Prevalência de fragilidade em idosos e fatores associados sob a perspectiva do curso da vida: análises do International Mobility in Aging Study - IMIAS

Abstract

Introduction: The Frailty Syndrome, a state of vulnerability and deficit homeostatic responses after a stressor event, occurs as a consequence of the cumulative process of several physiological systems throughout life, is one of the most problematic of population aging. This issue constitutes an important topic from a social perspective because identify groups of people in need of additional medical attention and at high risk of presenting adverse health outcomes. In the context, life-course epidemiology studies the long termeffects of biological, behavioral, and psychosocial experiences throughout life. The International Mobility in Aging Study - IMIAS drowns on the lifelong approach to contribute to knowledge about the health-related outcomes of the elderly in four countries with different epidemiological profiles. Objectives: To estimate the prevalence of frailty in the elderly participants of the study, to examine the associations between frailty and domestic violence and to identify possible mediators of these associations (paper 01); To examine the associations between variables of reproductive history (age at first birth, parity and history of hysterectomy) and frailty in old age (paper 02); To identify social and economic factors as predictors of the accentuation of the frailty phenotype in two years (paper 03). Methods: This is a cross-sectional study nested in a cohort study (IMIAS Study), in which the first evaluation (n = 2002) included elderly people of both sexes aged between 65 and 74 years living in the community in different locations (Kingston and Saint-Hyancinthe, Canada, Tirana, Albania, Manizales, Colombia and Natal, Brazil). Information was collected on sociodemographic, economic and health variables experienced during the course of life. The Frailty Syndrome was operationalized according to the criteria proposed by Linda Fried for the physical phenotype of frailty. Dispersion and central tendency measures were used for characterization of the sample, bivariate, multivariate and mediation analyzes were also used to reach the obectives proposed. Results: The prevalence of frailty varied according to study sites being lower in Canada (4.9% for men and 6.6% for women in Kingston and 2.1% for men and 4.8% for women in Saint Hyacinthe) and higher in Brazil (6.8% for men and 16% for women). In Colombia only, the prevalence of frailty was equivalent for men and women (6.4%). After multivariate analysis adjusted for covariables, the elderly who reported having suffered physical abuse in childhood had a higher prevalence of frailty in old age (OR = 1.68, 95% CI: 1.01, 2.78) and the same was observed among those exposed to psychological violence perpetrated by intima partner (OR = 2.07, 95% CI: 1.37, 3.12). The effects of physical violence in childhood were totally mediated by the presence of chronic conditions and depressive symptomatology, while the effects of intimate partner violence were partially mediated by these same variables. Among women, having a child before age 20 was associated with a higher prevalence of frailty (OR 2.15, 95% CI: 1.24-3.72), those with 1-2 children had lower pre-frailty status (OR 0.54, 95 (CI 0.36-0.82) and frailty (OR 0.43 95% CI 0.22-0.86) and having performed a hysterectomy was considered a factor contributing independently to a higher prevalence of frailty in all models. After adjustments (age, sex and place of study), income insufficiency (RR 1.40, 95% CI 1.00-1.96) and partner support (RR 0.80; 95% CI 0.64- 1.01) were considered predictors of the accentuation of the phenotype of frailty. Conclusions: Childhood physical abuse and experiences of psychological violence in adulthood leave marks on the path of life leading to adverse health outcomes in old age such as frailty. Age of first child, parity and hysterectomy are factors that should be considered as indicators of women's health and seem to contribute to the greater prevalence of frailty in women when compared to men. Age, sex, residency in Natal and income were considered as risk factors while counting on the social support of the partner was considered a protection factor for accentuation of the frailty phenotype. Therefore, measures aimed at reducing social and economic inequalities are necessary since they may have an impact on the health of the population, especially the elderly.