Fatores associados à multimorbidade e funcionalidade em pessoas idosas residentes na zona rural: um estudo de base populacional baseado na Estratégia Saúde da Família

Abstract

Introduction: Population aging is a global reality, which reflects the increased longevity of the population. Atrelado a isso, observa-se um aumento no número de doenças crônicas não transmissíveis, bem como o aumento do declínio da capacidade funcional das pessoas idosas, sobretudo, nas que residem em área rural. Objectives: to investigate the prevalence of multimorbidity and functional decline in elderly people living in rural areas of a small municipality in the Northeast region; to identify the sociodemographic, behavioral and clinicaltherapeutic factors associated with multimorbidity and functional decline in elderly people living in rural areas; to build a profile of multimorbidity and functional decline in elderly people living in rural areas; and to identify and map what is known in the literature about multimorbidity in elderly people living in rural areas. Method: this is an epidemiological investigation of the observational and cross-sectional type, with a quantitative approach, as well as a scope review guided by the recommendation of the Institute Reviewer's Manual (JBI) about multimorbidity in elderly people in rural areas. We carried out a descriptive and quantitative analysis of the data (univariate), using simple measures of absolute and relative frequency, as well as measures of central tendency such as mean and standard deviation, using IBM SPSS software version 25.0. In the bivariate statistics, the data were analyzed using the chi-square test and in the multivariate analysis we used Poisson regression through the Stata software version 14.0, being considered significant when the p-value < 0.05 for both analyses. Results: Most of the elderly presented multimorbidity (54.2%). As for functionality, about (7.5%) of the individuals presented total dependence for basic activities of daily living (ABVD) and (37.5%) for instrumental life activities (IADL). It was observed that multimorbidity is associated with female gender (p<0.001), age ≥70 years (p=0.018), overweight (p<0.001), access to treated and piped water (p=0.041), smoking history (p=0, 002), no alcohol consumption (p=0.001), chronic pain (p<0.001), use of hospital as 1st choice of health service (HOS) (p=0.005), and seeking medical consultation within one year (p<0.001). For ABVD there was significance among the variables: age ≥80 years (p=0.005), not working (p=0.002), polypharmacy (p=0.019) and not having transportation to go to the SS (p=0.028). For the AIVD there was significance between the variables: age ≥70 years (p<0.001), low level of education (p=0.018), not practicing physical activity (p=0.006), going to SS with a companion (p<0.001), having ischemic heart disease (p=0.026), urinary incontinence (p=0.008) and dementia (p=0.008). The review pointed to multimorbidity as a health problem in rural areas and that the elderly living in these places and presenting this health condition were more likely to have psychological disorders, pain/discomfort, poorer quality of life, poorer self-evaluation of health, more frail or at risk of frailty, greater suicidal ideation and plans, patterns of multimorbidity, associated factors, more prevalent chronic conditions and the division as to the classification of multimorbidity according to the number of diseases. Conclusion: The study allowed identifying the prevalence of multimorbidity and functional decline in elderly people living in rural areas, as well as identifying the factors that interfere in these two outcomes. In addition, the scope review allowed us to identify and map what is available in the literature about multimorbidity in rural elderly people. Thus, it is expected that with the results found, access to services and health care for the elderly population living in rural areas will be strengthened. Based on the findings, the management, health professionals, researchers, caregivers, family members, the aging public, as well as the elderly and other stakeholders should seek ways to change this scenario in order to prevent these diseases, promote health actions for health maintenance, etc.