, enabling, and need factors for use of health services. Among the participants, 55.1% were females, 57.9% were 60 to 69 years of age, and 51.8% reported multimorbidity. Frail and pre-frail elders accounted for 13.4% and 54.5% of the sample, respectively. Multivariate analyses showed that frail elders (compared to robust elders) showed higher odds of reporting problems with access (OR = 1.45; 95%CI: 1.08-1.93), longitudinal care (OR = 1.54; 95%CI: 1.19-2.00), and comprehensive care (OR = 1.45; 95%CI: 1.14-1.85), in addition to more problems with attributes of PHC (OR = 1.38; 95%CI: 1.05-1.82, for 5 or more). The study suggests the occurrence of inequities in the care provided by Brazilian PHC for frail elders, particularly in the attributes of access, longitudinal care, and comprehensiveness.
本研究旨在探讨巴西老年人中衰弱综合征与初级卫生保健(PHC)属性指标中问题认知之间的关联。这是一项横断面研究,研究对象为2015年和2016年巴西衰老纵向研究(ELSI - Brasil)第一波中的5432名60岁及以上参与者。作为自变量的衰弱根据衰弱表型的理论框架进行定义,作为因变量的初级卫生保健属性问题指标则从与卫生服务使用相关的问题中获取。可及性、纵向照护、协调性、全面性、家庭导向和文化适宜性是目标属性。数据分析采用逻辑回归模型,并对卫生服务使用的 predisposing、 enabling 和需求因素进行了调整。参与者中,55.1%为女性,57.9%年龄在60至69岁之间,51.8%报告患有多种疾病。衰弱和衰弱前期老年人分别占样本的13.4%和54.5%。多变量分析显示,与健康老年人相比,衰弱老年人报告可及性问题(OR = 1.45;95%CI:1.08 - 1.93)、纵向照护问题(OR = 1.54;95%CI:1.19 - 2.00)和全面照护问题(OR = 1.45;95%CI:1.14 - 1.85)的几率更高,此外,初级卫生保健属性方面的问题也更多(5个或更多问题时,OR = 1.38;95%CI:1.05 - 1.82)。该研究表明,巴西初级卫生保健为衰弱老年人提供的护理存在不公平现象,尤其是在可及性、纵向照护和全面性属性方面。