Limitação nas atividades instrumentais de vida diária de idosos atendidos na atenção primária à saúde e em serviços ambulatoriais de oncologia no estado de Mato Grosso e fatores associados

Abstract

Introduction: The functional capacity of the elderly constitutes an important indicator of the degree of independence, and combines the intrinsic capacity of the individual, the environment and how the elderly interacts in this environment. Objective: To assess the functional capacity to perform Instrumental Activities of Daily Living (IADL) in older adults treated at Primary Health Care (PHC) and oncology outpatient clinics in the state of Mato Grosso. Methods: Manuscript 1: A longitudinal study with a 24-month follow-up carried out in the municipality of Várzea Grande (MT) with 304 older people, whose baseline data collection took place from March to June 2016 and the follow-up from July to October 2018. The dependent variable was “functional decline in IADL”, defined as the decrease of at least one point in the score of functional capacity, assessed by the Lawton and Brody Scale, between baseline collection and follow-up. The associations between functional decline in IADL and the variables vulnerability, measured at baseline using the Vulnerable Elders Survey (VES-13), health conditions, sociodemographic factors, self-rated health, lifestyle and adverse health events were estimated through the Odds Ratio (OR), using binary logistic regression. Manuscript 2: This is a crosssectional study carried out in outpatient clinics of reference in cancer care in the state of Mato Grosso, whose data collection took place between November 2019 and March 2020, with 463 older people. The outcome variable was functional disability for IADL assessed by the Lawton and Brody scale. The independent variables were sociodemographic characteristics, lifestyle, social support and health conditions. We performed bivariate and multiple analyzes and calculated Prevalence Ratios (PR) using Poisson regression with robust variance. Results: Manuscript 1: 35.20% of the older people showed a decline in functional capacity in IADL. In the final model, they were associated with functional decline, dissatisfaction with life (OR=2.23, 95%CI, 1.09-4.56), hospitalization (OR=2.01, 95%CI, 1.18-3, 41) and the interaction term between vulnerability and physical inactivity (OR=3.12, 95%CI, 1.42-6.86). Manuscript 2: The prevalence of functional disability for IADL was 55.3%. The variables 10 associated with this disability in the multivariate analysis were: not working (PR=1.36, 95%CI 1.03–1.78); low (PR=1.49; 95%CI 1.10–2.03) and moderate (PR=1.30; 95%CI 1.04–1.64) perceived affectionate support; depressive symptoms (PR=1.31; 95%CI 1.10–1.56); malnutrition (PR=1.28; 95%CI 1.03–1.59); having two or more comorbidities (PR=1.30; 95%CI 1.03–1.64) and having a companion to the health services (PR=1.39; 95%CI 1.05–1.83). Conclusion: Among the factors associated with functional disability, there are physical health conditions, lifestyle, emotional issues, social support and work, reinforcing the importance of comprehensive care and actions to reduce the risk of adverse outcomes within biopsychosocial. The assessment of the functional capacity of the older people must be carried out at all levels of care, offering means that will enable the maintenance and recovery of functionality.