O cuidador idoso não remunerado e seu envolvimento em atividades avançadas da vida diária (AAVD): evidências do estudo ELSI -BRASIL

Abstract

INTRODUCTION: The aging population has been accompanied by significant changes in family dynamics and care arrangements. The increasing percentage of elderly individuals living in households with others who require care, including those of the same age or older, highlights the need to understand these caregivers concerning their health and involvement in advanced activities of daily living (AADLs). OBJECTIVE: To analyze the relationship between the frequency of unpaid care provided by elderly individuals and their engagement in advanced activities of daily living (AADLs), evaluating social, leisure, and productive dimensions, as well as identifying factors associated with this involvement. MATERIAL AND METHODS: This cross-sectional study utilized data from the second wave of the ELSI-Brasil (Longitudinal Study of Aging in Brazil). The sample consisted of 4,566 participants aged 60 years or older. “Unpaid elderly caregivers” were defined as those who answered positively to the question: “In the last 12 months, have you cared for someone without payment, including your spouse or another person?” The response variable was the global ADL score, constructed from 12 activities obtained from the ELSI-Brasil individual questionnaire, based on the Advanced Activities of Daily Living Scale (AADLS) proposed by Dias et al. (2019). Activities were organized into three analytical domains: social, leisure, and productive. Sociodemographic and general health variables were used for sample description and as adjustment variables. Descriptive analysis was presented through relative frequencies with 95% CI for categorical variables and mean and SD for numerical variables. Bivariate associations were examined using Fisher's Chi-square and ANOVA tests. The correlation between items of the global AADL score was estimated using tetrachoric correlation. Prevalence ratios and 95% CI between care frequency and global AADL score were obtained using Poisson regression with robust variance and sequential adjustment. All analyses considered the complex sample design (survey module), utilizing Stata 17.0, and a significance level of 5% was adopted. RESULTS: Among the total participants in this study, 11% were engaged in unpaid caregiving, with 8.7% doing so six to seven times a week. Most caregivers were aged between 60 and 69 years (59.6%), female (50.4%), and self-identified as white (48.4%). Frequent caregivers (3 to 5 times per week) or daily caregivers (6 to 7 times per week) were generally younger than non-caregivers (p < 0.05). Among daily caregivers, a higher proportion (33%) were aged 70 years or older. In the global AADL score, caregivers (both frequent and daily) and non-frequent caregivers showed similar levels of engagement in AADLs, while frequent caregivers had higher means (p-value < 0.05). Daily caregivers experienced approximately a 6% reduction in participation in ADLs. CONCLUSION: Overall, engagement in AADLs was similar across different caregiving frequency levels, suggesting that caregiving practice is not necessarily associated with a reduction in meaningful daily life activities. However, daily caregivers exhibited patterns of lower involvement in AADLs, indicating that intensive caregiving may restrict certain forms of social and productive engagement. This underscores the importance of public policies and support programs that recognize and value caregiving by the elderly, ensuring conditions that promote both the well-being of those receiving care and the health and quality of life of caregivers. Keywords: ELSI-Brasil, Aging, Care, Unpaid caregiver, AADLs