Multimorbidade e envelhecimento ativo e saudável: evidências do Brasil (ELSI-Brasil) e da Inglaterra (ELSA)

Abstract

Introduction: Promoting active and healthy aging has become a goal for governments due to accelerated population aging and adverse health outcomes, such as multimorbidity. Objective: To evaluate the association between health conditions, active aging, and healthy aging, considering older adults (50 years and older) living in Brazil (ELSI-Brazil) and England (ELSA). Methods: Data from the baseline (2015-2016) of the Brazilian Longitudinal Study of Older Adults (ELSI-Brazil) for Brazil and the eighth wave (2016-2017) of the English Longitudinal Study of Aging (ELSA) for England were used. Health conditions included the physical component of health (limitation in activities of daily living (ADL) and multimorbidity), the multimorbidity construct (high blood pressure; diabetes; dyslipidemia; heart problems (heart attack, angina, and heart failure); stroke; asthma; chronic obstructive pulmonary disease (DPOC); arthritis or rheumatism; osteoporosis; back problems; depression; cancer; chronic kidney failure; Parkinson's and Alzheimer's disease), and disease patterns. Active aging included behavioral (smoking, physical inactivity, and poor sleep quality), personal (verbal fluency and overall life satisfaction), social (education, loneliness, and volunteering), and health (activities of daily living and multimorbidity) determinants. Intrinsic capacity, a component of healthy aging, encompassed the following domains, cognitive (temporal orientation, delayed memory, semantic memory, and verbal fluency), psychological (depressive symptoms and sleep), sensory (auditory and visual acuity), locomotor (gait speed and balance test), and vitality (handgrip strength, weight loss, exhaustion, and low endurance). Statistical analyses were performed using: (1) Negative Binomial Regression to estimate the association of behavioral, personal, and social determinants with the physical component of health; (2) Linear regression to analyze the association between multimorbidity and the intrinsic capacity score; (3) Factor analysis to identify patterns of multimorbidity among older Brazilian adults. Results: The results are presented in three scientific articles: (1) when comparing Brazil and England, the determinants of active aging were worse in Brazil than in England. Furthermore, behavioral, personal, and social determinants were associated with health in Brazil and England. (2) In Brazil, multimorbidity was associated with poorer intrinsic capacity for both men and women, even after adjusting for several relevant individual and contextual characteristics. (3) Five disease patterns were identified based on ELSI-Brazil data: metabolic (diabetes, dyslipidemia, cancer, and chronic kidney disease), cardiovascular (hypertension, heart attack, angina, and heart failure), respiratory (asthma and DPOC), neurological (Parkinson's and Alzheimer's), musculoskeletal, and mental (arthritis or rheumatism, osteoporosis, back problems, and depression). Final considerations: With the increase in multimorbidity among the elderly population and its negative implications, as demonstrated by the research in this thesis, governments and societies experiencing population aging must take measures to adapt public programs to the growing proportion of older adults and chronic diseases. These strategies should include the development and implementation of public policies that contribute to an active and healthy aging process, based on a functional perspective and appropriate management of multimorbidity. Keywords: Aging. Healthy Aging. Multimorbidity. Chronic Disease. Functional Ability.