Depressive symptoms, emotional support and activities of daily living disability onset: 15-year follow-up of the Bambuí (Brazil) Cohort Study of Aging

The relationship between loneliness and healthy aging indicators in Brazil (ELSI-Brazil) and England (ELSA): sex differences

OBJECTIVES

This study aimed to estimate five harmonized healthy aging indicators covering functional ability and intrinsic capacity among older women and men from Brazil and England and evaluate their association with loneliness.

STUDY DESIGN

This was a cross-sectional study.

METHODS

We used two nationally representative samples of men and women aged ≥60 years from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) wave 2 (2019-2021; n = 6929) and the English Longitudinal Study of Aging wave 9 (2018-2019; n = 5902). Healthy aging included five separate indicators (getting dressed, taking medication, managing money, cognitive function, and handgrip strength). Loneliness was measured by the 3-item University of California Loneliness Scale. Logistic regression models stratified by sex and country were performed.

RESULTS

Overall, age-adjusted healthy aging indicators were worse in Brazil compared with England for both men and women. Considering functional ability, loneliness was negatively associated with all indicators (ranging from odds ratio [OR] = 0.26, [95% confidence interval (CI) 0.13-0.52] in English men regarding the ability to take medication to OR = 0.49 [95% CI 0.27-0.89] in Brazilian women regarding the ability to manage money). Considering intrinsic capacity, loneliness was negatively associated with a higher cognitive function (OR = 0.72; 95% CI 0.55-0.95 in English women) and a higher handgrip strength (OR = 0.61; 95% CI 0.45-0.83 in Brazilian women). Lonely women demonstrated lower odds of a higher number of healthy aging indicators than men in both countries.

CONCLUSIONS

Country-specific social environments should be targeted by public policies to decrease loneliness and promote healthy aging later in life.

Effective primary care attenuates the association between frailty and hospital admission in old age: the ELSI-Brazil

BACKGROUND

Frailty is a multidimensional syndrome leading to a higher hospitalization. However, few studies explicitly analyze whether measures of effective primary care modify the relationship between frailty and hospital admission.

METHODS

This cross-sectional study included data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative community-based study with older adults aged 50 years and over, conducted in 2019-2021. Self-reported hospital admission in the past 12 months was the outcome. Frailty included the 5 phenotypic criteria: weight loss, exhaustion, low physical activity, weakness, and slowness. The effective primary care index included 12 attributes indicators, continuously. Statistical analyzes comprised logistic regression.

RESULTS

Among the 7,436 study participants, frailty (odds ratio [OR] 2.17; 95% confidence intervals [95% CI] 1.31-3.62) and effective primary care index (OR 1.10; 95% CI 1.03-1.16) were positively associated with higher hospitalization. Interaction revealed that while effective primary care was positively associated with hospitalization, this association was different among frail older adults (OR 0.80; 95% CI 0.65-0.99). After stratification by frailty status, positive association with hospitalization remained only among prefrail and nonfrail individuals. The predicted probability of hospitalization tended to decrease along with higher primary care index values among frail older adults and became similar to prefrail/nonfrail at the highest end of the scale.

CONCLUSIONS

Effective primary care decreases the likelihood of hospital admission among frail older adults. Interventions for delaying frailty should be initiated in primary care along with policies to strengthen primary care's organizational and provider/team-level attributes.

Gender-Specific Associations between Late-Life Disability and Socioeconomic Status: Findings from the International Mobility and Aging Study (IMIAS)

Disability is a dynamic process and can be influenced by a sociocultural environment. This study aimed to determine whether the associations between socioeconomic status and late-life disability differ by gender in a multi-sociocultural sample from different countries. A cross-sectional study was developed with 1362 older adults from The International Mobility in Aging Study. Late-life disability was measured through the disability component of the Late-Life Function Disability Instrument. Level of education, income sufficiency and lifelong occupation were used as indicators of SES. The results indicated that a low education level β = -3.11 [95% CI -4.70; -1.53] and manual occupation β = -1.79 [95% -3.40; -0.18] were associated with frequency decrease for men, while insufficient income β = -3.55 [95% CI -5.57; -1.52] and manual occupation β = -2.25 [95% CI -3.89; -0.61] played a negative role in frequency for women. For both men β = -2.39 [95% -4.68; -0.10] and women β = -3.39 [95% -5.77; -1.02], insufficient income was the only factor associated with greater perceived limitation during life tasks. This study suggested that men and women had different late-life disability experiences. For men, occupation and education were associated with a decrease in the frequency of participation, while for women this was associated with income and occupation. Income was associated with perceived limitation during daily life tasks for both genders.

Loneliness and social disconnectedness in the time of pandemic period among Brazilians: evidence from the ELSI COVID-19 initiative

Objectives: This study aimed at estimating the pre-pandemic and pandemic prevalence of loneliness and investigating the association of loneliness with social disconnectedness during social distancing strategies in the time of the COVID-19 pandemic period.Methods: We used data from the ELSI COVID-19 initiative with participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which comprised 4,431 participants aged 50 years and over. Loneliness (hardly ever/some of the time/often) was assessed by the question "In the past 30 days, how often did you feel alone/lonely?". Social disconnectedness included information on social contacts through virtual talking (i.e. telephone, Skype, WhatsApp, or social media) and outside-home meetings with people living in another household. Covariates included sociodemographic and health related characteristics. Multinomial logistic regression models were used to estimate odds ratios (OR) with their 95% confidence interval (CI).Results: The overall prevalence of loneliness during the pandemic was 23.9% (95% CI 20.7-27.5); lower than in the pre-pandemic period (32.8%; 95% CI 28.6-37.4). In the pandemic period, 20.1% (95% CI 16.9-23.6) reported some of the time feeling lonely and 3.9% (95% CI 3.1-4.8) reported often feeling lonely. In the fully adjusted model, virtual talking disconnectedness (OR=1.67; 95% CI 1.09-2.56) was positively associated with some of the time feeling lonely and outside-home disconnectedness (OR=0.33; 95% CI 0.18-0.60) was negatively associated with often feeling lonely.Conclusion: Individuals with virtual talking disconnectedness and without outside-home disconnectedness are at higher risk of loneliness during the time of COVID-19 pandemic. Stimulating virtual talking connectedness might have the potential to diminish loneliness despite steep outside-home disconnectedness.

Gender-specific effects of adverse childhood experiences on incidence of activities of daily life disability in middle-age and elderly Chinese population

BACKGROUND

Adverse Childhood Experiences (ACEs) may have long-lasting effects on late life health, probably through life-course mediators. However, whether such effects still exist when these mediators have been appropriately controlled is unclear.

OBJECTIVES

To estimate the controlled direct effect of ACEs on Activities of Daily Life (ADL) disability in middle-aged people and examine the gender-difference of this effect.

PARTICIPANTS AND SETTING

We used data from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of persons aged 45+ years.

METHODS

ACEs were measured by the Adverse Childhood Experiences International Questionnaire and number of ACEs was classified as 0, 1, 2 and 3+, while ADL disability was measured using the Katz Index. Gender-specific controlled direct effects of ACEs on the incidence of ADL disability were estimated by marginal structural model (MSM) with stabilized inverse-probability-of-treatment weights of mediators (unhealthy behaviors, chronic diseases and depression).

RESULTS

4,544 males and 4,767 females were included. Gender differences existed in most categories of ACEs, and about 10 % participants had 3+ ACEs. Participants who had 3+ ACEs had 39 % and 59 % higher risk of ADL disability than those with 0 ACEs among males and females, respectively. After controlling for the mediators, the direct effect was slightly increased in males (risk ratio (RR) = 1.45, p < 0.001) but decreased in females (RR=1.28, p < 0.05).

CONCLUSIONS

Precautions targeted in reducing ACEs may be beneficial in preventing ADL disability, but gender-specific prevention should be considered.

Impact of clinical and psychological factors associated with depression in patients with rheumatoid arthritis: comparative study between Germany and Brazil

OBJECTIVE

To investigate the prevalence of depressive symptoms and its association with clinical and psychological factors in patients with rheumatoid arthritis (RA) in Germany and in Brazil.

METHOD

A convenience sample of 267 RA patients, 176 from Germany (age 62.4 ± 12.3 years) and 91 from Brazil (age 56.3 ± 12.6 years), was used in this cross-sectional study. The following questionnaires were used: Beck Depression Inventory (BDI), painDETECT test, Perceived Stress Questionnaire, fatigue questionnaire (FACIT), Health Assessment Questionnaire Disability Index (HAQ-DI), and the SF-36 questionnaires (Short-Form 36 Health Survey). Disease activity score (DAS 28-CRP) and visual analogue scale (VAS) for pain were also evaluated. Statistical analysis is based on comparison of means and proportions. Statistical significance for non-normal data was evaluated by non-parametrical tests.

RESULTS

Depressive symptoms were more prevalent in the Brazilian sample (44% vs 22.9%, p = 0.025). Compared to German patients, the Brazilian ones also experienced more pain (current pain status on VAS: 4.67 ± 3.4 vs 3.67 ± 2.31 respectively, p < 0.01), were physically more limited (1.89 ± 1.85 vs 1.01 ± 0.75, p = 0.012), and had higher C-reactive protein levels (7.78 ± 18.3 vs 5.82 ± 10.45, p = 0.028). Despite receiving a more intensive treatment, German patients presented similar disease activity when compared to Brazilian patients (DAS28-CRP: Brazil 3.4 ± 1.5 vs Germany 3.3 ± 1.3, p = 0.307).

CONCLUSION

Depressive symptoms are frequent in RA patients from different countries and interact with psychological disorders and the experience of pain. They contribute negatively to their well-being suggesting the need for psychoeducational strategies. Key Points • New psychoeducational strategies for RA management.• Higher inflammation marker in rheumatoid arthritis patients is associated with depression.• Medical treatment in RA influences depressive symptoms.• Depressive symptoms are dependent on population group.• High disease activity is related to depression.

Single Time-Point Study of the Home Environment and Functionality of Older Adults in Spain

Background: The literature favors discussion on socio-spatial conditions at the macro- (city) and micro- (housing) level that promote healthy aging in place. Objectives: (a) Identify the association between physical and social characteristics of the family home and the functional level and quality of life of older people and (b) provide normative data on adequate/inadequate households based on the Home Observation for Measurement of the Environment (HOME) inventory and the Spanish Informant Questionnaire on Cognitive Decline in the Elderly (S-IQCODE) test. Methods: In total, 79 healthy older adults completed the HOME inventory and the Montreal Cognitive Assessment (MoCA), S-IQCODE, Kessler Psychological Distress Scale (K-10) and ICEpop CAPability measure for Older people (ICECAP-O) tests. A regression model, the effect size and the means of the scores of HOME (adequate/inadequate) test and the cognitive level (optimal/normal) were calculated. Results: The regression model discloses that adequate home scores are associated with cognitive level (odds ratio (OR): 0.955, confidence interval (CI)95%: 0.918-0.955); quality of life (OR: 6.542, CI95%: 1.750-24.457), living with other people (OR: 5.753, CI95%: 1.456-22.733) and level of education (OR: 0.252, CI95%: 0.064-0.991). The normative data between HOME and S-IQCODE scores showed a good adjustment (d = 0.70). Conclusion: There is a significant relationship between the physical environment of the home and personal variables (sociodemographic information, quality of life and cognitive functionality). In addition, from this last variable, the normative data of an adequate/inadequate household for an older person have been established.

[Multimorbidity patterns and functional disability in elderly Brazilians: a cross-sectional study with data from the Brazilian National Health Survey]

The presence of multimorbidity patterns has been related to functional disability in basic activities (BADLs) and instrumental activities of daily living (IADLs), which are essential for elder individuals' self-care and autonomy. The study thus aimed to estimate the association between multimorbidity patterns and presence of functional disability in elderly Brazilians. This was a cross-sectional study using data from the Brazilian National Health Survey (PNS 2013) in a sample of elderly Brazilians (≥ 60 years). The measures of functional disability were from self-completed questionnaires, categorized in basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). The multimorbidity patterns analyzed here were: (1) cardiorespiratory; (2) vascular-metabolic; and (3) mental-musculoskeletal. The adjustment variables included age, sex, schooling, and region of Brazil. Multivariate logistic regression analyses were performed, estimating crude and adjusted odds ratios (OR) with Stata 16.0. Elderly individuals classified in the mental-musculoskeletal patterns showed the highest odds of disability in BADLs (OR = 2.72; 95%CI: 2.33; 3.18), while those with the cardiopulmonary pattern showed the highest odds of disability in IADLs (OR = 2.65; 95%CI: 1.95; 3.60), compared to those without the same patterns. All the multimorbidity patterns analyzed here were associated with disability in BADLs and IADLs and should thus be considered when planning measures to prevent disabilities in elderly individuals with multimorbidity.

Functional Capacity and Inflammatory Mediators in Elderly Residents of Counties with Different Human Development Index

A number of studies have indicated that certain factors, including socioeconomic status and education, are associated with the functional health status of the elderly. Another relevant factor in aging is chronic subliminal inflammation, with increased levels of circulating inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and soluble tumor necrosis factor receptor 1 (sTNFR-1), commonly seen in the elderly. High levels of these inflammatory mediators could impair the functional capacity. In this respect, the aim of this cross-sectional study was to compare plasma levels of inflammatory mediators and functional capacity of older women living in three Brazilian counties with different Human Development Index. We evaluated 154 women aged ≥65 years, regardless of race and/or social status. IL-6 and sTNFR-1 plasma levels were measured by ELISA and the functional capacity by the Short Physical Performance Battery (SPPB) test. Comparison among groups was performed using one-way ANOVA with Bonferroni post hoc correction, Kruskal–Wallis, and Mann–Whitney U tests. Women that lived in one of the counties with high HDI had lower functional capacity (p < 0.001). The population from the county with the highest HDI had lower plasma levels of sTNFR-1 (p < 0.05). There was no significant difference in plasma levels of IL-6 (p > 0.05). Besides this, women from the counties with lower HDI had a higher number of self-reported diseases and higher income (p < 0.05). Women that lived in the county with the highest HDI had a higher average education level (p < 0.05). The results showed differences in functional capacity and plasma levels of sTNFR-1 between the counties. In addition, the level of education, family income, and number of self-reported diseases show regional diversities in the aging process, suggesting these factors having an influence on inflammatory mediators and functional capacity.