[Clinical characteristics and social determinants in a sample of non-homebound elderly]

Incontinência urinária, senso de controle e autonomia, e participação social em idosos residentes na comunidade

Resumo Objetivo Identificar a presença de sintomas de incontinência urinária (IU) e testar um modelo de associações diretas e indiretas com as variáveis psicossociais senso de controle/autonomia e participação social em idosos residentes na comunidade. Método Estudo transversal, realizado com 419 idosos de 72 anos ou mais (70,2% feminino) participantes das medidas de seguimento do Estudo Fibra-Polo Unicamp. Idade, sexo e escolaridade foram as variáveis sociodemográficas selecionadas como antecedentes das relações entre IU e participação social. Senso pessoal de controle e autonomia foi testado como mediador dessas relações em análise de caminhos via método de equações estruturais (Path Analysis). Resultados A IU foi relatada por 38% da amostra, com diferenças significativas entre os sexos (41% feminino versus 31,3% masculino). Foram propostos três níveis de participação social a partir do grau de envolvimento dos indivíduos com a sociedade. O modelo de associações explicou 15% da variância em participação social. Efeitos diretos foram encontrados entre controle e autonomia e participação social. Efeitos indiretos entre escolaridade e participação foram mediados pela presença de IU. Conclusão IU contribuiu para a restrição em participação social em todos os níveis. Controle e autonomia não se mostrou um mediador psicológico para as relações entre IU e participação, embora associada a ambas variáveis. A presença de IU potencializou as relações desvantajosas entre escolaridade e participação social. Enquanto fatores de natureza modificável, iniciativas clínicas e psicossociais sobre IU podem resultar em diminuição de efeitos psicológicos negativos e redução de desigualdades educacionais em participação social.

Urinary incontinence, sense of control/autonomy and social participation in community-dwelling older adults

Abstract Objective Identify the presence of urinary incontinence (UI) symptoms and test a model of direct and indirect associations with the psychosocial variables sense of control/autonomy and social participation in community-dwelling older adults. Method Cross-sectional study conducted with 419 adults aged 72 years or over (70.2% female) participating in the follow-up survey of the FIBRA Study - Polo Unicamp. Age, sex and educational level were the sociodemographic variables selected as antecedents of the relationship between UI and social participation. A sense of control/autonomy was tested as a mediator of these relationships in a path analysis through structural equation modelling. Results UI was reported by 38% of the sample, with significant differences according to sex (41% female versus 31.3% male). Three levels of social participation were proposed, based on the degree of interaction between the individual and society. The model of relationships explained 15% of the variance in social participation. Direct effects were observed between control/autonomy and social participation; indirect effects between education and participation, mediated by the presence of UI. Conclusion UI contributed to restrictions in social participation at all levels. Control/autonomy, although related, did not prove to be a psychological mediator for the relationship between UI and participation. The presence of UI potentialized the disadvantageous relationships between education and social participation. As modifiable factors, the treatment and management of UI through clinical and psychosocial initiatives can act to reduce negative psychological effects and reduce socioeconomic inequalities in social participation.

Quality of life and mortality of Brazilian nonagenarians and centenarians with urinary incontinence

OBJECTIVES: Urinary incontinence (UI) commonly occur in elderly people and it is associated with reduced functionality, quality of life and survival in older adults (65-80 years). Little is known about its impact in nonagenarians and centenarians. Thus, this study aimed to evaluate the health and mortality of nonagenarians and centenarians with UI.METHODS: Nonagenarians and centenarians residents of Porto Alegre, Brazil, participated in this cohort study and were followed between 2016 to 2019. Survival analysis were performed using Cox Proportional Hazards Regression methods in the simple and adjusted models.RESULTS: The overall prevalence of UI was 56%, 64% among women and 38% among men (p<0.01). UI was more frequent in widowers (p <0.01), those who left home (p=0.02) and participated in social activities less frequently (p=0.07). Also they had a higher frequency of chronic diseases (p = 0.02), more symptoms of depression (p=0.08) and reduced cognitive performance (p=0.04). Participants with UI had reduced survival in the simple (HR 0.29, p=0.23) and adjusted analysis (HR 0.33%, p=0.19). The variables that influenced the most, UI and mortality, were participation in social activities, ability to leave the home, cognitive performance and lower-limb function/mobility.CONCLUSIONS: Although UI was not a direct predictor, it was associated with reduced survival. Nonagenarians and centenarians with UI will likely experience a lower risk of mortality if they continue to participate in social activities, preserve their cognitive performance and practice physical activities.

Características sociodemográficas e clínicas em nonagenários e centenários com e sem incontinência urinária

Objetivos: analisar as características sociodemográficas e clínicas em indivíduos nonagenários e centenários com e sem incontinência urinária. Métodos: trata-se de um estudo transversal e analítico, envolvendo 234 nonagenários e centenários avaliados nos seus domicílios, que foram aleatoriamente selecionados na cidade de Porto Alegre, RS. A presença de incontinência foi avaliada com relação às características clínicas e sociodemográficas cujas associações foram testadas pelo qui-quadrado e as diferenças nas médias testadas pelo t de Student usando o Programa Epi Info. Resultados: a prevalência de incontinência urinária foi de 56,41%, sendo 63,53% entre as mulheres e 37,5% entre os homens (p=0,0003). A relação entre presença de perda de urina e de estado conjugal foi significativa (p=0,0049), com maior frequência entre os viúvos. Os incontinentes saíam menos de casa, participavam menos de atividades físicas e sociais, tinham maior número de doenças crônicas e sintomas depressivos e pior pontuação na avaliação cognitiva. Em relação aos sintomas urinários, a maioria dos incontinentes referiu que a urina ou bexiga atrapalha a sua vida (p<0,0001) e, que a urina ou bexiga, causa embaraço (p<0,0001). Entre os participantes continentes, 25% relatou que a urina ou bexiga atrapalha a sua vida. Conclusões: a incontinência urinária foi mais frequente entre mulheres, participantes mais velhos, viúvos e indivíduos que moravam sozinhos. Apesar de maior prevalência entre as mulheres, chama atenção uma prevalência importante entre os homens. Ao fim, concluímos que a incontinência urinária impacta diretamente na vida social e na saúde de nonagenários e de centenários. Então, a incontinência urinária deve ser um importante componente na avaliação desse grupo. Observamos, também, que um número importante de nonagenários e de centenários apresentam incômodos relacionados à urina, mesmo sem incontinência urinária.

Determinantes da relação entre percepção do funcionamento do sistema urinário atrapalhar a vida e a qualidade de vida de longevos

Objetivo: este estudo buscou avaliar a relação entre a percepção do funcionamento do sistema urinário atrapalhar a vida de modo geral com a análise do questionário Kings Health Questionnaire (KHQ) em longevos.Métodos: estudo transversal e analítico. Foram investigadas características sociodemográficas e clínicas, bem como, o impacto da incontinência urinária (IU) na Qualidade de vida (QV) pelo instrumento KHQ. Frequências, médias e desvio-padrão, testes de qui-quadrado, t de student e regressões logísticas foram calculadas, aceitando como significativos valores de p<0,05.Resultados: participaram 82 longevos, 68% mulheres, idade média de 92,3±2,7 anos, 71% incontinentes e 43% referindo que a funcionalidade pélvica atrapalhava a vida. Indivíduos incontinentes relataram mais frequentemente a queixa investigada. Os domínios, impacto da IU, emoções, limitação físico-social, limitação no desempenho de tarefas do KHQ e seu escore total foram relacionados com a queixa. Indivíduos que relataram limitação de tarefas fora de casa, em viagens, vontade forte de urinar e difícil de controlar, sentimento de depressão e ansiedade ou nervosismo tinham aumento significativo na chance de relatar que a funcionalidade pélvica atrapalhava a vida.Conclusão: o KHQ foi relacionado com a chance de relato de que o funcionamento do sistema urinário atrapalhava a vida. Mesmo assim, boa parte dos incontinentes não relatava que a condição atrapalhava a vida. Por isso, os resultados demonstram que mesmo na ausência de afirmação positiva de ausência de IU, o funcionamento do sistema urinário pode comprometer a QV. Os achados sugerem que, ou os participantes realmente tinham IU e não a percebiam como tal, ou que é necessário investigar outras questões como frequência miccional, por exemplo. O uso do KHQ permitiu identificar que mesmo na ausência de relato de IU o funcionamento do sistema urinário pode interferir na QV de longevos.

Fatores de risco para incontinência urinária em idosos institucionalizados

Objetivo: Analisar os fatores de risco para incontinência urinária (IU) em idosos institucionalizados. Métodos: Estudo transversal, analítico, documental realizado por coleta em 203 prontuários de uma instituição de longa permanência no nordeste do Brasil. Foram utilizados um instrumento para caracterização sociodemográfica e de saúde e os valores do Mini Exame do Estado Mental (MEEM). Os dados foram analisados a partir da estatística descritiva, inferencial e por regressão logística múltipla. Resultados: A prevalência de IU foi de 42,36% e maior em mulheres (66,28%), mais velhos (média: 79,62 anos) e dependentes (89,53%). Houve associação entre idade (p = 0,01), sexo (p = 0,024), estado civil (p = 0,007), religião (p = 0,015), com quem residia antes da institucionalização (p = 0,033), grau de dependência (p < 0,001), valores do MEEM (p < 0,001) e doenças cardiovasculares (p < 0,001) e neurológicas (p < 0,001). Os fatores de risco para IU foram quantidade de doenças [odds ratio (OR) = 1,17; intervalo de confiança de 95% (IC95%) = 1,02-1,34], consumo de cinco a nove medicamentos (OR = 4,07; IC95% = 1,14-14,52), ser solteiro (OR = 2,09; IC95% = 1,30-8,01), dependente (OR = 3,27; IC95% = 1,33-8,04) e ter baixa pontuação no MEEM (OR = 0,88; IC95% = 0,85-0,93). Conclusão: Os resultados revelam a importância de estudar IU nessa população para identificar precocemente os fatores de risco passíveis de prevenção.

Risk factors for urinary incontinence in institutionalized elderly​

Objectives: To analyze the risk factors for urinary incontinence (UI) in institutionalized elderly. Methods: Cross-sectional, analytical, documentary study done by collection in 203 medical records of a long-stay institution in northeastern Brazil. An instrument for sociodemographic and health characterization and the values of the Mini Mental State Examination (MMSE) were used. The data were analyzed from the descriptive, inferential and multiple logistic regression. Results: The prevalence of UI was 42.36% and higher in women (66.28%), older (mean: 79.62 years) and dependent (89.53%). There was an association between age (p = 0.01), sex (p = 0.024), marital status (p = 0.007), religion (p = 0.015), with whom resided before institutionalization (p = 0.033), degree of dependency (p < 0.001), MMSE values (p < 0.001) and cardiovascular (p < 0.001) and neurological diseases (p < 0,001). The risk factors for UI were number of diseases (OR = 1.17; 95%CI = 1.02-1.34), consumption of five to nine medications (OR = 4.07, 95% CI = 1.14-14.52), single (OR = 2.09, 95% CI = 1.30-8.01),dependent (OR = 3.27, 95% CI = 1.33-8.04) and had a low MMSE score (OR = 0.88, 95% CI= 0.85-0.93). Conclusion: The results reveal the importance of studying UI in this population to identify early risk factors that can be prevented.

Associated factors with physical activity and social activity in a sample of Brazilian older adults: data from the FIBRA Study

OBJECTIVE

This study investigates associated factors to participation in four domains of physical activity and social activities among 2344 community-dwelling older adults (72.3 ± 5.5 years; 65.6% female) without cognitive impairment, residents in six Brazilian cities.

METHOD

An adapted version of Minnesota Leisure Time Activity Questionnaire was used to measure physical activity in four different domains. An inventory of social activities was developed for research. Age, gender and family income were assessed by self-report. Comparisons of frequencies and logistic regression analyzes were performed.

RESULTS

All sociodemographic variables were affecting the activity engagement profile of the sample. Have higher family income showed association with high level of leisure time, occupational and transportation physical activity, result supported by the literature. The gender associated with high level of activity varied according to the specific domain of the analyzed activity indicator. Have less age proved to be associated with higher level of activity in all indicators associated with age, highlighting the increasing age as the major barrier to performance physical and social activities in old age.

CONCLUSIONS

Allow the active involvement of older people is the great challenge of public policies that promote active aging.

University of the Third Age: the impact of continuing education on the quality of life of the elderly

Abstract Objective: To verify, among elderly participants of the University of the Third Age (UnATI) of PUC Goiás, Goiania, Brazil, whether quality of life was higher or lower among veteran or first-year participants of the UnATI, and to evaluate if there was a statistically significant difference between the quality of life of men and women or first-years and veterans. Method: An observational case-control study with a quantitative approach was performed with 100 elderly individuals from the UnATI. Fifty first-years and fifty veterans were involved. Two questionnaires were applied, one with sociodemographic data and the other using the World Health Organization Quality of Life - Old (WHOQOL-OLD) scale, which evaluates the quality of life of the elderly. Variance analysis (ANOVA) and multivariate variance analysis (MANOVA) were performed, with p≤0.05 applied to the relevant statistics. Result: The vast majority of the sample were women (90%), aged between 60 and 86 years old (average of 68.37±5.28 years old). The overall quality of life score was 3.68±0.50 (first-years) and 3.87±0.55 (veterans). There was a statistically significant difference in the areas: sensory functioning (veterans =4.28±0.65 and first-years =3.95±0.80) (p=0.025) and past, present and future activity (veterans =4.0±0.72 and first-years =3.59±0.79) (p=0.008). Multivariate variance analysis identified that the overall quality of life scores of both men (veterans =3.15 and first-years =4.21) and women (veterans =3.78 and first-years =3.86), were highest after they became veteran students (p=0.007). Conclusion: Veterans had a higher quality of life than first-years. The continuing education provided by UnATI has a positive impact on the quality of life of the elderly.

Factors associated with health-related decision-making in older adults from Southern Brazil

AIM

To analyze older adults' health-related decision-making profile.

METHODS

Secondary analysis of a population-based study with 6945 older-adults (aged ≥60 years) in Southern Brazil. Multiple logistic regressions were calculated to describe the odds of deciding alone or asking for advice, compared with the chance of letting someone else decide about health-related issues. Associated variables were age, sex, marital status, education level, number of chronic morbidities, having children and quality of life.

RESULTS

The odds of asking for advice instead of letting others decide were significantly higher in the younger group and those with better levels of quality of life, independent of other variables. The chance of asking for advice was lower for unmarried (62%), widowed (76%) and those with children (50%). The chance of men deciding for themselves about their health instead of letting others decide was 47% higher compared with women (P = 0.0002), but 45% lower in the older group (P < 0.0001). Participants who where unmarried and childless, and individuals with better levels of quality of life were more likely to decide alone instead of letting others decide (P < 0.05).

CONCLUSIONS

Decision-making is fundamental for older adults' good quality of life. Aging makes older adults more vulnerable to dependence; however, it does not necessarily mean that they lose or decrease their ability to make decisions regarding their own health and desires. Geriatr Gerontol Int 2017; 17: 798-803.