Maria Lúcia Lebrão

Saúde, bem-estar e envelhecimento: o estudo SABE no Município de São Paulo

O projeto SABE (Saude, bem-estar e envelhecimento) foi coordenado pela Organizacao Pan-Americana de Saude com o objetivo de coletar informacoes sobre as condicoes de vida dos idosos (60 anos e mais) residentes em areas urbanas de metropoles de sete paises da America Latina e Caribe - entre elas, o Municipio de Sao Paulo - e avaliar diferenciais de coorte, genero e socioeconomicos com relacao ao estado de saude, acesso e utilizacao de cuidados de saude. Por meio de questionario e processo amostral padronizados foram entrevistadas 2.143 pessoas. Encontrou-se que as mulheres sao maioria, os imigrantes eram 8,7%, 62,6% viveram por cinco anos ou mais na area rural ate os quinze anos de vida. Dos idosos, 13,2% viviam sos, sendo que esse valor aumentou com a idade e no sexo feminino. Em relacao ao estado mental, encontrou-se, pelo Mini Exame do Estado Mental (MEEM), 6,9% de deterioracao cognitiva e 18,1% de depressao, segundo a Escala de Depressao Geriatrica. As auto-avaliacoes de saude mostram que 53,8% dos entrevistados consideraram a sua saude regular ou ma. Dentre as doencas mais frequentes estavam a hipertensao (53,3%); artrite/artrose/reumatismo, 31,7%; e diabetes, 17,9%. A grande maioria dos idosos nao apresentou dificuldades nas atividades basicas de vida diaria (80,7%), e entre aqueles que apresentaram, a maioria tinha dificuldades em uma ou duas atividades. Foram apresentados dados dos arranjos domiciliares encontrados, do acesso e utilizacao de servicos de saude, e relativos a renda e condicao de trabalho. Conclui-se que as condicoes de saude sao preocupantes, assim como a insuficiencia do sistema de seguridade social.

A influência das doenças crônicas na capacidade funcional dos idosos do Município de São Paulo, Brasil

The main focus of this study was the effect of chronic disease (hypertension, diabetes mellitus, heart disease, lung disease, cancer, and arthropathy) on the functional status (activities of daily living - ADL, instrumental activities of daily living - IADL) among the elderly, controlling for age, gender, living arrangements, education, and comorbidity. The analysis was based on information provided by the SABE Project, from the city of Sao Paulo, Brazil, including individuals 60 years of age and over (n = 1,769), from January 2000 to March 2001. A multinomial logistic regression model was used. Compared to the absence of dependency category, heart disease (OR = 1.82), arthropathy (OR = 1.59), lung disease (OR = 1.50), and hypertension (OR = 1.39) were the main diseases that affected the IADL dependency category. Lung disease (OR = 2.58), arthropathy (OR = 2.27), hypertension (OR = 2.13), and heart disease (OR = 2.10) had important impact on the IADL and ADL dependency categories. The results were statistically significant (p < 0.05).

Desigualdades no uso e acesso aos serviços de saúde entre idosos do município de São Paulo

OBJETIVO: Analisar os fatores relacionados a determinacao e as desigualdades no acesso e uso dos servicos de saude por idosos. METODOS: Estudo integrante do Projeto Saude, Bem-estar e Envelhecimento (SABE), no qual foram entrevistados 2.143 individuos com 60 anos ou mais no municipio de Sao Paulo, SP, em 2000. A amostra foi obtida em dois estagios, utilizando-se setores censitarios com reposicao, probabilidade proporcional a populacao e complementacao da amostra de pessoas de 75 anos. Foi mensurado o uso de servicos hospitalares e ambulatoriais nos quatro meses anteriores a entrevista, relacionando-os com fatores de capacidade, necessidade e predisposicao (renda total, escolaridade, seguro saude, morbidade referida, auto-percepcao, sexo e idade). O metodo estatistico utilizado foi regressao logistica multivariada. RESULTADOS: Dos entrevistados, 4,7% referiram ter utilizado a internacao hospitalar e 64,4% o atendimento ambulatorial. Dos atendimentos ambulatoriais em servico publico, 24,7% ocorreram em hospital e 24,1% em servico ambulatorial; dentre os que ocorreram em servicos privados, 14,5% foram em hospital e 33,7% em clinicas. Pela analise multivariada, observou-se associacao entre a utilizacao de servicos e sexo, presenca de doencas, auto-percepcao de saude, interacao da renda e escolaridade e posse de seguro saude. A analise isolada com escolaridade apresentou efeito inverso. CONCLUSOES: Foram observadas desigualdades no uso e acesso aos servicos de saude e inadequacao do modelo de atencao, indicando necessidade de politicas publicas que levem em conta as especificidades dessa populacao, facilitem o acesso e possam reduzir essas desigualdades.

O Índex de Katz na avaliação da funcionalidade dos idosos

Con el aumento en el numero de ancianos, crece tambien la necesidad de utilizacion de instrumentos de evaluacion funcional. Esa utilizacion, todavia, debe poder compararse a los diversos estudios y diferentes realidades. El Indice de Independencia en las actividades de la vida diaria desarrollado por Sydney Katz es uno de los instrumentos mas antiguos, y tambien uno de los mas nombrados por la literatura nacional e internacional. Diferentes publicaciones apuntan versiones modificadas de este instrumento, dificultando a los lectores su utilizacion correcta. El estudio aqui presentado tiene como objetivo principal trazar un historico a respecto del desarrollo, evolucion y correcta utilizacion del Indice de Independencia en las actividades de la vida diaria de Sydney Katz, asi como las modificaciones y adaptaciones desarrolladas con la autorizacion del autor con el cambio de los tiempos, de manera a contribuir con la uniformidad de las informaciones contenidas en las investigaciones relacionadas a la evaluacion funcional en gerontologia.The growing number of the elders has been increasing the need for the use of functional evaluation instruments. But such use should be done in such a way as to allow comparisons among the various studies and the different realities. Among those instruments, the Index of Activities of Daily Living (ADL), developed by Sidney Katz, is one of the oldest and one of the most frequently mentioned in Brazilian and international literature. Different articles have been showing, however, modified versions of that instrument, thus making it difficult for readers to correctly use it. This paper has the objective of making a historical account of the development, evolution and correct use of Sidney Katzs Index of Independency in the Daily Living, as well as the changes and adaptations it has gone through time, with the authors agreement, so as to contribute for the standardization of the research information related to functional evaluation in gerontology.RESUMOCom o crescente aumento donumero de idosos, cresce, tambem,a necessidade de utilizacao deinstrumentos de avaliacaofuncional. Tal utilizacao, noentanto, deve ser comparavel entreos diversos estudos e diferentesrealidades. O Index de Independen-cia nas Atividades de Vida Diaria(AVD), desenvolvido por SidneyKatz, e um dos instrumentosmais antigos e tambem dos maiscitados na literatura nacional einternacional. Diferentes publi-cacoes tem mostrado, no entanto,versoes modificadas do referidoinstrumento, dificultando aosleitores sua correta utilizacao.Este estudo teve por objetivotracar o historico do desenvol-vimento, evolucao e correta utili-zacao do Index de Independencianas Atividades de Vida Diaria deKatz, bem como as modificacoese adaptacoes desenvolvidas, coma anuencia do autor, no trans-correr do tempo, de forma acontribuir para a uniformizacaodas informacoes das pesquisasrelacionadas a avaliacao funcionalem gerontologia.ABSTRACTThe growing number of the eldershas been increasing the need for theuse of functional evaluation ins-truments. But such use should bedone in such a way as to allowcomparisons among the various stu-dies and the different realities. Amongthose instruments, the Index ofActivities of Daily Living (ADL),developed by Sidney Katz, is oneof the oldest and one of the mostfrequently mentioned in Brazilianand international literature. Diffe-rent articles have been showing,however, modified versions of thatinstrument, thus making it difficultfor readers to correctly use it. Thispaper has the objective of makinga historical account of the deve-lopment, evolution and correct useof Sidney Katz’s Index of Inde-pendency in the Daily Living, aswell as the changes and adap-tations it has gone through time,with the author’s agreement, so asto contribute for the standardi-zation of the research informationrelated to functional evaluation ingerontology.RESUMENCon el aumento en el numero deancianos, crece tambien la necesidadde utilizacion de instrumentos deevaluacion funcional. Esa utilizacion,todavia, debe poder compararse alos diversos estudios y diferentesrealidades. El Indice de Indepen-dencia en las actividades de la vidadiaria desarrollado por SydneyKatz es uno de los instrumentosmas antiguos, y tambien uno delos mas nombrados por la literaturanacional e internacional. Diferentespublicaciones apuntan versionesmodificadas de este instrumento,dificultando a los lectores suutilizacion correcta. El estudio aquipresentado tiene como objetivoprincipal trazar un historico arespecto del desarrollo, evoluciony correcta utilizacion del Indice deIndependencia en las actividadesde la vida diaria de Sydney Katz,asi como las modificaciones yadaptaciones desarrolladas con laautorizacion del autor con el cambiode los tiempos, de manera a contri-buir con la uniformidad de las infor-maciones contenidas en las investi-gaciones relacionadas a la eva-luacion funcional en gerontologia.DESCRITORESAtividades cotidianas.Envelhecimento.Avaliacao geriatrica.KEY WORDSActivities of daily living.Aging.Geriatric assessment.DESCRIPTORESActividades cotidianas.Envejecimiento.Evaluacion geriatrica.

Óbitos por serpentes peçonhentas no Estado de São Paulo: avaliação de 43 casos, 1988/93

UNLABELLED The prognostic factors and the causes for obit occurrence in ophidian envenoming are yet not completely clear. PURPOSE To determine the prognostic factors and the most probable causes for obit occurrence in ophidian envenoming. METHODS In the State of Sao Paulo were notified 12,639 cases of accidents by venomous snakes from 1988 to 1993. There were 43 deaths (0.34%). The variables from the accident notification reports were compared with the promptuary notes and/or with the death records (in lethal cases). RESULTS The snake genus was classified in 11,297 accidents and in 41 from the lethal ones. Bothrops was responsible for 9,828 (87%) accidents and 28 (68.3%) deaths, Crotalus for 1,359 (12.0%) accidents and 13 deaths (31.7%) and Micrurus for 110 (1%) accidents and no death (p 0.05). Regarding to age, 15.9% of the patients and 41.8% of the ones who died were 50 years-old or more (p < 0.05). The most frequently bitten anatomic regions were: foot (42.2%), hand (20.6%), leg (17.6%), and ankle (13.1%) in the accidents, and foot (35.7%) and leg (35.7%) in the lethal cases (p < 0.05). Coagulation disorders occurred in 34 (91.9%) from 37 patients who died (those where this datum was available). The information above was not available in non lethal cases. The most common manifestations and complications implicated as possible death causes were: acute renal failure (34-79.1%), acute respiratory failure (28-65.1%), shock (18-41.9%), and sepsis (18-41.9%). Among all lethal cases but one without information, 29.4% of the patients died within the first two days after bite and 67.6% within the first 5 days. Acute respiratory failure was most common among the patients who died owing to crotalic envenoming, and sepsis was only seen in bothropic envenoming. CONCLUSION Most of the accidents and obits are caused by Bothrops; Crotalus envenoming, leg bites, and accidents in 50 year-old patients (or more) are frequently lethal; the most common complication in lethal cases is acute renal failure.The prognostic factors and the causes for obit occurrence in ophidian envenoming are yet not completely clear. PURPOSE: To determine the prognostic factors and the most probable causes for obit occurrence in ophidian envenoming. METHODS: In the State of Sao Paulo were notified 12,639 cases of accidents by venomous snakes from 1988 to 1993. There were 43 deaths (0.34%). The variables from the accident notification reports were compared with the promptuary notes and/or with the death records (in lethal cases). RESULTS: The snake genus was classified in 11,297 accidents and in 41 from the lethal ones. Bothrops was responsible for 9,828 (87%) accidents and 28 (68.3%) deaths, Crotalus for 1,359 (12.0%) accidents and 13 deaths (31.7%) and Micrurus for 110 (1%) accidents and no death (p 0.05). Regarding to age, 15.9% of the patients and 41.8% of the ones who died were 50 years-old or more (p<0.05). The most frequently bitten anatomic regions were: foot (42.2%), hand (20.6%), leg (17.6%), and ankle (13.1%) in the accidents, and foot (35.7%) and leg (35.7%) in the lethal cases (p<0.05). Coagulation disorders occurred in 34 (91.9%) from 37 patients who died (those where this datum was available). The information above was not available in non lethal cases. The most common manifestations and complications implicated as possible death causes were: acute renal failure (34- 79.1%), acute respiratory failure (28- 65.1%), shock (18- 41.9%), and sepsis (18- 41.9%). Among all lethal cases but one without information, 29.4% of the patients died within the first two days after bite and 67.6% within the first 5 days. Acute respiratory failure was most common among the patients who died owing to crotalic envenoming, and sepsis was only seen in bothropic envenoming. CONCLUSION: Most of the accidents and obits are caused by Bothrops; Crotalus envenoming, leg bites, and accidents in 50 year-old patients (or more) are frequently lethal; the most common complication in lethal cases is acute renal failure.

Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly

BackgroundSarcopenia, defined as low muscle mass (LMM), and dynapenia have been associated with adverse outcomes in elderly.ObjectiveContrast the association of sarcopenia versus dynapenia with incidence of disability.DesignA four-year prospective study (2006–2010).SettingSão Paulo, Brazil.Participants478 individuals aged 60 and older from the Saúde, Bem-Estar e Envelhecimento (SABE) study who were non-disabled at baseline.MeasurementsSarcopenia, measured according to the European Working Group on Sarcopenia in Older People (EWGSOP), includes: LMM assessed by skeletal muscle mass index ≤8.90kg/m2 (men) and ≤6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and <20kg (women); and low physical performance (LPP) assessed by gait speed ≤0.8m/s. Diagnosis of sarcopenia required LMM plus LMS or LPP. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, perception of vision, hearing and body mass index.OutcomesDisability in mobility or instrumental activities of daily living (IADL) or disability in activities of daily living (ADL) and IADL.ResultsThe incidence density of mobility or IADL disability was 43.4/1000 person/year and 22.6/1000 person/year for IADL and ADL disability. There was no significant difference in incidence density according sarcopenia or dynapenia status. After controlling for all covariates, sarcopenia was associated with mobility or IADL disability (relative risk ratio = 2.23, 95%Confidence Interval: 1.03–4.85). Dynapenia was not associated with disability.ConclusionsSarcopenia according to the EWGSOP definition can be used in clinical practice as a screening tool for early functional decline (mobility or IADL disability).

Anthropometry of elderly residents in the city of São Paulo, Brazil

The article presents gender and age-specific selected anthropometric data for a representative sample of elderly Brazilians in the city of São Paulo. This was a cross-sectional, population-based household survey. A total of 1,894 older adults (men and women, > 60 years) were examined from January to March 2001. Data were presented as means and percentiles for body mass (BM); height or stature (ST); body mass index (BMI); waist (WC), hip (HC), arm (AC), and calf (CC) circumferences; triceps skinfold thickness (TST); and arm muscle circumference (AMC), and differences were described according to age (all variables) and gender (BMI). Except for HC (men), all anthropometric variables were lower in the oldest than in the youngest individuals (p < 0.01) in both genders. BMI was significantly higher (p < 0.01) in women than men (all age groups). The observations suggest that there is loss of muscle mass and redistribution and reduction of fat mass with age (both genders). The data can be used in clinical practice and epidemiological studies based on interpretation of anthropometric measurements in the elderly in São Paulo.

Analysis of the prevalence of and factors associated with urinary incontinence among elderly people in the Municipality of São Paulo, Brazil: SABE Study (Health, Wellbeing and Aging)

To investigate the prevalence of urinary incontinence among elderly people living in São Paulo, Brazil and their associated risk factors. The Pan-American Health Organization and World Health Organization coordinated a multicenter study named Health, Wellbeing and Aging (SABE Study) in elderly people (over 60 years old) living in seven countries in Latin America and the Caribbean. In Brazil, the study was carried out in São Paulo in the year 2000. The total Brazilian sample included 2,143 people. The prevalence of self reported urinary incontinence was 11.8% among men and 26.2% for women. It was verified that among those reporting urinary incontinence, 37% also reported stroke and 34% depression. It was found that the greater the dependence that the elderly people presented, the greater the prevalence of urinary incontinence. The associated factors found were depression (odds ratio = 2.49), female (2.42), advanced age (2.35), important functional limitation (2.01). Urinary incontinence is a highly prevalent symptom among the elderly population of the municipality of São Paulo, especially among women. The adoption of preventive measures can reduce the negative effects of urinary incontinence.

Gender differences in incidence and determinants of disability in activities of daily living among elderly individuals: SABE study.

Determining the groups that are most susceptible to developing disability is essential to establishing effective prevention and rehabilitation strategies. The aim of the present study was to determine gender differences in the incidence of disability regarding activities of daily living (ADL) and determinants among elderly residents of Sao Paulo, Brazil. In 2000, 1634 elderly with no difficulties regarding ADL (modified Katz Index) were selected. These activities were reassessed in 2006 and disability was the outcome for the analysis of determinants. The following characteristics were analyzed at baseline: socio-demographic, behavioral, health status, medications, falls, hospitalizations, depressive symptoms, cognition, handgrip, mobility and balance. The incidence density was 42.4/1000 women/year and 17.5/1000 men/year. After adjusting for socioeconomic status and health conditions, women with chronic diseases and social vulnerability continued to have a greater incidence of disability. The following were determinants of the incidence of disability: age and depressive symptoms in both genders; stroke and slowness on the sit-and-stand test among men; and osteoarthritis and sedentary lifestyle among women. Better cognitive performance and handgrip strength were protective factors among men and women, respectively. Adverse clinical and social conditions determine differences between genders regarding the incidence of disability. Decreased mobility and balance and health conditions that affect the central nervous system or lead to impaired cognition disable men more, whereas a sedentary lifestyle, reduction in muscle strength and conditions that affect the osteoarticular system disable women more.

Gender Differences in Life Expectancy and Disability-Free Life Expectancy Among Older Adults in São Paulo, Brazil

BACKGROUND research on life expectancy has demonstrated the negative impact of disability on the health of older adults and its differential effects on women as evidenced by their higher disabled life expectancy (DLE). The goal of the present study was to investigate gender differences in total life expectancy (TLE), disability-free life expectancy (DFLE), and DLE; examine gender differences on personal care assistance among older adults in São Paulo, Brazil; and discuss the implications for public policies. METHODS the sample was drawn from two waves (2000, 2006) of the dataset of Salud, Bienestar, y Envejecimiento, a large longitudinal study conducted in São Paulo (n = 2,143). The study assessed disability using the activities of daily living (ADL). The interpolation of Markov Chain method was used to estimate gender differences in TLE, DLE, and DFLE. FINDINGS TLE at age 60 years was approximately 5 years longer for women than men. Women aged 60 years were expected to live 28% of their remaining lives-twice the percentage for men-with at least one ADL disability. These women also lived more years (M = 0.71, SE = 0.42) with three or more ADL disabilities than men (M = 0.82, SE = 0.16). In terms of personal care assistance, women received more years of assistance than men. CONCLUSION among older adults in São Paulo, women lived longer lives but experienced a higher and more severe disability burden than men. In addition, although women received more years of personal assistance than men, women experienced more unmet care assistance needs.