Objective: Information on dependency level of elderly in rapidly aging developing countries is limited, but this is needed to ascertain the extent of need for help with activities of daily living (ADLs). Method: In-person information was obtained in 1995 from a statewide survey of representative community residents ≥60 years of age in the state of Rio Grande do Sul, Brazil (N = 7,040), on demographic characteristics, health conditions, social ties, health behaviors, and ADL performance. Results: Nearly 40% needed help with one or more ADLs. In controlled analyses, need for help approximately doubled with each succeeding decade. Increased education and income and regular physical activity reduced risk. Selected health conditions (stroke, depression, poor self-rated health) were consistently associated with need for help. Discussion: A large proportion of noninstitutionalized elderly have ADL problems. In addition to health care, interventions promoting equity of access to education and economic opportunity could reduce ADL dependency in coming generations.
Alves, L.C., Quinet Leimann, B.C., López Vasconcelos, M.E. , Carvalho, M., Godoi Vasconcelos , A.G., Oliveira de Fonseca, T.C., et al. (2007). The effect of chronic diseases on functional status of the elderly living in the city of São Paulo, Brazil. Cadernos de Saude Publica, 23, 1924-1930.
2.
Aquino, R., de Oliviera, N.F., & Barreto, M.L. ( 2009). Impact of the family health program on infant mortality in Brazilian municipalities. American Journal of Public Health , 99, 87-93.
3.
Banks, J., Marmot, M., Oldfield, Z., & Smith, J.P. ( 2006). Disease and disadvantage in the United States and in England. Disease varies by income and education. Journal of the American Medical Association, 295, 2037-2045.
4.
Barreto, M.L., & Aquino, R. ( 2009). Recent positive developments in the Brazilian health system. American Journal of Public Health, 99, 8.
5.
Beckett, M., Weinstein, M., Goldman, N., & Yu-Hsuan, L. ( 2000). Do health interview surveys yield reliable data on chronic illness among older respondents? American Journal of Epidemiology , 151, 315-323.
6.
Blay, S.L., Ramos, L.R., & Mari, J.J. ( 1988). Validity of a Brazilian version of the Older Americans Resources and Services (OARS) mental health screening questionnaire. Journal of the American Geriatrics Society, 36, 687-692.
7.
Boult, C., Kane, R.L., Louis, T.A., Boult, L., & McCaffrey, D. ( 1994). Chronic conditions that lead to functional disability in the elderly. Journal of Gerontology: Medical Sciences, 49, M28-M36.
8.
Brazil Geography and Statistics Institute. (n.d.-a). Indicadores Sociais Mínimos [Minimum social indicators]. Retrieved October 1, 2009, from http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/indicadoresminimos/notasindicadores.shtm
9.
Brazil Geography and Statistics Institute. (n.d.-b). Tabela 2.2.3: Taxa de analfabetismo das pessoas de 10 anos ou mais de idade, por Grandes Regiões, segundo o recebimento de dinheiro de programa social do governo por algum morador do domicílio, no mês de referência, e os grupos de idade-2006 [Illiteracy rates among persons 10 years of age and older by major geographic regions, household receipt of social service funds in the reference month, and age group-2006]. Retrieved October 1, 2009, from http://www.ibge.gov.br/home/estatistica/populacao/trabalhoerendimento/pnad2006/suplementos/renda/tabelas/tab2023.pdf
10.
Brenes, G.A., Penninx, B.W.J.H., Judd, P.H., Rockwell, E., Sewell, D.D., & Wetherall, J.L. (2008). Anxiety, depression and disability across the lifespan. Aging & Mental Health , 12, 158-163.
11.
Camargos, M.C.S., Machado, C.J., & Rodrigues, R.D.N. (2007). Disability life expectancy for the elderly, city of São Paulo, Brazil, 2000: Gender and educational differences. Journal of Biosocial Science, 39, 455-463.
12.
Chaimowicz, F., & Greco, D.B. ( 1999). Dinâmica da institucionalização de idosos em Belo Horizonte, Brasil [Dynamics of institutionalization of older adults in Belo Horizonte, Brazil]. Revista Saúde Pública , 33, 454-460.
13.
Chandra, V., Ganguli, M., Pandav, R., Johnston, J., Belle, S., & DeKosky, S.T. ( 1998). Prevalence of Alzheimer’s disease and other dementias in rural Índia: The Indo-US study. Neurology , 51, 1000-1008.
14.
Clark, D.O. ( 1996). The effect of walking on lower body disability among older Blacks and Whites. American Journal of Public Health , 86, 57-61.
15.
Conselho Estadual do Idoso. (1997). Os Idosos do Rio Grande do Sul, Estudo Multidimensional de suas Condições de Vida. Relatório de Pesquisa. Conselho Estadual do Idoso [The elderly of Rio Grande do Sul, multidimensional study of their living conditions. Research Report. State Council for the Elderly]. Porto Alegre, Brazil: Author.
16.
Crawford, S.L., Jette, A.M., & Tennstedt, S.L. (1997).Test-retest reliability of self-reported disability measures in older adults. Journal of the American Geriatrics Society, 45, 338-341.
17.
de Mello, L., & Hoppe, M. ( 2005). Education attainment in Brazil: The experience of FUNDEF (OECD Economics Department Working Papers, No. 424). Paris : OECD.
18.
Federal Government. (2008). Política nacional para inclusão social da população em situação de rua [National policy for the social inclusion of the homeless]. Retrieved January 6, 2010, from http://www.rederua.org.br/pub/polnac_inclsoc.pdf
19.
Fillenbaum, G.G., Burchett, B.M., & Blazer, D.G. ( 2007). Health service use and outcome: Comparison of low charge, integrated, comprehensive services with usual health care. Aging & Mental Health, 11, 226-235.
20.
Ford, A.B., Folmar, S.J., Salmon, R.B., Medalie, J.H., Roy, A.W., & Galazka, S.S. ( 1988). Health and function in the old and very old. Journal of the American Geriatrics Society, 36, 187-197.
21.
Freedman, V.A., Schoeni, F., Martin, L.G., & Cornman, J.C. ( 2007). Chronic conditions and the decline in late life disability . Demography, 44, 459-477.
22.
Furner, S., Rudberg, M.A., & Cassel, C.K. ( 1995). Medical conditions differentially affect the development of IADL disability: Implications for medical care and research. The Gerontologist, 35, 444-450.
23.
George, L.K. ( 1996). Social factors and illness. In R. H. Binstock & L. K. George (Eds.), Handbook of aging and the social sciences (pp. 229-249). San Diego, CA: Academic Press.
24.
Guccione, A.A., Felson, D.T., Anderson, J.J., Anthony, J.M., Zhang, Y., Wilson, P.W.F., et al. (1994). The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. American Journal of Public Health, 84, 351-358.
25.
Guerro, R.O., Alvarado, B.E., & Zunzunegui, M.V. (2008). Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population. Aging: Clinical and Experimental Research, 20, 53-61.
26.
Hays, J.C., Saunders, W.B., Flint, E.P., Kaplan, B.H., & Blazer, D.G. ( 1997). Social support and depression as risk factors for loss of physical function in late life. Aging & Mental Health , 1, 209-220.
27.
Hendrie, H.C., Osuntokun, B.O., Hall, K.S., Ogunniyi, A.O., Hui, S.L., Unverzagt, F.W., et al. (1995). Prevalence of Alzheimer’s disease and dementia in two communities: Nigerian Africans and African Americans. American Journal of Psychiatry, 152, 1485-1492.
28.
Idler, E.L., & Benyamini, Y. ( 1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21-37.
29.
Isaacs, B., & Neville, Y. ( 1976). The measurement of need in old people (Scottish Health Service Studies, No. 34). Edinburgh , UK: Scottish Home and Health Department .
30.
Jagger, C., Arthur, J.A., Spiers, N.A., & Clarke, M. ( 2001). Patterns of onset of disability in activities of daily living with age. Journal of the American Geriatrics Society , 49, 404-409.
31.
Kington, R.S., & Smith, J.P. ( 1997). Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases. American Journal of Public Health, 87, 805-810.
32.
Laks, J., Batista, E.M., Guilherme, E.R., Contino, A.L., Faria, M.E., Rodrigues, C.S., et al. (2005). Prevalence of cognitive and functional impairment in community-dwelling elderly: Importance of evaluating activities of daily living. Arquivos de Neuro-Psiquiatria, 63, 207-212.
33.
Landerman, R.L., & Fillenbaum, G.G. (1997). Differential relationship of risk factors to alternative measures of disability. Journal of Aging and Health, 9, 266-279.
34.
Lei Orgânica da Saúde [Organic Health Law]. (1990). Retrieved September 19, 2007, from http://www.soleis.adv.br/leiorganicadasaude.htm
35.
Lopes, M.A., Hototian, S.R., Bustamante, S.E., Azevedo, D., Tatsch, M., Bazzarella, M.C., et al. (2007). Prevalence of cognitive and functional impairment in a community sample in Ribeirão Preto, Brazil. International Journal of Geriatric Psychiatry, 22, 770-776.
36.
Manton, K.G. ( 2008). Recent declines in chronic disability in the elderly U.S. population: Risk factors and future dynamics. Annual Review of Public Health, 29, 91-113.
37.
Manton, K.G., Gu, X., & Lamb, V.L. ( 2007). Change in chronic disability from 1982 to 2004/2005 as measured by long-term changes in function and health in the U.S. elderly population . Proceedings of the National Academy of Sciences USA, 103, 18374-18379.
38.
Melze, D., & Parahyba, M.I. (2004). Socio-demographic correlates of mobility disability in older Brazilians: Results of the first national survey. Age & Ageing, 33, 253-259.
39.
Menéndez, J., Guevara, A., Arcia, N., Díaz, A.M.L., & Marín, A.J.C. (2005). Enfermedades crónicas y limitación funcional en adulos mayores: estudio comparativo en siete ciudades de América Latina y el Caribe. Revista Panamericana de Salud Publica, 17, 353-361.
40.
Ostchega, Y., Harris, T.B., Hirsch, R., Parsons, V.L., & Kington, R. ( 2000). The prevalence of functional limitations and disability in older persons in the U.S.: Data from the National Health and Nutrition Survey III. Journal of the American Geriatrics Society, 48, 1132-1135.
41.
Palloni, A., Peláez, M., & Wong, R. ( 2006). Introduction: Aging among Latin American and Caribbean populations. Journal of Aging and Health, 18, 149-156.
42.
Pampel, F. ( 1998). Aging, social inequality, and public policy. Thousand Oaks, CA: Pine Forge.
43.
Pfeiffer, E. ( 1979). A short psychiatric evaluation schedule: A new 15-item monotonic scale indicative of functional psychiatric disorder. In F. Hoffmeister & C. Müeller (Eds.), Brain function in old age: Bayer Symposium VII (Vol. 22, pp. 228-236). Paris: Springer Verlag.
44.
Rodgers, W., & Miller, B. ( 1997). A comparative analysis of ADL questions in surveys of older people. Journal of Gerontology, 52B, 21-36.
45.
Santos, K.A., Koszuoski, R., Dias-da-Costa, J.S., & Pattussi, M.P. (2007). Factors associated with functional incapacity among the elderly in Guatambu, Santa Catarina State, Brazil. Cadernos de Saude Publica, 23, 2781-2788. (in Portuguese)
46.
Stuck, A.E., Walthert, J.M., Nikolaus, T., Büla, C.J., Hohmann, C., & Beck, J.C. ( 1999). Risk factors for functional status decline in community-living elderly people: A systematic review. Social Science & Medicine, 48, 455-469.
47.
U.S. National Health Interview Survey. (2008 ). NHIS draft survey questionnaire. Retrieved August 4, 2008, from http://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2008/english/qfamily.pdf
48.
Verbrugge, L.M., Lepkowski, J.M., & Imanaka, Y. ( 1989). Comorbidity and its impact on disability. Milbank Quarterly, 67, 450-484.
49.
Wray, L.A., & Blaum, C.S. ( 2001). Explaining the role of gender in disability: A population-based study. The Gerontologist, 41, 499-510.
