Global functionality and associated factors in the older adults followed by Home Care in Primary Health Care

Predebon, Mariane Lurdes; Ramos, Gilmara; Pizzol, Fernanda Laís Fengler Dal; Santos, Naiana Oliveira dos; Paskulin, Lisiane Manganelli Girardi; Rosset, Idiane

doi:10.1590/1518-8345.5026.3476

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.5026.3476 copy

Global functionality and associated factors in the older adults followed by Home Care in Primary Health Care^* * Paper extracted from master’s thesis “Global functionality and associated factors in aged people linked to Home Care of Primary Health Care”, presented to Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Supported by Fundo de Incentivo à Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre (FIPE/HCPA), Grant # 160580, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to analyze the association of global functionality with the main functional systems and the sociodemographic variables of older adults followed by Home Care in Primary Health Care.

Method:

a cross-sectional study with 124 older people developed through home interviews. Functionality was assessed by Basic Activities of Daily Living (Barthel) and Instrumental Activities of Daily Living (Lawton and Brody); the main functional systems were assessed using the Mini-Mental State Exam, by the Timed Up and Go test, by the Geriatric Depression Scale (15 items), and questionnaire with sociodemographic variables. Bivariate and multivariate analyses were applied (Poisson Regression).

Results:

46% of the older adults showed moderate/severe/total dependence for basic activities and instrumental activities had a median of 12. In the multivariate analysis, there was an association between moderate/severe/total dependence on basic activities with cognitive decline (p=0.021) and bedridden/wheelchair users (p=0.014). Regarding the dependence on instrumental activities, there was an association with age ≥80 years (p=0.006), single/divorced marital status (p=0.013), cognitive decline (p=0.001), bedridden/wheelchair (p=0.020), and Timed Up and Go ≥20 seconds (p=0.048).

Conclusion:

the decline in cognitive and mobility was associated with poor functionality in basic and instrumental activities. The findings highlight the need to monitor Home Care for these individuals and serve as guidelines for health actions.

Descriptors:
Geriatric Nursing; Aging; Activities of Daily Living; International Classification of Functioning; Disability and Health; Home Health Nursing; Primary Health Care

Variables	n=124 (%)
Biological sex^* * Categorical variables (%);
Female	94 (75.8)
Male	30 (24.2)
Age group^* * Categorical variables (%);
60 - 69	15 (12.1)
70 - 79	25 (20.2)
80 - 89	54 (43.5)
90 - 99	30 (24.2)
Marital status^* * Categorical variables (%);
Married	33 (26.6)
Single/Divorced	32 (25.8)
Widow/Widowed	59 (47.6)
Education^* * Categorical variables (%);
0 - 4 years	56 (45.2)
5 - 8 years	37 (29.8)
>8 years	31 (25.0)
Family income^* * Categorical variables (%); ^† † M.w. = 2018 minimum wage R$ 954.00; ^‡ ‡ The older adult could have more than one source of income
Up to 2 m.w.	43 (34.7)
3-5 m.w.	58 (46.8)
>5 m.w.	23 (18.5)
Source of income^* * Categorical variables (%); ^‡ ‡ The older adult could have more than one source of income
Retirement	99 (79.8)
Social Security Benefit	36 (29.0)
Support from Family	27 (21.8)
Follow-up time in HC1^* * Categorical variables (%);
<1 year	20 (16.1)
≥1 to 3 years	44 (35.5)
≥3 to 5 years	31 (25.0)
≥5 years	29 (23.4)

Variables	n=124 (%)
BADL - Barthel^* * Categorical variables (%);
Independence	15 (12.1)
Slight dependence	52 (41.9)
Moderate dependence	15 (12.1)
Severe dependence	19 (15.3)
Total dependence	23 (18.6)
IADL - Lawton and Brody^† † Continuous variables [mean and standard deviation or median and interquartile range (P25-P75)];	12 (10 - 21)^‡ ‡ Score less than 12: older people with a higher level of dependence for instrumental activities; a score equal to or greater than 12: older people with a lower level of dependence for instrumental activities
IADL - Lawton and Brody<12^‡ ‡ Score less than 12: older people with a higher level of dependence for instrumental activities; a score equal to or greater than 12: older people with a lower level of dependence for instrumental activities	51(41.1)
IADL - Lawton and Brody≥12^‡ ‡ Score less than 12: older people with a higher level of dependence for instrumental activities; a score equal to or greater than 12: older people with a lower level of dependence for instrumental activities	73(58.9)
COGNITION - cognitive decline^* * Categorical variables (%);
Without	63 (50.8)
With	61 (49.2)
COMMUNICATION^† † Continuous variables [mean and standard deviation or median and interquartile range (P25-P75)];	7.1 ± 2.0
MOOD - depressive symptoms^* * Categorical variables (%);
Normal	63 (50.8)
Mild	47 (37.9)
Severe	14 (11.3)
MOBILITY^* * Categorical variables (%);
TUG<20 seconds (n=27)	27 (21.8)
TUG≥20 seconds (n=48)	48 (38.7)
Bedridden/wheelchair user	49 (39.5)

Variables (n=124)	BADL			IADL
Variables (n=124)	Dependence^* * Moderate, severe, and total dependence in the Barthel Index; n=57 (%)^§ § Percentage referring to the total sample (n=124);	PR^† † PR = Prevalence Ratio; (CI 95%)	p	<12^‡ n=64(%)^§ § Percentage referring to the total sample (n=124);	PR^† † PR = Prevalence Ratio; (CI 95%)	p
Biological sex
Male (n=30)	12 (40.0)	1.00		12 (40.0)	1.00
Female (n=94)	45 (47.9)	1.20 (0.74-1.95)	0.469	52 (55.3)	1.38 (0.86 - 2.22)	0.180
Age group
<80 years (n=40)	14 (35.0)	1.00		13 (32.5)	1.00
≥80 years (n=84)	43 (51.2)	1.46 (0.91 - 2.34)	0.114	51 (60.7)	1.87 (1.16 - 3.02)	0.010
Education
0 - 4 years (n=56)	27 (48.2)	0.83 (0.55 - 1.24)	0.367	33 (58.9)	1.02 (0.70 - 1.47)	0.938
5 - 8 years (n=37)	12 (32.4)	0.56 (0.32 - 0.97)	0.039	13 (35.1)	0.61 (0.36 - 1.03)	0.063
>8 years (n=31)	18 (58.1)	1.00		18 (58.1)	1.00
Live alone
Yes (n=20)	2 (10.0)	0.19 (0.05 - 0.71)	0.014	2 (10.0)	0.17 (0.05 - 0.63)	0.008
No (n=104)	55 (52.9)	1.00		62 (59.6)	1.00
Marital status
Married (n=33)	12 (36.4)	1.00		13 (39.4)	1.00
Single/Divorced (n=32)	14 (43.8)	1.20 (0.66 - 2.19)	0.545	15 (46.9)	1.19 (0.68 - 2.09)	0.544
Widow/Widowed (n=59)	31 (52.5)	1.45 (0.87 - 2.41)	0.159	36 (61.0)	1.55 (0.97 - 2.48)	0.068
Family income^\|\| \|\| m.w. = 2018 minimum wage R$ 954.00
1 - 2 m.w. (n=43)	16 (37.2)	0.54 (0.33 - 0.86)	0.010	18 (41.9)	0.54 (0.35 - 0.81)	0.003
3 - 5 m.w. (n=58)	25 (43.1)	0.62 (0.42 - 0.93)	0.019	28 (48.3)	0.62 (0.44 - 0.87)	0.006
>5 m.w. (n=23)	16 (69.6)	1.00		18 (70.3)	1.00
Cognitive decline
Without (n=63)	16 (25.4)	1.00		15 (23.8)	1.00
With (n=61)	41 (67.2)	2.65 (1.67 - 4.18)	<0.001	49 (80.3)	3.37 (2.13 - 5.34)	<0.001
Communication	-	0.84 (0.79 - 0.90)	<0.001	-	0.82 (0.78 - 0.87)	<0.001
Depressive symptoms
Normal (n=63)	22 (34.9)	1.00		24 (38.1)	1.00
Mild (n=47)	26 (55.3)	1.58 (1.04 - 2.42)	0.033	27 (57.4)	1.51 (1.01 - 2.25)	0.044
Severe (n=14)	9 (64.3)	1.84 (1.10 - 3.08)	0.020	13 (92.9)	2.44 (1.72 - 3.45)	<0.001
Mobility
<20 seconds (n=27)	1 (3.7)	1.00		1 (3.7)	1.00
≥20 seconds (n=48)	18 (37.5)	10.1 (1.43 - 71.7)	0.020	24 (50.0)	13.5 (1.93 - 94.3)	0.009
Bedridden/wheelchair user (n=49)	38 (77.6)	20.9 (3.04 - 144)	0.002	39 (79.6)	21.5(3.12 - 147)	0.002

Variables	BADL^* * Moderate, high, and total dependence in the Barthel Index;		IADL^† † Score less than 12 on the Lawton and Brody scale;
Variables	PR^‡ ‡ PR = Prevalence Ratio; (CI 95%)	p	PR^‡ ‡ PR = Prevalence Ratio; (CI 95%)	p
Age group
<80 years (n=40)	-	-	1.00
≥80 years (n=84)	-	-	1.58 (1.14 - 2.18)	0.006
Education
0 - 4 years (n=56)	0.88 (0.59 - 1.29)	0.498	1.02 (0.74 - 1.41)	0.903
5 - 8 years (n=37)	0.72 (0.45 - 1.17)	0.190	0.74 (0.51 - 1.07)	0.112
>8 years (n=31)	1.00		1.00
Live alone
Yes (n=20)	0.40 (0.15 - 1.06)	0.066	0.38 (0.13 - 1.12)	0.078
No (n=104)	1.00		1.00
Marital status
Married (n=33)	-	-	1.00
Single/Divorced (n=32)	-	-	1.58 (1.10 - 2.26)	0.013
Widow/Widowed (n=59)	-	-	1.31 (0.90 - 1.90)	0.157
Family income^§ § m.w. = 2018 minimum wage R$ 954.00
1 - 2 m.w. (n=43)	0.78 (0.53 - 1.15)	0.209	0.73 (0.53 - 1.01)	0.060
3 - 5 m.w. (n=58)	0.76 (0.54 - 1.08)	0.125	0.88 (0.67 - 1.15)	0.336
> 5 m.w. (n=23)	1.00		1.00
Cognitive decline
Without (n=63)	1.00		1.00
With (n=61)	1.66 (1.08 - 2.54)	0.021	2.23 (1.54 - 3.23)	<0.001
Depressive symptoms
Normal (n=63)	1.00		1.00
Mild (n=47)	1.41 (0.95 - 2.09)	0.089	1.26 (0.91 - 1.75)	0.160
Severe (n=14)	1.04 (0.70 - 1.56)	0.833	1.25 (0.96 - 1.63)	0.093
Mobility
<20 seconds (n=27)	1.00		1.00
≥20 seconds (n=48)	6.10 (0.87 - 42.7)	0.069	6.77 (1.01 - 45.3)	0.048
Bedridden/wheelchair user (n=49)	11.5 (1.66 - 80.5)	0.014	9.56 (1.43 - 64.2)	0.020

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[1] *
Paper extracted from master’s thesis “Global functionality and associated factors in aged people linked to Home Care of Primary Health Care”, presented to Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Supported by Fundo de Incentivo à Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre (FIPE/HCPA), Grant # 160580, Brazil.