Abstract

This study aimed to verify the occurrence of changes in the functional capacity and physical performance of community-dwelling elderly and its determining factors over a two-year period. This is a quantitative, observational and longitudinal household survey conducted in 2014 and 2016, with the participation of 380 elderly from Uberaba, Minas Gerais. The following instruments were used: The Mini-Mental State Examination and questionnaires with sociodemographic/economic, clinical and life habits data. The functional capacity was evaluated through the Katz Index and Lawton-Brody’s scale. Physical performance was verified through the Short Physical Performance Battery. A descriptive, bivariate and linear multiple regression analysis was conducted, with a significance level of α < 0.05. The results showed reduced functional capacity for the instrumental activities of daily living and physical performance in a two-year period. The determining factors for both outcomes were age group, occupational activity, and physical activity. Schooling was a specific factor only for the instrumental activities of daily living, and gender and the number of medicines used, for physical performance.

Key words
Elderly; Activities of daily living; People with disability; Limited mobility; Longitudinal studies

Introduction

The elderly contingent has become globally expressive, and the aging population is pointed out as one of the most relevant trends of the 21^st century¹1 Fundo de População das Nações Unidas. Envelhecimento no Século XXI: celebração e desafio. [Internet] 2012. [acessado 2017 Ago 15]. Disponível em: http://www.unfpa.org.br/novo/index.php/biblioteca/publicacoes/populacao/633-envelhecimento-no-seculo-xxi-celebracao-e-desafio
http://www.unfpa.org.br/novo/index.php/b... . The growing elderly population has been advancing in parallel with changes in the epidemiological profile marked by the increased incidence and prevalence of chronic noncommunicable diseases that occur even before the onset of old age²2 Chatterji S, Byles J, Cutler D, Seeman T, Verdes E. Health, functioning, and disability in older adults-present status and future implications. Lancet 2015; 385(9967):563-575..

According to the theoretical conceptual models, diseases can contribute to the onset of disability and functional limitations³3 Nagi S. Disability concepts revisited: implications for prevention. In: Pope AM, Tarlov AR, editors. Disability in America: Toward a National Agenda for Prevention. Washington: National Academy Press; 1991. p. 309-327.^,44 Verbrugge LM, Jette AM. The disablement process. Soc Sci Med 1994; 38(1):1-14.. However, other factors such as physical, environmental, socioeconomic, genetic and lifestyle habits are known to affect the elderly’s functions, making them reliant on family, community and the health system⁵5 Sudré MRS, Reiners AAO, Nakagawa JTT, Azevedo RCS, Floriano LA, Morita LHM. Prevalência de dependência em idosos e fatores de risco associados. Acta Paul Enferm 2012; 25(6):947-953..

The belief that dependence is inherent to the aging process produces negative attitudes and intimidates the elderly population within a sociocultural context that values the preservation of autonomy and independence⁶6 Camarano AA, organizadora. Cuidados de longa duração para a população idosa: um novo risco social a ser assumido? Rio de Janeiro: IPEA; 2010.. Thus, the identification of functional disabilities and limitations, as well as their determinants are highlighted in the literature⁷7 Figueiredo CS, Assis MG, Silva SLA, Dias RC, Mancini MC. Mudanças funcionais e cognitivas em idosos da comunidade: estudo longitudinal. Braz J Phys Ther 2013; 17(3):297-306.

8 den Ouden ME, Schuurmans MJ, Brand JS, Arts IE, Mueller-Schotte S, van der Schouw YT. Physical functioning is related to both an impaired physical ability and ADL disability: A ten-year follow-up study in middle-aged and older persons. Maturitas 2013; 74(1):89-94.

9 Matos FS, Carneiro JAO, Jesus CS, Coqueiro R, Fernandes M, Brito TA. Redução da capacidade funcional de idosos residentes em comunidade: estudo longitudinal. Cien Saude Colet 2016; 23(10):3393-3401.^-1010 Cabrero-García J, Muñoz-Mendoza CL, Cabañero-Martínez MJ, González-Llopís, L, Ramos-Pichardo JD, Reig-Ferrer A. Valores de referencia de la Short Physical Performance Battery para pacientes de 70 y más años en atención primaria de salud. Aten Primaria 2012; 44(9):540-548., as they provide information to propose prevention and intervention measures for the functional status of the elderly.

Functional capacity is usually assessed through questionnaires of the elderly’s or their caregiver/family’s report on the performance of daily living activities¹¹11 Ricci NA, Kubota MT, Cordeiro RC. Concordância de observações sobre a capacidade funcional de idosos em assistência domiciliar. Rev Saude Publica 2005; 39(4):655-662., and the physical performance related to functional limitations is investigated through physical tests where individuals perform specific tasks, which confers greater responsiveness to relevant clinical changes¹²12 Gill TM. Assessment of function and disability in longitudinal studies. J Am Geriatr Soc 2010; 58(Supl. 2):S308-S312..

No longitudinal studies that identified the occurrence of changes in functional capacity and physical performance of community-dwelling elderly concurrently were found, but only investigations on functional capacity⁷7 Figueiredo CS, Assis MG, Silva SLA, Dias RC, Mancini MC. Mudanças funcionais e cognitivas em idosos da comunidade: estudo longitudinal. Braz J Phys Ther 2013; 17(3):297-306.^,99 Matos FS, Carneiro JAO, Jesus CS, Coqueiro R, Fernandes M, Brito TA. Redução da capacidade funcional de idosos residentes em comunidade: estudo longitudinal. Cien Saude Colet 2016; 23(10):3393-3401.^,1313 Moreira PL, Correa CR, Corrente JE, Martin LC, Villas Boas PJF, Ferreira ALA. Anthropometric, functional capacity, and oxidative stress changes in Brazilian community-living elderly subjects. A longitudinal study. Arch Gerontol Geriatr 2016; 66:140-146.. According to Pinheiro et al.¹⁴14 Pinheiro PA, Passos TDO, Coqueiro RS, Fernandes MH, Barbosa AR. Desempenho motor de idosos do Nordeste brasileiro: diferenças entre idade e sexo. Rev Esc Enferm USP 2013; 47(1):128-136., information on the functional health of community-dwelling elderly based on direct measures (physical tests) is still scarce.

National scientific production focuses on predominantly cross-sectional studies⁵5 Sudré MRS, Reiners AAO, Nakagawa JTT, Azevedo RCS, Floriano LA, Morita LHM. Prevalência de dependência em idosos e fatores de risco associados. Acta Paul Enferm 2012; 25(6):947-953.^,1414 Pinheiro PA, Passos TDO, Coqueiro RS, Fernandes MH, Barbosa AR. Desempenho motor de idosos do Nordeste brasileiro: diferenças entre idade e sexo. Rev Esc Enferm USP 2013; 47(1):128-136.^,1515 Nunes JD, Saes MO, Nunes BP, Siqueira FCV, Soares DC, Fassa MEG, Thumé E, Facchini LA. Functional disability indicators and associated factors in the elderly: a population-based study in Bagé, Rio Grande do Sul, Brazil. Epidemiol Serv Saúde 2017; 26(2):295-304., which are essential for practice but prevent a causal analysis¹⁶16 Pereira GN, Bastos GAN, Del Duca GF, Bós AJG. Indicadores demográficos e socioeconômicos associados à incapacidade funcional em idosos. Cad Saude Publica 2012; 28(11):2035-2042.. Thus, the longitudinal design can overcome this limitation, besides reducing harm to the elderly population through the elaboration of more effective strategies¹⁵15 Nunes JD, Saes MO, Nunes BP, Siqueira FCV, Soares DC, Fassa MEG, Thumé E, Facchini LA. Functional disability indicators and associated factors in the elderly: a population-based study in Bagé, Rio Grande do Sul, Brazil. Epidemiol Serv Saúde 2017; 26(2):295-304..

Considering the context of population aging and the relevance of longitudinal studies for the planning and implementation of actions aimed at the functional status of the elderly population, this study aimed to verify the occurrence of changes in the functional capacity and physical performance of community-dwelling elderly and their determinants over a period of two years.

Methods

This is a quantitative, observational and longitudinal household survey with community-dwelling elderly residents in Uberaba, Minas Gerais, Brazil. Data were collected in 2014 (from January to April) and 2016 (from March to July) and are part of a project developed by the Public Health Research Group of the Federal University of the Triângulo Mineiro (UFTM).

The study population was determined by multi-stage cluster sampling. The elderly were selected through systematic sampling, where the first stage was based on a random draw of 50% of the census tracts of the municipality, with a single listing of the tracts and identification of the respective neighborhood¹⁷17 Nascimento JS, Tavares DMS. Prevalência e fatores associados a quedas em idosos. Texto Contexto Enferm 2016; 25(2):e0360015.. Thus, 204 tracts were selected from 409 tracts in 2014.

The first census tract was randomly drawn, and the others were selected by sampling interval (SI), which was obtained through the formula: SI = total number of census tracts / number of census tracts drawn¹⁷17 Nascimento JS, Tavares DMS. Prevalência e fatores associados a quedas em idosos. Texto Contexto Enferm 2016; 25(2):e0360015.. In 2014, of the 816 eligible elderly, 87 were lost and were related to incomplete tracts, leaving out 729 individuals. In 2016, for recomposition, the random draw considered 415 sectors, totaling 769 older adults, of which 613 completed the whole interview (154 were excluded due to cognitive decline in the Mini-Mental State Examination, one address was not found, and one elderly was duplicated). Of the 613, only 380 were the same elderly as in 2014.

The study included individuals aged 60 years and older residing in the urban area of Uberaba who participated in the data collection in 2014 and 2016. Elderly who were institutionalized or hospitalized and who had a cognitive decline in the Mini-Mental State Examination (MMSE), per schooling criteria¹⁸18 Bertolucci PHF, Brucki SMD, Campacci SR, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuro-Psiquiatr 1994, 52(1):1-7. were excluded to minimize self-reporting interferences and difficulties of understanding to answer the questionnaires and performing the physical tests.

Data collection was supported by interviewers from the UFTM Public Health Research Group, who received training and guidance. After applying the MMSE, the elderly answered a structured instrument prepared by the research group containing the following sociodemographic, economic and clinical data: gender (male, female), age group (60|-80 years, 80 years and over), marital status (never married or lived with a partner; living with spouse or partner; widowed; separated; divorced), years of schooling (0; 1|-5; 5|-9; 9|-12, more than 12), retirement (yes, no), professional activity (yes, no), monthly income in minimum wages (no income; < 1; 1; 1-|3; 3-|5; more than 5), drugs of continuous use and self-reported morbidities (total number).

The question “Have you been hospitalized in the last 12 months?” (yes, no)¹⁹19 Lebrão ML, Duarte YAO. SABE - Saúde, Bem-estar e Envelhecimento - O Projeto Sabe no município de São Paulo: uma abordagem inicial. Brasília: Organização Pan-Americana da Saúde; 2003. was used to identify the occurrence of hospitalization in the last year and the extended version of the International Physical Activity Questionnaire (IPAQ)²⁰20 Benedetti TB, Mazo GZ, Barros MVG. Aplicação do questionário internacional de atividades físicas (IPAQ) para avaliação do nível de atividades físicas de mulheres idosas: validade concorrente e reprodutibilidade teste-reteste. Rev Bras Ciênc Mov 2004; 12(1):25-33. was employed to investigate physical activity, by which the elderly were classified as active (≥150 minutes/week) or inactive ( < 150 minutes/week)²¹21 Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard, Buchner D, Ettinger W, Heath GW, King AC. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273(5):402-407..

The functional capacity (dependent variable) for basic (BADL) and instrumental activities of daily living (IADL) were evaluated, respectively, by the Katz Index and Lawton-Brody Scale. The BADL instrument was adapted in Brazil by Lino et al.²²22 Lino VTS, Pereira SRM, Camacho LAB, Ribeiro Filho ST, Buksman S. Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Katz). Cad Saude Publica 2008; 24(1):103-112. and encompasses six areas of functioning related to self-care that have three response options, depending on the level of dependence to perform the activities²²22 Lino VTS, Pereira SRM, Camacho LAB, Ribeiro Filho ST, Buksman S. Adaptação transcultural da Escala de Independência em Atividades da Vida Diária (Escala de Katz). Cad Saude Publica 2008; 24(1):103-112., and the total number of BADL that the elderly could not perform (dependent) was adopted in this study. The IADL scale has a reliability analysis and is adapted to the Brazilian reality²³23 Santos RL, Virtuoso Júnior JS. Confiabilidade da versão brasileira da Escala de Atividades Instrumentais da Vida Diária. RBPS 2008; 21(4):290-296.. It evaluates performance in seven activities, and a total score ranging from 7 to 21 points, where the highest scores denote better functional capacity²³23 Santos RL, Virtuoso Júnior JS. Confiabilidade da versão brasileira da Escala de Atividades Instrumentais da Vida Diária. RBPS 2008; 21(4):290-296., is considered for the study.

The Short Physical Performance Battery (SPPB) was used to evaluate the physical performance (dependent variable), duly translated and adapted for Brazil²⁴24 Nakano MM. Versão Brasileira da Short Physical Performance Battery - SPPB: Adaptação Cultural e Estudo da Confiabilidade [dissertação]. Campinas: Universidade Estadual de Campinas; 2007., with three realms: balance, gait speed, and lower limb strength. This study considered the total score ranging from 0 to 12 points, where the highest score denotes the best physical performance²⁴24 Nakano MM. Versão Brasileira da Short Physical Performance Battery - SPPB: Adaptação Cultural e Estudo da Confiabilidade [dissertação]. Campinas: Universidade Estadual de Campinas; 2007..

Data were double-entered in the Microsoft Office Excel® program and submitted for analysis in the Statistical Package for Social Sciences (SPSS) software version 20.0. We used descriptive statistics that included absolute and relative frequencies, measures of central tendency (mean) and variability (standard deviation and amplitudes). We employed the t-test for dependent samples to identify changes in functional capacity for BADL (total number of activities that could not be performed) and IADL (total score), and physical performance (total score) in the follow-up period.

In the bivariate analysis, the t-test for independent samples was used to verify the influence of the 2014 categorical variables (gender, age, schooling, professional activity, hospitalization in the last 12 months and practice of physical activity) on functional capacity and physical performance in 2016. The influence of the 2014 quantitative variables (number of medicines used and self-reported morbidities) on the 2016 outcomes was verified with Pearson’s Correlation Coefficient.

The independent variables (gender, age group, schooling, occupational activity, hospitalization in the last 12 months, number of medicines used and self-reported morbidities and physical activity) associated with functional capacity and physical performance were later inserted into the multiple linear regression model. The significance level was set at α < 0.05 for all the tests.

A power analysis was performed for multiple linear regression with eight predictors, in the Power Analysis and Sample Size (PASS) application, version 13. To this end, a determination coefficient of R² = 0.25, a level of significance or type I error of α < 0.05 and sample size of 380 elderly were considered, which allowed the achievement of sufficient statistical power for the inferences of the regression analyses (99%).

The Health Research Ethics Committee of the UFTM approved the research. The study was conducted after the consent of the elderly who signed the Informed Consent Form.

Results

Of the 380 elderly people who participated in both collections, 65.8% (n = 250) were women and 34.2% (n = 130) were men. In the two evaluations, elderly in the of 60|-80 years’ age group, who lived with a spouse or partner, had 1|-5 schooling years and were retired, but exercised some occupational activity prevailed. Only individual monthly income in minimum wages showed a small variation from 2014 to 2016, with the prevalence of one minimum wage (43.7%) and 1-|3 minimum wages (41.3%), respectively.

Concerning changes in the functional capacity and physical performance in the follow-up period, the paired t-test for dependent samples showed a statistically significant decrease in the scores of the Lawton and Brody Scale (p < 0.001) and the SPPB (p = 0.001), indicating worse functional capacity and physical performance, respectively. There was a slight increase in the mean number of BADL that the elderly could not perform, but no statistically significant difference was found (p = 0.78) (Table 1).

Regarding the determinants for decreased functional capacity in the IADL, the bivariate analysis showed a statistically significant association for the elderly aged 80 and over (p < 0.001), who did not study (p < 0.001) without occupational activity (p < 0.001) and were inactive (p < 0.001) in 2014, that is, they showed lower means in the IADL in 2016, developing towards higher dependence. Pearson’s Coefficient of Correlation showed that the elderly who used fewer medicines in 2014 had higher means for IADL in 2016 (r = -0.15; p = 0.004).

When the bivariate analysis considered the declining physical performance in 2016, it was possible to identify a statistically significant association for elderly who were 80 years old or older (p < 0.001) and were inactive (p < 0.001) in 2014. Elderly with a lower number of morbidities (r = -0.15; p = 0.003) and lower number of medicines used (r = -0.28; p < 0.001) in 2014 had the highest mean physical performance in 2016, according to Pearson’s Correlation Coefficient.

The variables previously used in the bivariate analysis were included in the final multiple linear regression model to identify the determinant factors for lower functional capacity in the IADL and physical performance, according to the established criterion of α < 0.05. Table 2 shows that decreased functional capacity for IADL in 2016 was associated with the following 2014 variables: physical activity (β = -0.21, p < 0.001), schooling (β = -0.21, p < 0.001), professional activity (β = -0.22, p < 0.001) and age group (β = -0.25, p < 0.001).

According to Table 3, the 2014 variables that were associated with the declining physical performance in 2016 were: occupational activity (β = -0.16, p = 0.01), gender (β = -0.19; p = 0.003), number of medicines used (β = -0.23, p < 0.001), physical activity (β = -0.24, p < 0.001) and age group (β = -0.24, p < 0.001).

Discussion

This study revealed that a decreased functional capacity in the IADL and physical performance of the community-dwelling elderly was observed over a two-year period. Furthermore, it reinforced the multifactorial nature of the process of functional disabilities and limitations in identifying the influence of sociodemographic, clinical, and life habits determinants.

Lower functional capacity for IADL was noted in the period studied, but there was no significant change in BADL. The finding corroborates longitudinal studies carried out in Belo Horizonte-MG⁷7 Figueiredo CS, Assis MG, Silva SLA, Dias RC, Mancini MC. Mudanças funcionais e cognitivas em idosos da comunidade: estudo longitudinal. Braz J Phys Ther 2013; 17(3):297-306. and Botucatu-SP¹³13 Moreira PL, Correa CR, Corrente JE, Martin LC, Villas Boas PJF, Ferreira ALA. Anthropometric, functional capacity, and oxidative stress changes in Brazilian community-living elderly subjects. A longitudinal study. Arch Gerontol Geriatr 2016; 66:140-146.. Similarly, cross-sectional investigations have identified a higher prevalence of disability for IADL¹⁵15 Nunes JD, Saes MO, Nunes BP, Siqueira FCV, Soares DC, Fassa MEG, Thumé E, Facchini LA. Functional disability indicators and associated factors in the elderly: a population-based study in Bagé, Rio Grande do Sul, Brazil. Epidemiol Serv Saúde 2017; 26(2):295-304.^,1616 Pereira GN, Bastos GAN, Del Duca GF, Bós AJG. Indicadores demográficos e socioeconômicos associados à incapacidade funcional em idosos. Cad Saude Publica 2012; 28(11):2035-2042.. The greater dependence for IADL can be justified by the hierarchy existing between activities of daily living, where losses occur first in the IADL, which are more complicated, and later affect the BADL²⁵25 Ramos LR, Perracini M, Rosa TE, Kalache A. Significance and management of disability among urban elderly residents in Brazil. J Cross Cult Gerontol 1993; 8(4):313-323..

Furthermore, impaired IADL may have also occurred due to the relationship between these activities and the level of schooling²⁶26 Costa EC, Nakatani AYK, Bachion MM. Capacidade de idosos da comunidade para desenvolver Atividades de Vida Diária e Atividades Instrumentais de Vida Diária. Acta Paul Enferm 2006; 19(1):43-48., which was considered low among the elderly in this study (1|-5 years). Learning opportunities contribute to the development of the skills and confidence required to achieve healthy aging²⁷27 Santos KA, Koszuoski R, Dias-da-Costa JS, Pattussi MP. Fatores associados com a incapacidade funcional em idosos do Município de Guatambu, Santa Catarina, Brasil. Cad Saude Publica 2007; 23(1):2781-2788., with the maintenance of the IADL, which, when compromised, may adversely affect the autonomy and social life of the elderly, as well as of relatives, who will start to provide care to and channel financial resources to meet the demands of the dependent individual²⁶26 Costa EC, Nakatani AYK, Bachion MM. Capacidade de idosos da comunidade para desenvolver Atividades de Vida Diária e Atividades Instrumentais de Vida Diária. Acta Paul Enferm 2006; 19(1):43-48..

Similar to the IADL, physical performance declined. No national longitudinal studies with community-dwelling seniors were identified for comparison. However, research developed in an Interdisciplinary Home Care Center showed that over a year, the elderly had a lower physical performance assessed by the SPPB²⁸28 Ansai JH, Glisoi SFN, Silva TO, Ferreira FPC, Lunardi AC, Sera CTN. Evolução de desempenho físico e força de preensão palmar em idosos assistidos por um programa de assistência domiciliar interdisciplinar em um ano. Fisioter Pesqui 2013; 20(2):197-202., in contrast to the findings of this research.

The accumulation of various cellular and molecular damages at the biological level causes gradual depletion in the physiological reserves and, consequently, a general decline in the intrinsic capacity of the elderly²⁹29 Organização Mundial da Saúde (OMS). Relatório mundial de envelhecimento e saúde. [Internet] 2015 [acessado 2017 Ago 10]. Disponível em: http://sbgg.org.br/wp-content/uploads/2015/10/OMS-ENVELHECIMENTO-2015-port.pdf
http://sbgg.org.br/wp-content/uploads/20... , and can affect the physical performance. However, it should be pointed out that, although many older adults are living with reduced function, the development of this condition is specific to each individual and may occur progressively, distributed over the years, or swing between partial or total recovery²⁹29 Organização Mundial da Saúde (OMS). Relatório mundial de envelhecimento e saúde. [Internet] 2015 [acessado 2017 Ago 10]. Disponível em: http://sbgg.org.br/wp-content/uploads/2015/10/OMS-ENVELHECIMENTO-2015-port.pdf
http://sbgg.org.br/wp-content/uploads/20... .

The final multiple linear regression model showed that age, professional activity and physical activity were determining factors for both outcomes. Schooling was related only to the functional capacity for the IADL, and gender and the number of medicines used were related to physical performance.

The relationship between age and IADL corroborates a longitudinal study with community-dwelling elderly¹³13 Moreira PL, Correa CR, Corrente JE, Martin LC, Villas Boas PJF, Ferreira ALA. Anthropometric, functional capacity, and oxidative stress changes in Brazilian community-living elderly subjects. A longitudinal study. Arch Gerontol Geriatr 2016; 66:140-146. and cross-sectional studies in southern Brazil¹⁵15 Nunes JD, Saes MO, Nunes BP, Siqueira FCV, Soares DC, Fassa MEG, Thumé E, Facchini LA. Functional disability indicators and associated factors in the elderly: a population-based study in Bagé, Rio Grande do Sul, Brazil. Epidemiol Serv Saúde 2017; 26(2):295-304.^,1616 Pereira GN, Bastos GAN, Del Duca GF, Bós AJG. Indicadores demográficos e socioeconômicos associados à incapacidade funcional em idosos. Cad Saude Publica 2012; 28(11):2035-2042.. Regarding physical performance, the literature shows that older elderly have worse results in physical tests¹⁴14 Pinheiro PA, Passos TDO, Coqueiro RS, Fernandes MH, Barbosa AR. Desempenho motor de idosos do Nordeste brasileiro: diferenças entre idade e sexo. Rev Esc Enferm USP 2013; 47(1):128-136.^,3030 Confortin SC, Barbosa AR, Danielewicz AL, Meneghini V, Testa WL. Motor performance of elderly in a community in southern Brazil. Rev Bras Cineantropom Desempenho Hum 2013; 15(4):417-426.. Although chronological age is not a precise marker for changes in senescence⁷7 Figueiredo CS, Assis MG, Silva SLA, Dias RC, Mancini MC. Mudanças funcionais e cognitivas em idosos da comunidade: estudo longitudinal. Braz J Phys Ther 2013; 17(3):297-306., it should be noted that physical function decreases over the years and may have negative consequences for the elderly, such as impaired mobility, social isolation, decreased quality of life and disabilities that require specialized services³¹31 Cano-Gutiérrez C, Borda MG, Reyes-Ortiz C, Arciniegas AJ, Samper-Ternent R. Evaluación de factores asociados al estado funcional en ancianos de 60 años o más en Bogotá, Colombia. Biomédica 2017; 37(Supl. 1):57-65..

The professional activity was also related to the two outcomes. A study carried out in Belo Horizonte-MG showed that the elderly who worked were 2.5 times more likely to increase their independence in the IADL⁷7 Figueiredo CS, Assis MG, Silva SLA, Dias RC, Mancini MC. Mudanças funcionais e cognitivas em idosos da comunidade: estudo longitudinal. Braz J Phys Ther 2013; 17(3):297-306., confirming the association of this study. We found no national surveys showing the influence of occupational activity on physical performance, but it is suggested that both outcomes may benefit from professional exercise, as according to D’Orsi et al.³²32 d'Orsi E, Xavier AJ, Ramos LR. Trabalho, suporte social e lazer protegem idosos da perda funcional: estudo Epidoso. Rev Saude Publica 2011; 45(4):685-692., besides being a complex executive function that keeps the elderly active, it also has a protective effect through social support mechanisms, similar to the relationship with friends, that is, living with other people allows cooperation and interaction relationships.

Physical activity was also significantly associated with a decreased functional capacity for IADL and physical performance. Concerning the IADL, the finding is confirmed in other studies conducted with community-dwelling English³³33 d'Orsi E, Xavier AJ, Steptoe A, Oliveira C, Ramos LR, Orrell M, Demakakos P, Marmot MG. Socioeconomic and lifestyle factors related to instrumental activity of daily living dynamics: Results from the English Longitudinal Study of Ageing. J Am Geriatr Soc 2014; 62(9):1630-1639. and Colombian³¹31 Cano-Gutiérrez C, Borda MG, Reyes-Ortiz C, Arciniegas AJ, Samper-Ternent R. Evaluación de factores asociados al estado funcional en ancianos de 60 años o más en Bogotá, Colombia. Biomédica 2017; 37(Supl. 1):57-65. elderly. The influence on physical performance agrees with a longitudinal study in Italy, which highlights the relevance of developing public health strategies aimed at maintaining the levels of physical activity in the active elderly and encouraging this practice among the inactive ones³⁴34 Martinez-Gomez D, Bandinelli S, Del-Panta V, Patel KV, Guralnik JM, Ferrucci L. Three-year changes in physical activity and decline in physical performance over 9 years of follow-up in older adults: The Invecchiare in Chianti Study. J Am Geriatr Soc 2017; 65(6):1176-1182..

Schooling was related to lower functional capacity for IADL, as found in an epidemiological survey¹⁶16 Pereira GN, Bastos GAN, Del Duca GF, Bós AJG. Indicadores demográficos e socioeconômicos associados à incapacidade funcional em idosos. Cad Saude Publica 2012; 28(11):2035-2042., but it differed partially from a study carried out in Bagé (RS), which found an association between low educational level and a higher probability of developing functional disability for both IADL and BADL¹⁵15 Nunes JD, Saes MO, Nunes BP, Siqueira FCV, Soares DC, Fassa MEG, Thumé E, Facchini LA. Functional disability indicators and associated factors in the elderly: a population-based study in Bagé, Rio Grande do Sul, Brazil. Epidemiol Serv Saúde 2017; 26(2):295-304.. However, as already stated, it is believed that the relationship between schooling and IADL is more expressive since these activities require more intellectual aspects for its implementation¹⁶16 Pereira GN, Bastos GAN, Del Duca GF, Bós AJG. Indicadores demográficos e socioeconômicos associados à incapacidade funcional em idosos. Cad Saude Publica 2012; 28(11):2035-2042..

Gender and number of medicines were determinants for reduced physical performance. The influence of gender agrees with studies carried out in communities in the Northeast¹⁴14 Pinheiro PA, Passos TDO, Coqueiro RS, Fernandes MH, Barbosa AR. Desempenho motor de idosos do Nordeste brasileiro: diferenças entre idade e sexo. Rev Esc Enferm USP 2013; 47(1):128-136. and South of Brazil³⁰30 Confortin SC, Barbosa AR, Danielewicz AL, Meneghini V, Testa WL. Motor performance of elderly in a community in southern Brazil. Rev Bras Cineantropom Desempenho Hum 2013; 15(4):417-426., where women evidenced greater functional limitation in the performance tests. The higher life expectancy that exposes women to the risk of developing incapacitating chronic diseases²⁷27 Santos KA, Koszuoski R, Dias-da-Costa JS, Pattussi MP. Fatores associados com a incapacidade funcional em idosos do Município de Guatambu, Santa Catarina, Brasil. Cad Saude Publica 2007; 23(1):2781-2788. and the vulnerability to discrimination that reflects in access to work, health care, and income distribution¹1 Fundo de População das Nações Unidas. Envelhecimento no Século XXI: celebração e desafio. [Internet] 2012. [acessado 2017 Ago 15]. Disponível em: http://www.unfpa.org.br/novo/index.php/biblioteca/publicacoes/populacao/633-envelhecimento-no-seculo-xxi-celebracao-e-desafio
http://www.unfpa.org.br/novo/index.php/b... can contribute to an intergender gap, requiring specific care and actions for this segment of the population.

Concerning the association between the number of lifelong use medicines by the elderly and lower physical performance, studies carried out in Spain with elderly in primary care centers¹⁰10 Cabrero-García J, Muñoz-Mendoza CL, Cabañero-Martínez MJ, González-Llopís, L, Ramos-Pichardo JD, Reig-Ferrer A. Valores de referencia de la Short Physical Performance Battery para pacientes de 70 y más años en atención primaria de salud. Aten Primaria 2012; 44(9):540-548. and in Brazil in a group of elderly³⁵35 Martins FP, Maia HU, Pereira LSM. Desempenho de idosos em testes funcionais e o uso de medicamentos. Fisioter Mov 2007; 20(1):85-92. also confirmed this association, which is still poorly explored in the literature. Health professionals should be knowledgeable about patterns of use, prescription, drug interactions, and clinical implications that may adversely affect performance components, such as mobility and balance³⁵35 Martins FP, Maia HU, Pereira LSM. Desempenho de idosos em testes funcionais e o uso de medicamentos. Fisioter Mov 2007; 20(1):85-92..

Among the limitations of the present study are the scarcity of longitudinal studies at the national level on the functional capacity and physical performance of the community elderly concomitantly, which hinders the comparison of findings. Another aspect that requires attention in the interpretation, comparison and generalization of the results is the existence of various concepts and instruments used in the studies to identify the functional disabilities and limitations.

Although longitudinal studies with lower follow-up time⁷7 Figueiredo CS, Assis MG, Silva SLA, Dias RC, Mancini MC. Mudanças funcionais e cognitivas em idosos da comunidade: estudo longitudinal. Braz J Phys Ther 2013; 17(3):297-306. or similar to this study have been identified¹³13 Moreira PL, Correa CR, Corrente JE, Martin LC, Villas Boas PJF, Ferreira ALA. Anthropometric, functional capacity, and oxidative stress changes in Brazilian community-living elderly subjects. A longitudinal study. Arch Gerontol Geriatr 2016; 66:140-146., another limitation is the follow-up period (two years), which was short when compared to other studies⁸8 den Ouden ME, Schuurmans MJ, Brand JS, Arts IE, Mueller-Schotte S, van der Schouw YT. Physical functioning is related to both an impaired physical ability and ADL disability: A ten-year follow-up study in middle-aged and older persons. Maturitas 2013; 74(1):89-94.^,3333 d'Orsi E, Xavier AJ, Steptoe A, Oliveira C, Ramos LR, Orrell M, Demakakos P, Marmot MG. Socioeconomic and lifestyle factors related to instrumental activity of daily living dynamics: Results from the English Longitudinal Study of Ageing. J Am Geriatr Soc 2014; 62(9):1630-1639.. Regardless of this issue, the results of this study point to the relevance of the evaluation, follow-up, and identification of functional capacity and physical performance determinants, since the elderly evidenced losses over a short period. It is hoped that these findings will contribute to the promotion of independent aging by directing preventive measures to the functional state of the elderly considering the identified determinants and, mainly, to provide supporting elements for new investigations.

Conclusion

This study showed that the two evaluations revealed a predominance of female elderly in the 60|-80 age group living with a spouse or partner, with 1|-5 years of schooling, retired, with a professional activity and income of one minimum wage in 2014 and 1-|3 in 2016.

In two years, we found that the elderly had a declining functional capacity to perform the IADL and lower physical performance, and age group, professional activity, and physical activity have been identified as determinants common to the outcomes. Schooling was a specific factor only for functional capacity in IADL, and gender and number of medicines used, for physical performance.

The change in both functional capacity and physical performance alerts us to the relevance of early identification and follow-up of cases, and mainly of proposing interventions based on the identified factors, to prevent the onset and deterioration of incapacitating conditions that cause biopsychosocial harm to the elderly, health system expenditure, and household and community overload.

References

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