Envelhecimento e urbanização: o papel da vizinhança na funcionalidade do idoso da RegiãoMetropolitana de Belo Horizonte

Abstract

Introduction: Nowadays half of the worlds population live in cities. It has been estimated that this proportion will reach 60.0% by 2030. At the same time, the worlds population of elderly persons may double from 11.0% to 22.0% by 2050 and will be concentrated in urban areas of developing countries, representing 25.0% of the urban population of those countries.In 2000, the percentage of the population living in cities in Brazil was already 81.2%. In Brazil, by 2020, the elderly will represent 13.8% of the population, and Brazil will have the sixth largest elderly population in the world. Changes associated with normal aging, or aging with diseases, may make the elderly more vulnerable to deterioration of their physical and social environment. Thus, neighborhood attributes may define whether the elderly will participate in a community. When the resources of the environment and the ability of individuals interact and negatively affect dependency levels and mobility, the result is a process of disability. Objectives: 1) to understand the functional status of elderly personswho age in the Belo Horizonte Metropolitan Area (BHMA) and Belo Horizonte City (BH); 2) to identify factors associated with independence for carrying out activities of daily living (ADL); 3) to identify factors concerning the perception of their neighborhood that might berelated with their functional status; and 4) to identify factors related to characteristics of the neighborhood, specifically the Planning Units (PU) in the city of Belo Horizonte, which may be associated with the functionality of the elderly residents. Material and Method: Weadopted two theoretical models: the International Classification of Functioning, Disability and Health (ICF) for the analysis involving only the individual level, and the causal model of the effects of aging in the neighborhood proposed by Glass and Balfour, for multilevel analysis.The study included 1611 elderly (³60 anos), selected by random sampling from an extensive health survey carried out between May and July 2003 in 24 municipalities in the Belo Horizonte Metropolitan Area (BHMA). The response variable functional performance wasdeveloped based on the number of basic and instrumental ADL that the elderly found difficult to accomplish. Zero-inflated negative binomial regression model (ZINB) was used in statistical analysis involving only the individual level. ZINB Multilevel model was used to test the contribution of features of the PU as predictors of functional performance among the elderly, by using the Urban Quality of Life Index (UQLI) and their variables. The level of significance for both tests was 0.05. Results: Difficulty in carrying out at least one ADL was reported by 47.1% in BHMA and 46.0% in BH. In BHMA, independence in ADL was associated with the male sex, lower age groups, better education, working in a job, being the head of household, no report of chronic illness, not using healthcare services, not using medication regularly, and not being concerned about going out home due to fear of falling because of sidewalk defects. Concern about going out because of fear of being robbed has been confirmed in 78.0% of older respondents in BHMA and 80.0% when considering the city of BH. The concern for leaving home due to fear of falling because of sidewalks defects had a significant relationship with the dependent variable (p = 0.000), implying an increase of62.0% and 69.0% in the expected number of ADL that the elderly have difficulty performing in BHMA and BH, respectively. In BH, the fact of being less satisfied with the neighborhood, compared to residents very satisfied, increases in 50.0% the number of ADLs performed withdifficulty (p = 0.003). ZINB Multilevel model indicated that in BH functional performance is influenced by urban infrastructure, one of the UQLI variables. Living in a location with better infrastructure index ( 0.80) increased by 4.2 times the chance of the elderly to be independent when compared with those who live in places where the index is less than 0.80,after controlling for individual variables. The intraclass correlation coefficient for the secondlevel variable was 0.17, indicating that 17.0% of the variance in functional performance of the elderly may be explained by differences in the infrastructure of the PU. Conclusion: The useof new analytical methodologies and the combination of data sources can contribute to better understand how the characteristics of neighborhood may influence the functionality of the elderly and to guide intervention actions that aim to improve the quality of life of individualsapproaching biological, psychological and social aspects.