Análise da associação entre fragilidade, condições clínicas, fatores sociodemográficos e capacidade funcional em idosos comunitários de Belo Horizonte (MG), Barueri (SP), Santa Cruz (RN): estudo da rede FIBRA

Abstract

Population aging is a reality in Brazil, but the decrease in functional capacity and frailty are adverse events that can be influenced by environmental and personal factors. The objective of this study was to investigate the relation between frailty, clinical conditions and functional capacity of elderly from three cities in the country, who took part of the FIBRA project (Group of Study of Frailty in the Brazilian Elderly), UFMG thread. The sample was composed by 1308 elderly, older than 65, without cognitive decline and who were able to walk independently. Functional capacity was assessed by Katz scale for Basic Activities of Daily Living (BADL), Lawton scale to evaluate Instrumental Activities of Daily Living (IADL) and a semi structured questionnaire for the FIBRA group to assess Advanced Activities of Daily Living (AADL). Frailty was assessed based on the frailty phenotype through the items unintentional weight loss, low physical activity level, self- reported exhaustion, low grip strength and slowness. The presence of one or two items characterized the elderly as pre frail, three or more as frail and none of the items as non-frail. Descriptive statistics was used to explore the selected variables; to evaluate the association between socio-demographic and clinical variables and performance on Activities of Daily Living (ADL) integration tests were used; to determine the differences between the groups of frail, pre-frail and non-frail elderly in each activity of daily living an ANOVA analysis with Tukey´s post hoc test was used when variables were numerical, and chi-square when they were categorical. Subsequently a factorial ANOVA was used to verify possible interactions between frailty profile and the city were the elderly live on the determination of the functional capacity. Greatest part of the sample was considered independent for BADL with a mean score of 0.14 (±0.40), 19.48 (±2.31) for IADL and 3.24 (±2.09) for AADL. The three analyzed cities showed significant differences when compared with each other in relation to functional capacity (p=0.000). Belo Horizonte was the city with more functional elderly in relation to AADL (3.78±2.20), followed by Barueri (3.43±1.97) and Santa Cruz (2.22 ±1.61). For BADL and IADL, Barueri showed the best scores: 0.05 (±0.22) and 20.18(±1.69), respectively. Santa Cruz was the city with the most dependent elderly for all three levels of functional capacity. Age, marital status, schooling, hospitalization, number of medications and comorbidities were the socio-demographic and clinical variables that influenced functional capacity in the three cities. There was difference between the frailty groups, both for the total sample and the cities individually (p=0.000). An increase in the dependency level to accomplish a task was observed as the frailty condition got worse between the groups. There was a combined effect of frailty and city on the determination of functional capacity only for BADL (p=0.047) for the total sample. Functional capacity is influenced by the place of residence of the elderly as well as the socio-demographic and clinical factors the subject presents. Frailty is associated with a decrease in functional capacity even being distinct entities, which shows the need of identification and intervention by the public health.