Yeda Aparecida de Oliveira Duarte

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.

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.

Contribuição dos arranjos domiciliares para o suprimento de demandas assistenciais dos idosos com comprometimento funcional em São Paulo, Brasil

OBJETIVO: Apresentar os resultados do Projeto Saude, Bem-Estar e Envelhecimento na America Latina e Caribe (SABE) no que tange ao desempenho funcional, as demandas assistenciais e aos arranjos familiares dos idosos do Municipio de Sao Paulo, Brasil. METODOS: Em 2000, foram entrevistados 2 143 individuos com 60 anos ou mais, utilizando-se o questionario padronizado do SABE. A amostra foi obtida em dois estagios, utilizando-se setores censitarios com reposicao e com probabilidade proporcional a populacao. A complementacao da amostra de pessoas de 75 anos ou mais foi realizada atraves da localizacao de moradias proximas aos setores selecionados. Os dados finais foram ponderados, de forma a serem expandidos. O desempenho funcional foi medido pela capacidade dos idosos de executar atividades basicas de vida diaria (ABVD, atravessar um comodo da casa, comer, deitar-se e levantar da cama, usar o vaso sanitario, vestir-se e despir-se e tomar banho) e atividades instrumentais de vida diaria (AIVD, comprar e preparar alimentos, realizar tarefas domesticas leves e pesadas, ir a outros lugares sozinho, usar o telefone, tomar os proprios medicamentos e manejar dinheiro), sendo a limitacao funcional (demanda assistencial) definida como a necessidade de ajuda para executar pelo menos uma dessas atividades. Os 66 tipos de arranjos domiciliares identificados foram agrupados em sete categorias, de acordo com a presenca ou nao de co-residentes e o grau de parentesco entre o idoso e os co-residentes. RESULTADOS: Dos entrevistados, 19,2% apresentaram limitacoes funcionais nas atividades basicas e 26,5% nas atividades instrumentais, sendo a maior proporcao entre mulheres e na velhice avancada. A proporcao de idosos com limitacoes que recebeu ajuda variou, nas atividades basicas, de 25,6% (para deitar-se e levantar da cama) a 70,5% (para comer), e nas instrumentais, de 79,7% (para a execucao de tarefas domesticas leves) a 97,8% (para comprar alimentos). Quanto aos arranjos familiares, a maioria dos idosos morava com o conjuge e os filhos ou apenas com os filhos (32,1%) ou somente com o conjuge (20,0%). O arranjo domiciliar em que a maior proporcao de idosos com limitacao funcional recebia ajuda (56,4%) foi aquele no qual o idoso residia tambem com nao-familiares. CONCLUSAO: Os idosos com limitacoes funcionais nao estao sendo assistidos suficientemente pela familia ou co-residentes, e as politicas publicas nao suprem esse deficit assistencial. Dado o acelerado processo de envelhecimento da populacao, o sistema de assistencia corre o risco de se tornar nao so insuficiente, mas caotico.

Polifarmácia entre idosos do Município de São Paulo - Estudo SABE

Polypharmacy for the elderly and associated factors were assessed. A cross-sectional study was conducted using data from the SABE Study (Health, Well-being and Aging), 2006. 1,115 individuals representing 422,377 elderly aged 65 or more, living in Sao Paulo City, were interviewed. Polypharmacy was defined as the use of five or more medications. A multivariate regression logistics was used. Polypharmacy prevalence was 36%. Female (OR = 1.7; IC 95%: 1.0; 2.9), age over 75 years (OR = 1.9; CI 95%: 1.3; 2.7), higher income (OR = 1.8; CI 95%: 1.2; 2.8), working (OR = 1.8; CI 95%: 1.1; 2.9), regular self assessed health (OR = 1.6; CI 95%: 1.1; 2.3) or poor (OR = 2.6; CI 95%: 1.4; 4.9), hypertension (OR = 2.0; CI 95%: 1.4; 2.9), diabetes (OR = 4.1; CI 95%: 2.2; 7.5), rheumatic diseases (OR = 2.3; CI 95%: 1.5; 3.6) and cardiac problems (OR = 2.9; CI 95%: 1.9; 4.5) were associated positively with polypharmacy. Using only the public health system (OR = 0.5, 95% CI: 0.3; 0.7) was inversely associated with polypharmacy. Medicines for the cardiovascular system and for the alimentary tract and metabolism were the most used. The knowledge of factors associated with polypharmacy, such as those identified in this study, may be useful to alert health professionals about the importance of identifying and monitoring the elderly groups most vulnerable to polypharmacy.

Relationship Between Oral Health–Related Quality of Life, Oral Health, Socioeconomic, and General Health Factors in Elderly Brazilians

To assess the impact of oral health on quality of life in elderly Brazilians and to evaluate its association with clinical oral health measures and socioeconomic and general health factors.

Relationship between oral health and frailty in community-dwelling elderly individuals in Brazil.

To test the hypothesis that clinical oral health conditions are associated with frailty independent of socioeconomic and general health status.

Undernutrition as a major risk factor for death among older Brazilian adults in the community-dwelling setting: SABE survey

OBJECTIVE To investigate the independent association between undernutrition and death in older adults in a community-dwelling setting. METHODS This retrospective study was based on the Health, Well-being and Ageing survey conducted in 2000 that included 1170 older adults (≥60 y) from São Paulo, Brazil. Death occurrences were considered through March, 2007. The variables analyzed were undernutrition (Mini-Nutritional Assessment), gender, income, muscle strength, hip fracture, smoking habits, cancer, depression, diabetes, coronary heart disease, chronic lung disease, cerebral vascular disease, and hypertension. A hierarchical multivariate analysis by logistic regression was performed according to age groups (60-74 and ≥75 y). RESULTS Undernutrition frequency was higher in adults ≥75 y old (2.6% versus 2.4%). The frequency of death in undernourished subjects was higher in the 60- to 74-y-old group (7.6%) than in those ≥75 y old (3.9%). Undernutrition was the strongest independent risk factor for death (P < 0.05) in the 60- to 74-y-old group (odds ratio 6.05, 95% confidence interval 5.76-6.35) and in the ≥75-y-old group (odds ratio 2.76, 95% confidence interval 2.51-3.04). All other variables were also associated with death, except for hip fracture and cerebral vascular disease, in the two age groups and hypertension in the 60- to 74-y-old group; however, the effect of these variables was less. CONCLUSION Undernutrition represented the strongest risk factor for death in Brazilian community-dwelling older adults 60 to 74 y old and showed a stronger association than for adults ≥75 y old.