Orcasitas Health Care Center, i+12 Research Institute of the Doce de Octubre Hospital, GIDO Collaborative Group Codirector, Madrid, Spain.
Orcasitas Health Care Center, GIDO Collaborative Group Codirector, Madrid, Spain.
Front Public Health. 2024 Sep 25;12:1411390. doi: 10.3389/fpubh.2024.1411390. eCollection 2024.
Mortality among people with dependency to perform basic activities of daily living (ADL) is higher than that of non-dependent people of the same age. Understanding the evolutionary course and factors involved in non-institutionalized ADL dependency, including the influence of the family structure that supports this population, would contribute to improved health planning.
A longitudinal study carried out in the ADL-dependent population of the Orcasitas neighborhood, Madrid (Spain), between June 2020, when the nationwide COVID-19 lockdown ended, and June 2023. A total of 127 patients participated in the study, 78.7% of whom were women and 21.3% were men. Risk analysis was performed via odds ratios (OR) and hazard ratios (HR). Survival analysis was performed using Cox regression.
A total of 54.33% of the ADL-dependent persons did not live with their adult children and 45.67% did, being associated living independently with economic capacity and the married marital status but not with the dependency level. In women, being married increased the probability of living independently of their adult children (OR = 12.632; 95% CI = 3.312-48.178). Loss of mobility (OR = 0.398; 95% CI = 0.186-0.853), economic capacity of the dependent (HR = 0.596; 95% CI = 0.459-0.774), and living independently and having better economic capacity (HR = 0.471; 95% CI = 0.234-0.935) were associated with 3-year survival. Those who lived with their adult children had a worse autonomy profile and higher mortality (HR = 1.473; 95% CI = 1.072-2.024). Not being employed, not being married, and not owning a home were significantly associated with being an essential family caregiver. Caregivers were mostly women (OR = 1.794; 95% CI = 1.011-3.182).
Among ADL-dependent persons, economic capacity influenced the ability to living independently and affected survival after 3 years. Loss of mobility (wheelchair use) was a predictor of mortality. Social inequalities promote that adult children end up as essential family caregivers. This generates reverse dependency and maintains a vulnerability that is transmitted from generation to generation, perpetuating social and gender inequalities. Dependent parent care in this cohort maintained an archaic pattern in which the eldest daughter cared for her parents. This study made it possible to show that ADL dependence is accompanied by complex interrelationships that must be considered in socio-health planning.
日常生活活动（ADL）依赖的人的死亡率高于同年龄的非依赖者。了解非机构化 ADL 依赖的演变过程和相关因素，包括支持这部分人群的家庭结构的影响，将有助于改善健康规划。
这是一项在马德里（西班牙）奥卡西塔斯社区 ADL 依赖人群中进行的纵向研究，研究时间为 2020 年 6 月，当时全国范围内的 COVID-19 封锁结束，到 2023 年 6 月结束。共有 127 名患者参与了这项研究，其中 78.7%为女性，21.3%为男性。风险分析通过比值比（OR）和风险比（HR）进行。生存分析采用 Cox 回归。
共有 54.33%的 ADL 依赖者没有与成年子女同住，45.67%的人与之同住，独立生活与经济能力和已婚婚姻状况有关，但与依赖程度无关。在女性中，已婚会增加与成年子女独立生活的可能性（OR=12.632；95%CI=3.312-48.178）。丧失活动能力（OR=0.398；95%CI=0.186-0.853）、依赖者的经济能力（HR=0.596；95%CI=0.459-0.774）、独立生活和更好的经济能力（HR=0.471；95%CI=0.234-0.935）与 3 年生存率相关。与成年子女同住的人自主生活能力较差，死亡率较高（HR=1.473；95%CI=1.072-2.024）。无工作、未婚和无房与成为基本家庭照顾者显著相关。照顾者主要是女性（OR=1.794；95%CI=1.011-3.182）。
在 ADL 依赖者中，经济能力影响独立生活的能力，并影响 3 年后的生存。丧失活动能力（使用轮椅）是死亡率的预测因素。社会不平等促使成年子女最终成为基本家庭照顾者。这会产生反向依赖，并维持从一代传递到另一代的脆弱性，从而延续社会和性别不平等。在这一组中，对依赖父母的照顾保持了一种古老的模式，即长女照顾父母。本研究表明，ADL 依赖伴随着复杂的相互关系，这在社会健康规划中必须加以考虑。
