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Nicholson K, Liu W, Fitzpatrick D, Hardacre KA, Roberts S, Salerno J, Stranges S, Fortin M, Mangin D. Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. THE LANCET. HEALTHY LONGEVITY 2024; 5:e287-e296. [PMID: 38452787 DOI: 10.1016/s2666-7568(24)00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024] Open
Abstract
Multimorbidity (multiple conditions) and polypharmacy (multiple medications) are increasingly common, yet there is a need to better understand the prevalence of co-occurrence. In this systematic review, we examined the prevalence of multimorbidity and polypharmacy among adults (≥18 years) and older adults (≥65 years) in clinical and community settings. Six electronic databases were searched, and 87 studies were retained after two levels of screening. Most studies focused on adults 65 years and older and were done in population-based community settings. Although the operational definitions of multimorbidity and polypharmacy varied across studies, consistent cut-points (two or more conditions and five or more medications) were used across most studies. In older adult samples, the prevalence of multimorbidity ranged from 4·8% to 93·1%, while the prevalence of polypharmacy ranged from 2·6% to 86·6%. High heterogeneity between studies indicates the need for more consistent reporting of specific lists of conditions and medications used in operational definitions.
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Affiliation(s)
- Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
| | - Winnie Liu
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daire Fitzpatrick
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kate Anne Hardacre
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Roberts
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, Western University, London, ON, Canada; Department of Medicine, Western University, London, ON, Canada; Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of General Practice, University of Otago, Christchurch, New Zealand
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Mascarelo A, Alves ALS, Hahn SR, Doring M, Portella MR. Incidence and risk factors for polypharmacy among elderly people assisted by primary health care in Brazil. BMC Geriatr 2023; 23:470. [PMID: 37542225 PMCID: PMC10403929 DOI: 10.1186/s12877-023-04195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 07/21/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Polypharmacy is recognized as a global public health problem and one of the greatest challenges related to the aging population. Few studies have investigated the incidence and risk factors for polypharmacy among elderly individuals. These studies provided important information on the issue but were developed in high-income countries. This study investigates the incidence and risk factors for polypharmacy among elderly people assisted by primary health care over a period of 11 years. METHODS This was a census-based prospective longitudinal study that included people aged 60 years or older living in a small municipality in the state of Rio Grande do Sul, Brazil. The baseline occurred in 2010 and the second wave of the study occurred in 2021. The study population consisted of elderly individuals who did not use polypharmacy at baseline and were reinterviewed in 2021 (N = 128). Data collection in the first and second waves was performed through a household survey using a structured questionnaire. The dependent variable was polypharmacy, defined as the simultaneous use of 5 or more drugs. The independent variables included sociodemographic, health and functionality factors. For multivariate analyses, Poisson regression with robust variance was used, estimating the relative risk and 95% confidence intervals. RESULTS The incidence of polypharmacy was 46.1% in the 11-year period. The highest number of health problems was a risk factor for polypharmacy (RR = 1.177; 95% CI 1.093-1.267). CONCLUSIONS The incidence of polypharmacy among elderly people assisted in primary health care in Brazil is high. The number of diseases is a risk factor for polypharmacy. These results have implications for future primary health care practices and may support the development of policies, actions and services aimed at reducing polypharmacy and promoting the rational use of drugs in the population at higher risk.
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Affiliation(s)
- Andréia Mascarelo
- Postgraduate Program in Human Aging, University of Passo Fundo/UPF, BR 285 Km 292,7, Campus I, Bairro São José, Passo Fundo, RS, CEP 99052-900, Brazil.
| | - Ana Luisa Sant'Anna Alves
- Postgraduate Program in Human Aging, University of Passo Fundo/UPF, BR 285 Km 292,7, Campus I, Bairro São José, Passo Fundo, RS, CEP 99052-900, Brazil
| | - Siomara Regina Hahn
- Postgraduate Program in Human Aging, University of Passo Fundo/UPF, BR 285 Km 292,7, Campus I, Bairro São José, Passo Fundo, RS, CEP 99052-900, Brazil
| | - Marlene Doring
- Postgraduate Program in Human Aging, University of Passo Fundo/UPF, BR 285 Km 292,7, Campus I, Bairro São José, Passo Fundo, RS, CEP 99052-900, Brazil
| | - Marilene Rodrigues Portella
- Postgraduate Program in Human Aging, University of Passo Fundo/UPF, BR 285 Km 292,7, Campus I, Bairro São José, Passo Fundo, RS, CEP 99052-900, Brazil
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Diniz BS, Lima-Costa MF, Peixoto SV, Firmino JO, Torres KC, Martins-Filho OA, Teixeira-Carvalho A, Grady J, Kuchel GA, Castro-Costa E. Cognitive Frailty is Associated With Elevated Proinflammatory Markers and a Higher Risk of Mortality. Am J Geriatr Psychiatry 2022; 30:825-833. [PMID: 35227616 PMCID: PMC9177532 DOI: 10.1016/j.jagp.2022.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cognitive impairment and physical frailty are common among older adults and associated with a higher likelihood of adverse health outcomes. These two conditions frequently coexist in the same individual as cognitive frailty, yet few studies have examined the impact of such comorbidity on clinical outcomes or underlying biological mechanisms. METHODS A total of 1,340 older adults (age ≥60 years old) from the Bambui Cohort Study of Ageing, with a total follow-up of 10 years, were included in this study. Frailty was defined by the accumulation of deficit framework and cognitive impairment based on scores on the MMSE less than 22. In addition, serum IL-6 levels were measured by cytometric bead array assay. RESULTS Individuals classified with cognitive frailty had significantly higher serum IL-6 levels compared to the robust, cognitively unimpaired group. Those with cognitive frailty (aOR = 1.97 [1.18-3.27] and prefrailty and cognitive impairment (aOR = 1.83 [1.24-2.69]) had the highest mortality risk over 10 years of follow-up. Higher IL-6 levels were also independently associated with a higher mortality rate (aOR = 1.37 [1.23-1.54]). CONCLUSION Our study shows that cognitive Frailty indicates a vulnerability state and of increasing mortality risk. Our findings also suggested that proinflammatory abnormalities can be viewed as a central phenomenon underlying common age-related problems (e.g., cognitive impairment and Frailty) and outcomes (e.g., mortality).
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Affiliation(s)
- Breno S. Diniz
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT,Department of Psychiatry, School of Medicine, University of Connecticut Health
| | | | - Sérgio Viana Peixoto
- Center for Studies in Public Health and Aging (NESPE), Rene Rachou Research,Nursing School, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | | | - Karen C.L. Torres
- Integrated Research Group on Biomarkers, Rene Rachou Research Center, Oswaldo,Faculty of Medicine, University José do Rosário Vellano, UNIFENAS, Belo Horizonte, MG Brazil
| | | | | | - James Grady
- Department of Public Health Sciences, School of Medicine, University of Connecticut Health Center, Farmington, CT USA
| | - George A. Kuchel
- UConn Center on Aging, University of Connecticut Health Center, Farmington, CT
| | - Erico Castro-Costa
- Center for Studies in Public Health and Aging (NESPE), Rene Rachou Research
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Firmo JOA, Peixoto SV, Souza GAD, Loyola Filho AID. Evolution of publications on health of the older adults in the Journal Ciência & Saúde Coletiva. CIENCIA & SAUDE COLETIVA 2020; 25:4853-4862. [PMID: 33295506 DOI: 10.1590/1413-812320202512.16662020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Abstract
The present study analyzed the profile of publications related to the health of the older adults in the Journal Ciência & Saúde Coletiva, in terms of quantitative evolution, methodological approach, thematic and institutions involved. The selection of articles considered the title, abstract and descriptors and covered all the content published between 1996 and 2019. The articles included were classified according to the year of publication, type, theme, methodological approach and institutional link of the first author. Data analysis was based on absolute and relative frequencies, in addition to summary (mean) and variability (standard deviation) measures. The results showed a consistent increase in publications on the health of the older adults in the Journal Ciência & Saúde Coletiva, with a predominance of the quantitative approach, mainly focused on investigating the topic related to health conditions and the use of health services and supplies. In the majority, the main author was linked to a public teaching/research institution, located in the Southeast region. The results indicate that the journal contributed to give greater visibility to the health of the older adults, but that the publications on this theme reproduce the inequality observed in the national scientific production.
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Affiliation(s)
- Josélia Oliveira Araújo Firmo
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fiocruz Minas. Av. Augusto de Lima 1715, Barro Preto. 30190-002 Belo Horizonte MG Brasil.
| | - Sérgio Viana Peixoto
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fiocruz Minas. Av. Augusto de Lima 1715, Barro Preto. 30190-002 Belo Horizonte MG Brasil. .,Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | - Gislaine Alves de Souza
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz Minas. Belo Horizonte MG Brasil
| | - Antônio Ignácio de Loyola Filho
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fiocruz Minas. Av. Augusto de Lima 1715, Barro Preto. 30190-002 Belo Horizonte MG Brasil. .,Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
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Falci DM, Mambrini JVDM, Castro-Costa É, Firmo JOA, Lima-Costa MF, de Loyola AI. Use of psychoactive drugs predicts functional disability among older adults. Rev Saude Publica 2019; 53:21. [PMID: 30726502 PMCID: PMC6390663 DOI: 10.11606/s1518-8787.2019053000675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/29/2018] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Denise Mourão Falci
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
| | - Juliana Vaz de Melo Mambrini
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Érico Castro-Costa
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Josélia Oliveira Araújo Firmo
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Maria Fernanda Lima-Costa
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
| | - Antônio Ignácio de Loyola
- Instituto René Rachou. Fundação Oswaldo Cruz. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, MG, Brasil
- Instituto René Rachou. Fundação Oswaldo Cruz. Núcleo de Estudos em Envelhecimento e Saúde Pública. Belo Horizonte, MG, Brasil
- Universidade Federal de Minas Gerais. Escola de Enfermagem. Departamento de Enfermagem Aplicada. Belo Horizonte, MG, Brasil
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Lutz BH, Miranda VIA, Bertoldi AD. Potentially inappropriate medications among older adults in Pelotas, Southern Brazil. Rev Saude Publica 2017; 51:52. [PMID: 28658367 PMCID: PMC5493363 DOI: 10.1590/s1518-8787.2017051006556] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 02/21/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the use of potentially inappropriate medications among older adults. METHODS This is a population-based cross-sectional study with 1,451 older individuals aged 60 years or more in the city of Pelotas, State of Rio Grande do Sul, Brazil, in 2014. We have investigated the use of medications in the last 15 days. Using the Beers criteria (2012), we have verified the use of potentially inappropriate medications and their relationship with socioeconomic and demographic variables, polypharmacy, self-medication, and burden of disease. RESULTS Among the 5,700 medications used, 5,651 could be assessed as to being inappropriate. Of these, 937 were potentially inappropriate for the older adults according to the 2012 Beers criteria (16.6%). Approximately 42.4% of the older adults studied used at least one medication considered as potentially inappropriate. The group of medications for the nervous system accounted for 48.9% of the total of the potentially inappropriate medications. In the adjusted analysis, the variables female, advanced age, white race, low educational level, polypharmacy, self-medication, and burden of disease were associated with the use of potentially inappropriate medications. CONCLUSIONS It is important to known the possible consequences of the use of medication among older adults. Special attention should be given to the older adults who use polypharmacy. Specific lists should be created with more appropriate medications for the older population in the National Essential Medicine List. OBJETIVO Avaliar o uso de medicamentos potencialmente inadequados entre idosos. MÉTODOS Estudo transversal de base populacional com 1.451 idosos com 60 anos ou mais em Pelotas, RS, em 2014. Investigou-se o uso de medicamentos nos últimos 15 dias. Utilizando os critérios de Beers (2012), verificou-se a potencial inadequação dos medicamentos e sua relação com variáveis socioeconômicas e demográficas, polifarmácia, automedicação e carga de doença. RESULTADOS Dentre os 5.700 medicamentos utilizados, 5.651 puderam ser avaliados quanto à inadequação. Destes, 937 eram potencialmente inadequados para idosos segundo os critérios de Beers de 2012 (16,6%). Cerca de 42,4% dos idosos usaram no mínimo um medicamento considerado potencialmente inapropriado. O grupo de medicamentos para o sistema nervoso correspondeu a 48,9% do total de medicamentos potencialmente inadequados. Na análise ajustada, as variáveis sexo feminino, idade avançada, cor da pele branca, baixa escolaridade, polifarmácia, automedicação e carga de doença mostraram-se associadas ao uso de medicamentos potencialmente inadequados. CONCLUSÕES É importante que sejam bem conhecidas as possíveis consequências do uso de medicamentos entre idosos. Atenção especial deve ser dada aos idosos que fazem uso de polifarmácia. É necessário existir listas específicas com medicamentos mais adequados para uso em idosos na Relação Nacional de Medicamentos Essenciais.
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Affiliation(s)
- Bárbara Heather Lutz
- Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil.,Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | | | - Andréa Dâmaso Bertoldi
- Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil.,Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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Tavares NUL, Bertoldi AD, Thumé E, Facchini LA, de França GVA, Mengue SS. [Factors associated with low adherence to medication in older adults]. Rev Saude Publica 2013; 47:1092-101. [PMID: 24626547 PMCID: PMC4206106 DOI: 10.1590/s0034-8910.2013047004834] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 08/19/2013] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess factors associated with low adherence to pharmacotherapy in older adults. METHODS Cross-sectional population-based study, with a representative sample of 1,593 individuals aged 60 or older, living in the urban area of Bagé, RS, Southern Brazil, in 2008. A multiple stage sampling model was used. The data were collected through individual household interviews. The analyses of the association between low adherence regarding pharmacotherapy, measured using the Brief Medication Questionnaire (BMQ), and demographic, socioeconomic, behavioral, health, assistance and prescription factors were carried out applying Poisson regression model to assess crude and adjusted prevalence ratios, their respective 95% confidence intervals and p-value (Wald test). RESULTS Around 78.0% of individuals reported have taken at least one medication in the seven days prior to the interview. Of these, approximately one third (28.7%) were considered to have low adherence to the treatment. The factors significantly associated to low adherence to treatment were: age (65 to 74 years old), not having health insurance, having to purchase (totally or partially) their own medicines, having three or more morbidities, having functional disabilities and using three or more medicines. CONCLUSIONS The increased use of medicines by older adults, because of the high prevalence of non-communicable diseases in this group, and the access to the treatment need to be considered by health care professionals regarding fostering adherence to treatment, which increases therapeutic solutions and quality of life among older people.
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Affiliation(s)
| | - Andréa Dâmaso Bertoldi
- Departamento de Medicina Social. Faculdade de Medicina.
Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Elaine Thumé
- Departamento de Enfermagem. Faculdade de Enfermagem. Universidade
Federal de Pelotas. Pelotas, RS, Brasil
| | - Luiz Augusto Facchini
- Departamento de Medicina Social. Faculdade de Medicina.
Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | | | - Sotero Serrate Mengue
- Departamento de Medicina Social. Faculdade de Medicina. Universidade
Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Oliveira CMD, Lima-Costa MF. Birth cohort differences in physical functioning levels among elderly Brazilians: findings from the Bambuí cohort study of aging (1997-2008). CAD SAUDE PUBLICA 2011; 27 Suppl 3:S444-53. [DOI: 10.1590/s0102-311x2011001500015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 05/07/2011] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the cohort differences in physical functioning levels among the older (cohort members born in 1916-1926 and in 1927-1937) participants of the Bambuí Cohort Study of Aging. The data came from participants aged 71-81 who took part at baseline in 1997 (n = 491) and in the 11th wave in 2008 (n = 620). The physical functioning variables included the following self-reported measures: activities of daily living, the instrumental activities of daily living and mobility. Poisson regression analyses were used to investigate the cohort year differences in physical functioning levels. Overall, the young cohort (2008) showed better levels of physical functioning compared to the older cohort (1997) across all three measures of physical functioning used.
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