Ageing and functioning: a trajectory analysis

Author(s)

Etienne Larissa Duim Negrini

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
• Defense date: 2020-07-17

Examining board members

José Leopoldo Ferreira Antunes; Tereza Etsuko da Costa Rosa; Jair Licio Ferreira Santos

• Advisor: José Leopoldo Ferreira Antunes

Abstract

Aging is a heterogeneous and dynamic process, influenced by biological, psychological, lifestyle, socioeconomic and environmental characteristics that individuals are exposed throughout life. From the combination of such characteristics, different aging profiles can occur with regard to functional impairment. The physical functioning of the elderly person can be assessed according to their condition of mobility and the ability to perform life activities. Objective: To evaluate functional trajectories of elderly people and to verify the effect of social determinants of health on these trajectories. Method: This thesis consists of three longitudinal studies, using data from the Health, Well-Being and Aging studies in Brazil and Chile and from the Mexican Health and Aging Study. Three functional outcomes were used as a basis: (i) basic activities of daily living that are related to self-care (eating, bathing, dressing, lying down and getting out of bed, using the toilet and walking inside home); (ii) instrumental activities of daily living, associated with community life (using means of transport, handling one\'s own money, preparing meals, using the telephone, washing clothes, taking care of household chores and controlling one\'s medication); and (iii) mobility. As independent characteristics of interest we focused on social determinants of health and its linked with trajectories of functioning of older adults. Deterministic and probabilistic trajectory models were adopted to assess the functional evolution of the study participants. After defining or extracting the distinct groups of trajectories, logistic and multinomial regression models assessed unadjusted and adjusted associations between the trajectories and covariates. Results: The study 1 observed that individuals with less than 4 years of formal education had 2.7 times the chance of experiencing worse functional trajectories compared to older people with at least eight years of schooling. Differences were also observed between the countries studied, with individuals living in São Paulo - Brazil being more likely to belong to worse functional trajectories than those living in Santiago - Chile (Odds Ratio (OR) 6,10, 95% Confidence Interval (95% CI) %) 3.55; 10.49). The study 2 showed six trajectories of functioning. Black and brown older people were more likely to belong to a trajectory with an accelerated functional loss process compared to white elderly people (OR 1.60; 95% CI 1.14; 2.26). Women were also more likely to be assigned to trajectories 3 (Traj 3 OR 1.82; 95% CI 1.33;2.48), 4 (Traj 4 OR 2.14; 95% CI 1.59;2.88) and 5 (Traj 5 OR 1.95; 95% CI 1.41;2.69) than to the Functional Trajectory (Traj. 2) in comparison to men. The study 3 showed the association between classes of socioeconomic condition and aging trajectories, the worse the social condition throughout life the greater the chance of being part of the worst trajectories in old age (p<0,001). In all the three studies, the older the individual, the higher the likelihood to be assigned to worse functional trajectories. Conclusion: The results presented show the heterogeneity in the aging process and its relationship with social inequalities assessed by different perspectives. Although guided by age, the aging process in worse functional conditions can also be explained by low level of education, by the fact of being a woman, being black or brown and by other socioeconomic characteristics that place the elderly person at a disadvantage during the aging process. The present findings reinforce the discussion of social inequalities and aging itself within a life course perspective. (AU)

• FAPESP's process: 16/19696-3 - Ageing and functional ability: an analysis of trajectories
• Grantee: Etienne Larissa Duim Negrini
• Support Opportunities: Scholarships in Brazil - Doctorate