Elsevier

Archives of Gerontology and Geriatrics

Volume 55, Issue 2, September–October 2012, Pages 431-437
Archives of Gerontology and Geriatrics

Gender differences in incidence and determinants of disability in activities of daily living among elderly individuals: SABE study

https://doi.org/10.1016/j.archger.2012.04.001Get rights and content

Abstract

Determining the groups that are most susceptible to developing disability is essential to establishing effective prevention and rehabilitation strategies. The aim of the present study was to determine gender differences in the incidence of disability regarding activities of daily living (ADL) and determinants among elderly residents of Sao Paulo, Brazil. In 2000, 1634 elderly with no difficulties regarding ADL (modified Katz Index) were selected. These activities were reassessed in 2006 and disability was the outcome for the analysis of determinants. The following characteristics were analyzed at baseline: socio-demographic, behavioral, health status, medications, falls, hospitalizations, depressive symptoms, cognition, handgrip, mobility and balance. The incidence density was 42.4/1000 women/year and 17.5/1000 men/year. After adjusting for socioeconomic status and health conditions, women with chronic diseases and social vulnerability continued to have a greater incidence of disability. The following were determinants of the incidence of disability: age and depressive symptoms in both genders; stroke and slowness on the sit-and-stand test among men; and osteoarthritis and sedentary lifestyle among women. Better cognitive performance and handgrip strength were protective factors among men and women, respectively. Adverse clinical and social conditions determine differences between genders regarding the incidence of disability. Decreased mobility and balance and health conditions that affect the central nervous system or lead to impaired cognition disable men more, whereas a sedentary lifestyle, reduction in muscle strength and conditions that affect the osteoarticular system disable women more.

Introduction

The development of disability regarding the performance of activities of daily living (ADL) has a negative impact on the lives of elderly individuals and those who assist these individuals on such tasks. This situation affects thousands of people and constitutes a public health problem in modern society (Dunlop et al., 1997, Dunlop et al., 2002).

Risk factors of disability include cognitive deficit, depression, chronic conditions, multiple illnesses, malnutrition, excess weight, functional limitation in the legs, a sedentary lifestyle, smoking habits, alcohol abuse and conditions that lead to visual impairment (Stuck et al., 1999). Although widely studied, the etiology of the complex, dynamic mechanisms that lead to the development of disability in elderly individuals has not yet been fully clarified.

In Brazil, cross-sectional analyses with data from the SABE (Saúde, Bem-Estar e Envelhecimento [Health, Wellbeing and Aging]) study have associated a greater prevalence of disability regarding activities of daily living with the female gender, social inequalities during the course of life, poorer socioeconomic status in adult life and old age, chronic disease and cognitive deficit (Guerra et al., 2008). Moreover, investigations have demonstrated that the prevalence of disability is greater among those with lesser schooling and increases with age in both genders, independently of level of schooling (Camargos et al., 2007). However, there is little conclusive evidence in either developed or developing countries that gender and socio-cultural characteristics affect the incidence of disability or that risk factors are different between men and women.

Thus, the aim of the present study was to analyze gender differences in the incidence and determinants of disability regarding activities of daily living over a six-year period among elderly residents of Sao Paulo, Brazil.

Section snippets

Method

The sample of the present study came from the SABE study initiated in the year 2000, which was a multicenter survey carried out in the main urban centers of seven countries in Latin America and the Caribbean. In Brazil, a probabilistic sample representative of the urban population aged 60 years or more was used, totaling 2143 residents of the city of Sao Paulo. At baseline, the evaluation involved an at-home interview, anthropometric measures and physical performance tests.

Among these 2143

Results

Among the 1634 elderly individuals interviewed and evaluated in 2000, most of those with a conjugal life and accompanied living situation were men. Men also had a higher level of schooling and greater hand grip strength, consumed more alcohol and reported more lung and heart diseases. Women had a greater proportion of arterial hypertension, osteoarthritis, falls, obesity and a greater mean number of depressive symptoms (Table 1).

In the comparison of baseline characteristics of both genders

Discussion

The present study found that women have a greater incidence of disability under conditions of social vulnerability and chronic disease. Moreover, decreased mobility and balance and conditions that affect the central nervous system or impair cognition disable men more, whereas a sedentary lifestyle, reduction in grip strength and conditions that affect the osteoarticular system disable women more. Thus, there is a greater incidence of disability regarding activities of greater complexity.

Conclusions

The planning of effective preventive and rehabilitation strategies for reducing disability in the elderly population should be based on the fact that there are differences in the determinants of disability between genders and that conditions that affect the central nervous system, impair cognition or decrease mobility and balance disable men more, whereas a sedentary lifestyle and conditions that affect the osteoarticular system or reduce muscle strength disable women more. Moreover, women with

Conflict of interest statement

All authors declare no conflict of interest in this research.

Acknowledgement

The author would like to thank the São Paulo Research Foundation (FAPESP) for financing the SABE Study.

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