Inflammatory markers associated with fall recurrence and severity: The Bambuí Cohort Study of Aging

BACKGROUND

The aim of this study was to analyze the association between inflammatory markers and recurrent and severe falls in 1304 community-dwelling older adults from the Bambuí Cohort Study of Aging.

METHODS

Information about falls in the previous 12 months was collected, and classified based on recurrence (two or more falls) and severity (requirement of medical attention). The screened biomarkers included interleukins (IL-1β, IL-6, IL-10, and IL-12, TNF), chemokines (CXCL8, CXCL9, CXCL10, CCL2, and CCL5), and high-sensitive C-reactive protein (hs-PCR). Potential confounders included sociodemographic, behavioral, and health indicators. Associations were evaluated through logistic regression, using odds ratios (OR) and 95% confidence intervals (95% CI), with Stata 13.1.

RESULTS

The prevalence of recurrent and severe falls was 10.7% and 9.0%, respectively. After adjustments, elevated levels of IL-12 (OR: 1.92; 95% CI: 1.09-3.37) and CXCL9 (OR: 1.67; 95% CI: 1.05-2.66) were found to be associated with recurrent falls, while elevated levels of TNF (OR: 1.58; 95% CI: 1.01-2.50), IL-12 (OR: 2.04; 95% CI: 1.13-3.70), CXCL10 (OR: 1.75; 95% CI: 1.04-2.92), and CCL5 (OR: 1.90; 95% CI: 1.18-3.07) were associated with severe falls.

CONCLUSIONS

The results highlight a wide range of biomarkers not yet explored in the literature and suggest that inflammation may be an important component of recurrent and severe falls.

Genetics of cognitive trajectory in Brazilians: 15 years of follow-up from the Bambuí-Epigen Cohort Study of Aging

Age-related cognitive decline (ACD) is the gradual process of decreasing of cognitive function over age. Most genetic risk factors for ACD have been identified in European populations and there are no reports in admixed Latin American individuals. We performed admixture mapping, genome-wide association analysis (GWAS), and fine-mapping to examine genetic factors associated with 15-year cognitive trajectory in 1,407 Brazilian older adults, comprising 14,956 Mini-Mental State Examination measures. Participants were enrolled as part of the Bambuí-Epigen Cohort Study of Aging. Our admixture mapping analysis identified a genomic region (3p24.2) in which increased Native American ancestry was significantly associated with faster ACD. Fine-mapping of this region identified a single nucleotide polymorphism (SNP) rs142380904 (β = -0.044, SE = 0.01, p = 7.5 × 10-5) associated with ACD. In addition, our GWAS identified 24 associated SNPs, most in genes previously reported to influence cognitive function. The top six associated SNPs accounted for 18.5% of the ACD variance in our data. Furthermore, our longitudinal study replicated previous GWAS hits for cognitive decline and Alzheimer's disease. Our 15-year longitudinal study identified both ancestry-specific and cosmopolitan genetic variants associated with ACD in Brazilians, highlighting the need for more trans-ancestry genomic studies, especially in underrepresented ethnic groups.

[Alcohol consumption patterns and associated factors among elderly Brazilians: National Health Survey (2013)]

The scope of this study was to analyze the pattern of alcohol consumption among elderly Brazilians (60 years and over) and their association with sociodemographic factors, lifestyle habits and health conditions. This is a cross-sectional study of 10,537 elderly (90.1%) participants from the National Health Survey of 2013. The consumption of alcoholic beverages was classified as non-use, mild / moderate use and risk use. The multinomial regression model was used to study the associated factors. The prevalence for mild / moderate and risk use was 9.4% (95% CI: 8.4- 10.6%) and 4.6% (95%CI: 4.0-5.3%), respectively. The two consumption patterns were inversely associated with age and more frequent among men, better schooling, smokers and physical activity practitioners. Mild / moderate consumption was less frequent among non-whites and those with a history of stroke and diabetes, whereas risk use was less frequent among the elderly diagnosed for heart disease and more frequent among those suffering from depression. This result identifies profiles of greater vulnerability, with small differences between two patterns of consumption. This information should be considered in the preparation of proposals to promote healthy habits and control of alcohol use among the elderly.

Diabetes, depressive symptoms, and mortality risk in old age: The role of inflammation

BACKGROUND

Both diabetes and depression increase the mortality risk in the elderly. In this study, we evaluated mortality risk associated with the comorbidity between depression and diabetes. We also assessed the moderating role of inflammation in the mortality risk in this population.

METHODS

We included a total of 1,183 community-dwelling older adults, divided into four groups: "neither diabetes nor depression"; "diabetes only"; "depression only," and "both diabetes and depression," and followed-up for a median of 13.5 years. We evaluated the inflammatory status by the high-sensitivity C-reactive protein (hs-CRP) levels. Date of death was computed by reviewing death certificates. We used Cox's proportional hazards models and additive interactions to evaluate the risk of mortality in the subject groups and the moderating effect of hs-CRP.

RESULTS

Participants with both diabetes and depression had higher death risk (hazard ratio [HR]: 2.33; 95% confidence interval [CI]: 1.59-3.42) than those with each condition alone (HR diabetes: 2.08 95% CI: 1.56-2.76 HR depression: 1.26; 95% CI: 1.03-1.54). High level of hs-CRP, indicative of high inflammatory status, significantly moderated the risk of mortality in subjects with both diabetes and depression (Bonferroni-adjusted p = 0.0116).

CONCLUSIONS

The coexistence of diabetes and depression symptoms is associated with the highest death risk in this population. This risk is moderated by inflammatory status.

[Effect of age, period, and birth cohort on incapacity in community-dwelling elderly: the Bambuí Elderly Cohort (1997-2012)]

Time trends in the prevalence rates of incapacity in the elderly can occur due to the effects of age, period, or cohort. Age is related to biological factors, the period to the subject's environmental context, and the cohort to the subject's exposures from birth to the present. The study aimed to verify which time dimensions most influence the evolution in the prevalence of incapacity in the elderly over the course of 15 years. Data were used from the Bambuí Elderly Cohort, and incapacity was assessed by report of "great difficulty" or "inability" to perform at least one of the activities related to mobility and basic and instrumental activities of daily living. The analysis was done with the age-period-cohort model for aggregate data, with calculation of the effects of time dimensions by analysis of deviance. A Poisson regression model determined the associations between age, period, and cohort and prevalence of incapacity, considering the total population and stratification by sex and schooling. Period effect was the most important for the three dimensions of incapacity, with an increase in prevalence at the start of the period, followed by a reduction over time, with minor differences in relation to sex and schooling. Cohort effect was significant, although less important than period effect. The results highlight the importance of analyzing the elder's environment for reducing prevalence of incapacity, with an emphasis on policies and programs that can positively impact the time trend in this outcome, given the consistent effect of period observed in this study.

Health behaviors and hypertension control: the results of ELSI-BRASIL

This study aimed to measure the contribution of selected health behaviors to the prevalence of hypertension control in Brazilian adults 50 years or older, based on data from the ELSI-Brasil study. The study included 4,318 individuals 50 years or older who reported having received a medical diagnosis of hypertension and were taking antihypertensive medication. The selected health behaviors were: physical activity, healthy diet, not consuming excessive alcohol, and never having smoked. The contribution of each health behavior to prevalence of hypertension control was estimated by the attribution method, via adjustment of the binomial additive hazards model, stratified by sex. Prevalence of hypertension control was 50.7% (95%CI: 48.2; 53.1). Overall, health behaviors made a larger contribution to hypertension control in women (66.3%) than in men (36.2%). Moderate alcohol consumption made the largest contribution in both sexes, but particularly in women (52.7% in women versus 19% in men). Physical activity contributed 12.6% in women and 10.7% in men. The other behaviors were more relevant in men: never having smoked (3.4%) and regular consumption of vegetables, legumes, and fruits (3.1%). These results underline the need for measures to promote the adoption of healthy behaviors by hypertensive individuals to reduce blood pressure levels, improve the effectiveness of antihypertensive medication, and decrease their cardiovascular risk.

Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study

BACKGROUND

With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups.

METHODS AND FINDINGS

We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife.

CONCLUSIONS

These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.

[Multimorbidity profile associated with disability among the elderly living in the Metropolitan Region of Belo Horizonte, Brazil]

The scope of this paper was to investigate the associations of disability in three domains (BADL, IADL and mobility) with cardiovascular diseases, diabetes and multimorbidity profile, among the elderly living in the Metropolitan Region of Belo Horizonte (MRBH). A cross-sectional study was conducted with a representative sample of 2,172 elderly persons (60 years and over). Disability, for each domain (BADL, IADL and mobility), was assessed as reporting great difficulty or need for help to perform at least one activity among those investigated, and self-reported diseases included arterial hypertension, myocardial infarction or angina, stroke, diabetes, and combinations of these diseases. Adjusted Poisson regression was used, and the attributable population fraction was also estimated. A major contribution of Cerebral Vascular Accidents (strokes) to disability in all domains was observed, especially BADLs, as well as the presence of infarction or angina in disability in IADLs and mobility, especially when combined with diabetes and hypertension. The multimorbidity profile can be used to identify vulnerable groups, which should be the target of prevention and rehabilitation, reducing the financial and social cost of this event among the elderly.

Association between inflammatory markers and hospitalizations: evidence from the Bambuí cohort of aging baseline

INTRODUCTION

Inflammation plays an important role in the aging process.

OBJECTIVE

This cross-sectional study aims to examine the association between inflammatory markers and hospitalizations among older adults, considering as potential confounding factors the predisposing and enabling factors for the use of health services and health conditions.

METHODS

We used data from 1,393 participants (≥ 60 years) in the baseline cohort from Bambuí. The markers assessed were ten cytokines and chemokines [interleukin (IL)-1, IL-6, IL-10, IL-12, tumor necrosis factor (TNF), CCL2, CCL5, CXCL8, CXCL9, and CXCL10]. The outcome variable was one or more hospitalizations in the preceding 12 months.

RESULTS

Elevated serum levels of IL-6 were significantly associated with hospitalizations [prevalence ratio (PR) = 1.38; confidence interval of 95% (95%CI) 1.02 - 1.87 and PR = 1.38; 95%CI 1.01 - 1.88 for the intermediate and highest tertiles, respectively]. High levels of CXCL9 were also independently associated with the outcome (PR = 1.38; 95%CI 1.01 - 1.89 and PR = 1.46; 95%CI 1.07 - 2.00, respectively). Other markers showed no statistically significant association with hospitalizations.

CONCLUSION

Among the ten markers analyzed, only IL-6 and CXCL9 were associated with hospitalizations.

Factors associated with the evaluation of quality of primary health care by older adults living in the Metropolitan Region of Belo Horizonte, Minas Gerais, Brazil, 2010

OBJECTIVE

to analyze factors associated with the perception of quality of primary health care (PHC) services by older adults.

METHODS

this was a cross-sectional survey with 893 older adults aged 60 years and over living in the Metropolitan Region of Belo Horizonte, MG, Brazil; the study's outcomes were the indicators of the essential attributes of PHC, while explanatory variables included sociodemographic conditions, use of health services and health conditions; Poisson regression with robust variance was used.

RESULTS

older adults aged 80 years and over, women and those with higher education levels gave better evaluations for access and longitudinality, while evaluation was worst among those who reported greater use of health services and chronic health conditions, especially for the PHC attributes of coordination of care and family and community orientation.

CONCLUSION

poorer health conditions and higher use of services are associated with a more negative perception of PHC attributes among the elderly.

Inflammatory markers and occurrence of falls: Bambuí Cohort Study of Aging

OBJECTIVE

Analyze whether inflammatory markers are associated with falls among older adults living in Bambuí.

METHODS

Study that analyzed baseline data from a Bambuí Cohort Study of Aging, involving 1,250 participants. Data about falls were collected from previous 12 months, classified as single or multiple occurrence and severity (participant seeking health services). Information about sociodemographic characteristics, health behaviors and health condition was also collected and used as confounding factors. The exposures of interest included interleukins (IL-1β, IL-6, IL-8, IL-10, IL-12), tumor necrosis factor (TNF), ultra-sensitive C-reactive protein (us-CRP) and chemokines (CXCL9, CCL5, CCL10, MCP1). Data were processed through logistic regression, obtaining odds ratio and 95% confidence interval (95%CI).

RESULTS

The prevalence of falls was 27.1%; 40.1% of the older adults reported multiple falls and 33.3% sought health services. After adjustments, the following elevated levels were associated with falls: us-CRP (OR = 1.46, 95%CI 1.04–2.03), CCL5 (OR = 1.38, 95%CI 1.01–1.90) and CXCL9 (OR = 1.43, 95%CI 1.02–2.02). An association was observed between the number of elevated markers and the occurrence of falls: two (OR = 1.47, 95%CI 1.02–2.12) and three (OR = 2.08, 95%CI 1.12–3.87) elevated biomarkers indicated fall probability of 32.0% and 39.4%, respectively.

CONCLUSIONS

Elevated levels of us-CRP, CCL5 and CXCL9, which were associated with falls, may contribute to a proper understanding of the mechanism associated with the occurrence of falls among older people.

Association of metabolic syndrome with inflammatory markers in a sample of community-dwelling older adults

The study aimed to identify the cutoff points for inflammatory markers that best discriminate the occurrence of metabolic syndrome in community-dwelling older adults. Baseline data were used from the elderly cohort in the city of Bambuí, Minas Gerais State, Brazil. The target exposure was presence of metabolic syndrome, defined according to the Adult Treatment Panel III criterion, and the outcomes included the following inflammatory markers: cytokines (IL-1β, IL-6, IL-10, IL-12 e TNF), chemokines (CXCL8, CXCL9, CCL2, CXCL10, and CCL5), and C-reactive protein (CRP). Definition of the cutoff points for the inflammatory markers was based on the Classification and Regression Tree (CART) method. The associations between these markers and metabolic syndrome were estimated by logistic regression models, obtaining odds ratios and 95% confidence intervals, considering adjustment for confounding factors. Prevalence of metabolic syndrome was 49.1%, and IL-1β, IL-12, and TNF levels were not associated statistically with this exposure. After adjustment, presence of metabolic syndrome was associated with higher IL-6 and CRP levels and lower CXCL8 and CCL5. Significant associations were also observed with intermediate serum CXCL9 and CXCL10 levels. The combination of markers also showed a significant and consistent association with metabolic syndrome. In addition to demonstrating an association between metabolic syndrome and a wide range of biomarkers (some not previously described in the literature), the results highlight that this association occurs at much lower levels than previously demonstrated, suggesting that metabolic syndrome plays an important role in the inflammatory profile of the older adults.

Perceived discrimination among older adults living in urban and rural areas in Brazil: a national study (ELSI-Brazil)

Background

Research on discrimination and health focused on older adults has been scarce, comparatively with younger and middle-aged adults. Considering where people live matters, accurate measures of perceived discrimination might consider how the place of residence interferes on discriminatory experiences. This study aimed to assess the association between perceived discrimination and urban/rural place of residence among a representative sample of older adults in Brazil.

Methods

Data came from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015/2016, with individuals aged 50 years and older. Perceived Discrimination was measured by means of the following question: “In the past 12 months have you felt a victim of any type of discrimination” with five possible answers: (1)“when you sought medical services or health care?”, (2)“in social gatherings?”, (3)“in the work place?”, (4)“within the family?”, (5)“due to where you live?”. Participants who answered yes for any of the five domains were coded as having reported an experience of discrimination. The main exposure variable was the urban-rural classification of the households, carried out according to the methods employed by the Brazilian Institute of Geography and Statistics during the 2010 Population Census. Other covariates included: age, sex, skin color, household wealth and education. Multiple Poisson regression was used to estimate prevalence ratios and their respective 95% confidence interval for the association between discrimination and independent variables.

Results

Prevalence of any perceived discrimination among Brazilian older adults was 16.8%. Regardless the place of residence (either urban or rural), participants reported health care settings as the most common domain where discriminatory experiences occurred and the work place as the least common. According to the adjusted model, perceived discrimination was significantly higher among urban dwellers when compared to their rural counterparts, independent of sociodemographic characteristics, health status and neighborhood social environment. The outcome was significant associated with skin color, education and health status.

Conclusions

Urban environment plays a core role in perceived discrimination and health care settings constitute the most common domain where discriminatory experiences occurred. Our findings may contribute to fulfill the knowledge gap on discrimination among older adults living in developing countries.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1076-4) contains supplementary material, which is available to authorized users.

A longitudinal study of the association between social capital and mortality in community-dwelling elderly Brazilians

The aim of this study was to verify whether social capital is a predictor of all-cause mortality in community-dwelling elderly Brazilians. Participation included 935 surviving elderly from the elderly cohort of the Bambui Project in 2004, who were followed until 2011. The outcome was all-cause mortality and the exposure of interest was social capital, measured in its two components, cognitive (social cohesion and social support) and structural (social participation and neighborhood satisfaction). Sociodemographic variables, health conditions, and smoking were included in the analysis for adjustment purposes. Data analysis was based on the Cox proportional hazards model, providing hazard ratios (HR) and 95% confidence intervals (95%CI). The social participation dimension of social capital's structural component was the only dimension independently associated with mortality: elderly Brazilians that did not participate in social groups or associations showed a two-fold higher risk of death (HR = 2.28; 95%CI: 1.49-3.49) compared to their peers. The study's results reveal the need to extend interventions beyond the specific field of health in order to promote longevity, focusing on environmental and social characteristics.

Use of psychoactive drugs predicts functional disability among older adults

OBJECTIVE

Investigate whether the use of psychoactive drugs would be a predictor of incidence of functional disability among seniors living in community.

METHODS

It is a population-based longitudinal study, developed between January 1, 1997 and December 31, 2011, with older adults living in community. The association between the use of psychoactive drugs and the development of functional disability for instrumental (IADLs) and basic (BADLs) activities of daily living was tested using the extended Cox proportional hazards model, which considers the measure of exposure of interest throughout the follow-up period. The analyses were stratified by sex and adjusted by sociodemographic characteristics, health behavior and health conditions.

RESULTS

After multivariate adjustment, the use of two or more psychoactive drugs in the female stratum was associated with disability for both IADLs (HR = 1.58; 95%CI 1.17-2.13) and BADLs (HR = 1.43; 95%CI 1.05-1.94), the use of benzodiazepines was associated with disability for IADLs (HR = 1.32; 95%CI 1.07-1.62), and the use of antidepressants was associated with disability for both IADLs (HR = 1.51; 95%CI 1.16-1.98) and BADLs (HR = 1.44; 95%CI 1.10-1.90). In the male stratum, the use of antipsychotics was associated with disability for IADLs (HR = 3.14; 95%CI 1.49-6.59).

CONCLUSIONS

The study showed a prospective association between the use of psychoactive drugs and functional disability. These results indicate the need to carefully assess the prescription of psychoactive drugs for older adults and monitor their usage in order to detect damages to the health of users.

“A body shape index” and its association with arterial hypertension and diabetes mellitus among Brazilian older adults: National Health Survey (2013)

The aim was to evaluate the separate and joint association of abdominal adiposity indicators (a body shape index - ABSI, waist circumference - WC, waist-to-height ratio - WHtR) and body mass index (BMI) with arterial hypertension and diabetes mellitus, in Brazilian older adults. Data from the 2013 Brazilian National Health Survey (PNS 2013) were used for the population aged 60 years or older (10,537 older adults). Arterial hypertension and diabetes mellitus outcomes were self-reported and the following anthropometric indices were evaluated by direct measurement: a ABSI, BMI, WC and WHtR. Associations were assessed by logistic regression, with adjustments for confounding factors. The results of this study evidenced a higher strength of association between the report of arterial hypertension and diabetes mellitus with BMI, WC and WHtR in the Brazilian population of older adults in separate analyses, when compared to ABSI. When adjusted for BMI, ABSI showed a greater strength of association with the outcomes, but it was not superior to the performance of WC and WHtR. Considering the lower strength of association, in separate and joint analyses, between the new index (ABSI) and the chronic conditions assessed, BMI, WC and WHtR probably remain as useful indices in public health, at least in relation to arterial hypertension and diabetes mellitus in Brazilian older adults.

Primary care and healthcare utilization among older Brazilians (ELSI-Brazil)

OBJECTIVE

To characterize healthcare access and utilization among older Brazilians.

METHODS

Data are from the baseline wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative, population-based cohort study of persons aged 50 years and older conducted in 2015/2016 (n = 9,412). The prevalence of barriers to primary care and number and type of doctor visits in the past 12 months are compared by three main sources of healthcare (private, Family Health Strategy, traditional public clinics). Two-part multivariable hurdle analyses assess the relation between healthcare utilization, primary care problems, and source of healthcare, while controlling for healthcare determinants.

RESULTS

Females comprised 54% of the sample, with a mean age of 63 years. There were no demographic differences by source of healthcare. Nearly 83% had at least one doctor visit in the past 12 months, with higher use among private health plan holders. Private health plan holders most frequently visited specialists, while those using the public system were more likely to visit a general practitioner. Primary care barriers averaged 3.5 out of 12 and were the highest among those using traditional health posts. A greater number of primary care problems was negatively associated with all types of healthcare utilization.

CONCLUSIONS

By international standards, access to basic healthcare among older Brazilians is relatively high. Nevertheless, different levels of primary care problems between the public and private sectors and resulting utilization patterns suggest the need to continue working to close remaining gaps.

Aspects of social participation and neighborhood perception: ELSI-Brazil

OBJECTIVE

To determine the impact of the physical and social surroundings of the neighborhood, which are presented as facilitators or barriers for the social participation of Brazilian older adults.

METHODS

The study was conducted in a probabilistic representative sample of the Brazilian population aged 50 years and older and who lived in urban areas (n = 7,935). The response variable was social participation, which was defined from two questions about activities performed with other persons: visited friends or relatives in their homes in the last 12 months (yes, no); went out with other persons to public places, such as restaurant, movies, club, park, in the last 12 months (yes, no). The explanatory variables included fear of falling because of defects in sidewalks, concern about the difficulty to get on a bus, subway, or train, difficulty to cross streets, and perception of violence in the neighborhood. Potential confounding variables included age, marital status, education level, self-rated health, living in an asphalted or paved street, time living in the municipality, and socioeconomic position score. Prevalence ratios and respective confidence intervals were estimated using Poisson regression.

RESULT

Difficulty to cross streets presented an independent association with restricted social participation (PR = 0.95; 95%CI 0.93-0.98) among both women (PR = 0.96; 95%CI 0.92-0.99) and men (PR = 0.94; 95%CI 0.90-0.99). Concern about the difficulty to get on a bus, subway, or train was associated with the outcome only among men (PR = 0.95; 95%CI 0.91-0.99). The fear of falling because of defects in sidewalks and the perception of violence in the neighborhood were not associated with social participation.

CONCLUSIONS

Urban characteristics that hinder the crossing of streets and accessibility to public transport can be inferred as important barriers for the social participation of Brazilian older adults.

Life course socioeconomic inequalities and oral health status in later life: ELSI-Brazil

OBJECTIVE

To investigate the association between life course socioeconomic conditions and two oral health outcomes (edentulism and use of dental prostheses among individuals with severe tooth loss) among older Brazilian adults.

METHODS

This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) which includes information on persons aged 50 years or older residing in 70 municipalities across the five great Brazilian regions. Regression models using life history information were used to investigate the relation between childhood (parental education) and adulthood (own education and wealth) socioeconomic circumstances and edentulism and use of dental prostheses. Slope index of inequality and relative index of inequality for edentulism and use of dental prostheses assessed socioeconomic inequalities in both outcomes.

RESULTS

Approximately 28.8% of the individuals were edentulous and among those with severe tooth loss 80% used dental prostheses. Significant absolute and relative inequalities were found for edentulism and use of dental prostheses. The magnitude of edentulism was higher among individuals with lower levels of socioeconomic position during childhood, irrespective of their current socioeconomic position. Absolute and relative inequalities related to the use of dental prostheses were not related to childhood socioeconomic position.

CONCLUSIONS

These findings substantiate the association between life course socioeconomic circumstances and oral health in older adulthood, although use of dental prostheses was not related to childhood socioeconomic position. The study also highlights the long-lasting relation between childhood socioeconomic inequalities and oral health through the life course.

Adequate control of hypertension among older adults: ELSI-Brazil

OBJECTIVE

To estimate the prevalence of adequate control of hypertension among older adults and to examine its association with predisposing and enabling factors and the need to use health services.

METHODS

The analysis was carried out with 4,148 participants (≥ 50 years) from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), who reported being hypertensive and using antihypertensive medication. Adequate control of hypertension was defined as systolic and diastolic blood pressure below 140 mmHg and 90 mmHg, respectively. The following exploratory variables were included: age, sex, health behaviors, and body mass index (predisposing factors); region of residence, rural or urban residence, education level, socioeconomic status of the household, and coverage by private health plan (enabling factors); and medical diagnosis of diabetes (need). The multivariate analysis was performed using Poisson regression and binary logistic regression.

RESULTS

The prevalence of adequate control of hypertension was equal to 51.1% (95%CI 48.5-53.6). After adjusting for potential confounders, we observed statistically significant associations (p < 0.05) for education level > 4 years [prevalence ratio (PR) = 1.12 in relation to the lowest level], highest quintile of the socioeconomic status (PR = 1.22 in relation to the lowest quintile), coverage by private health plan (PR = 1.13), residence in the South (PR = 1.19) and Midwest regions (PR = 1.20) in relation to the Southeast region, and obesity (PR = 1.10).

CONCLUSIONS

Half of the population studied had adequate control of hypertension. The improvement of this control is an important challenge, which should consider overcoming social and regional inequalities associated with it.

Physical activity practice among older adults: results of the ELSI-Brazil

OBJECTIVE

To describe the prevalence of the practice of physical activity (PA) among older Brazilian adults and associated factors. In addition, potential effect modifiers of the association between PA and age were investigated.

METHODS

We have analyzed data from 8,736 participants (92.8%) aged 50 and older from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Physical activity was measured using the short version of the International Physical Activity Questionnaire. The outcome variable was defined as at least 150 minutes of weekly activities in all domains. The exploratory variables were age, sex, education, ethnicity, marital status, number of chronic diseases and medical appointments, and knowledge about or participation in public programs that encourage physical activity. Logistic regression and estimates of predicted probabilities were performed.

RESULTS

The prevalence of recommended levels of physical activity was 67.0% (95%CI 64.3-69.5). Physical activity was associated with age [odds ratio (OR) = 0.97; 95%CI 0.96-0.98], higher educational level (OR = 1.27; 95%CI 1.11-1.45 for 4-7 years and OR = 1.52; 95%CI 1.28-1.81 for eight years or more), participants who were married/ in a long term relationship (OR = 1.22; 95%CI 1.08-1.38), and those who reported knowledge about (OR = 1.34; 95%CI 1.16-1.54) or participation in (OR = 1.78; 95%CI 1.34-2.36) a program aimed at the practice of physical activity. Women and those with lower educational level (p value for interaction < 0.05) reported lower physical activity levels.

CONCLUSIONS

In addition to the association with marital status and health promotion programs, there were significant sex and educational level inequalities in physical activity decline later in life. These findings help the identification of groups more vulnerable to decreased physical activity levels with aging, as well as the planning of health promotion strategies, especially in older groups.

Life course and work ability among older adults: ELSI-Brazil

OBJECTIVE

To examine factors associated with perception of work ability in a nationally representative sample of Brazilians aged 50 years and over.

METHODS

We used data from 8,903 participants of the baseline survey of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The dependent variable was self-rated work ability (good or very good versus fair, poor, or very poor). Independent variables included factors that operate at the beginning, middle, and current stage of life. Multivariate analysis was based on prevalence ratios (PR) and 95% confidence intervals (95%CI) estimated by Poisson regression.

RESULTS

Good work ability was reported by 49% of \ participants (49.4% among men and 48.6% among women). Results of the multivariate analysis showed that, for both men and women, good work ability showed positive and statistically significant associations (p < 0.05) with good health up to 15 years of age (PR = 1.22 and 1.18 , respectively), educational level ≥ 8 years (PR = 1.19 and 1.21, respectively), and current good self-rated health (PR = 1.88 and 1.94, respectively). Negative associations were observed for current age (PR = 0.99 for each increase of one year among men and women), medical diagnosis of depression (PR = 0.70 for men and PR = 0.87 for women), and having one or more at least chronic diseases (PR = 0.88 for men and 0.91 for women). Only for men, positive associations for the age at which they started working (PR = 1.14 and 1.12 for 11–17 and ≥ 18 years, respectively) and living with a spouse (PR = 1.09) were found.

CONCLUSIONS

Work ability in older ages is built over the life course, particularly by the health conditions in childhood and adolescence, age at which men begin working, educational level, and health conditions in older ages. Policies aimed at increasing longevity in the labor market must take these factors into account.