Department of Health 1, State University of Southwest Bahia, Jequié, Bahia, Brazil.
Department of Social Medicine, Federal University of Rio Grande Do Sul, Rio Grande Do Sul, Porto Alegre, Brazil.
BMC Public Health. 2024 Jan 10;24(1):140. doi: 10.1186/s12889-023-17564-w.
Despite the advancements in knowledge about health care for older adults, essential gaps persist regarding the effects of chronic diseases as epidemiological markers of the state of functional dependence. This study aimed to identify the prevalence of moderate and severe functional dependence in Brazilian older adults and its association with chronic diseases and verify the multimorbidity patterns by dependence status.
This cross-sectional analytical study used data from 11,177 community-dwelling Brazilian older adults from the 2013 National Health Survey conducted in Brazil. The dependent variables were moderate and severe functional dependence in basic activities of daily living (BADLs) and instrumental ADLs (IADLs). The independent variables were defined based on the questions applied to measure each morbidity in a self-reported manner and asked, "Has a doctor ever diagnosed you as having (each disease)? Multimorbidity was simultaneously considered present for older adults with ≥ 2 chronic morbidities. The association between functional dependence on BADLs and IADLs separately by severity and the independent variables was verified from crude and adjusted estimates of the point prevalence ratios and their 95% confidence intervals using the regression model Poisson with robust variance. To group diseases into patterns, exploratory factor analysis was used.
The prevalences of moderate and severe BADL dependence were 10.2% (95% CI, 9.6-10.7) and 4.8% (95% CI, 4.4-5.2), respectively. Moderate and severe IADL dependence prevalences were 13.8% (95% CI, 13.1-14.4) and 15.6% (95% CI, 14.9%-16.2), respectively. When changing the condition from moderate to severe dependence in BADLs, in the presence of other mental illnesses and stroke, the probability of dependence increased more than four times in the case of other mental illnesses and more than five times for stroke. There was a linear trend for dependence severity, both moderate and severe, whereas, for severe dependence on IADLs, this same factor maintained a linear trend toward an increase in probability as the number of diseases simultaneously increased.
Chronic diseases are associated with functional dependence, with greater emphasis on mental illnesses and stroke in severe disability, considering their acute adverse effects.
尽管人们对老年人的医疗保健知识有了进步，但在慢性疾病作为功能依赖状态的流行病学标志物方面，仍存在一些基本的差距。本研究旨在确定巴西老年人中中度和重度功能依赖的流行率及其与慢性疾病的关系，并根据依赖程度验证多疾病模式。
这是一项使用巴西 2013 年全国健康调查中 11177 名社区居住的巴西老年人数据的横断面分析研究。因变量为日常生活活动（BADLs）和工具性日常生活活动（IADLs）的中度和重度功能依赖。自变量根据自我报告的方式测量每种疾病的问题来定义，并询问“医生是否曾经诊断过你患有（每种疾病）？对于患有≥2 种慢性疾病的老年人，同时考虑同时存在多种疾病。使用泊松回归模型和稳健方差，从粗估计和调整后点流行率比及其 95%置信区间来验证 BADLs 和 IADLs 功能依赖的严重程度和独立变量之间的关联。为了将疾病分组成模式，使用探索性因子分析。
中度和重度 BADL 依赖的流行率分别为 10.2%（95%CI，9.6-10.7）和 4.8%（95%CI，4.4-5.2）。中度和重度 IADL 依赖的流行率分别为 13.8%（95%CI，13.1-14.4）和 15.6%（95%CI，14.9%-16.2）。当 BADLs 从中度依赖变为重度依赖时，在存在其他精神疾病和中风的情况下，依赖的概率在其他精神疾病的情况下增加了四倍以上，在中风的情况下增加了五倍以上。BADLs 和 IADLs 的严重程度都呈线性趋势，而对于严重的 IADL 依赖，随着同时存在的疾病数量增加，这种因素也保持了依赖概率增加的线性趋势。
慢性疾病与功能依赖相关，在严重残疾中更强调精神疾病和中风，因为它们有急性不良影响。
