OBJECTIVE Evaluate the association of multimorbidity, primary health care model and possession of a private health plan with hospitalization.METHODS A population-based cross-sectional study with 1,593 elderly individuals (60 years old or older) living in the urban area of the city of Bagé, State of Rio Grande do Sul, Brazil. The outcome was hospitalization in the year preceding the interview. The multimorbidity was evaluated through two cut-off points (≥ 2 and ≥ 3). The primary health care model was defined by residence in areas covered by traditional care or by Family Health Strategy. The older adults mentioned the possession of a private health plan. We performed a gross and adjusted analysis by Poisson regression using a hierarchical model. The adjustment included demographic, socioeconomic, functional capacity disability and health services variables.RESULTS The occurrence of overall and non-surgical hospitalization was 17.7% (95%CI 15.8–19.6) and 10.6% (95%CI 9.1–12.1), respectively. Older adults with multimorbidity were admitted to hospitals more often when to older adults without multimorbidity, regardless of the exhibition’ form of operation. Having a private health plan increased the hospitalization by 1.71 (95%CI 1.09–2.69) times among residents in the areas of the Family Health Strategy when compared to elderly residents in traditional areas without a private health plan.CONCLUSIONS The multimorbidity increased the occurrence of hospitalizations, especially non-surgical ones. Hospitalization was more frequent in older adults with private health plan and those living in Family Health Strategy areas, regardless of the presence of multiple diseases.

Avaliar a prevalência e os fatores associados à assistência domiciliar na população idosa brasileira. Estudo transversal de base populacional com indivíduos de 60 anos ou mais, residentes na área urbana de 100 municípios, localizados em 23 estados brasileiros. Foi utilizado modelo de regressão de Poisson para análise bruta e ajustada. Foram entrevistados 6.624 idosos e a prevalência da assistência domiciliar foi de 11,7%. Após ajuste, a ocorrência foi maior entre as mulheres, nos mais velhos, com menor escolaridade e poder aquisitivo, com diagnóstico de morbidade crônica, história de queda, hospitalização prévia e consulta médica nos últimos três meses. Os resultados destacam a maior utilização da assistência domiciliar por idosos mais vulneráveis. Esse achado indica uma contribuição da assistência domiciliar à promoção da equidade na atenção à saúde no país, principalmente em decorrência da expansão da Estratégia Saúde da Família. Os resultados podem subsidiar a organização do processo de trabalho de profissionais e gestores na atenção básica à saúde.

Objective: to verify the prevalence of urinary incontinence and its relationship with physical and mental health indicators in the elderly population of Bagé, Rio Grande do Sul, Brazil. Method: a cross-sectional population-based study was conducted in 2008 with 1,593 elderly persons. Poisson regression was used for crude and adjusted analysis between the outcomes and the independent variables. Results: the prevalence of urinary incontinence was 20.7%, being 26.9% among women and 10.3% among men. The associated factors were female gender, age 70 to 74 and 75 years or over, yellow/brown/indigenous ethnicity/skin color and no schooling. The prevalence of functional disability, depression, cognitive deficit and very poor/poor self-perception of health was significantly higher in women with urinary incontinence. Among incontinent men, the same was observed with regard to functional disability and cognitive deficit. Conclusion: the occurrence of urinary incontinence in the elderly is frequent, especially in women, with a significant relationship with physical and mental health conditions in the elderly population. These results support the development of care strategies to prevent incontinence and minimize its health impacts.

The scope of the article is to present the reflections of professionals from the

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To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity and physical inactivity. Deaths were identified through linkage to mortality registers. For each risk factor, estimated all-cause mortality hazard ratios (HR) and population attributable fractions (PAF) were adjusted by age, sex, all other risk factors and socioeconomic position (wealth) using Cox proportional hazards modelling. We also quantified the risk factor adjusted wealth gradients in mortality, by age and sex. Among the participants, 659 (ELSA) and 638 (SIGa-Bagé) died during the 9-year follow-up. Mortality rates were higher in SIGa-Bagé. HRs and PAFs showed more similarities than differences, with physical inactivity (PAF 16.5% ELSA; 16.7% SIGa-Bagé) and current smoking (PAF 4.9% for both cohorts) having the strongest association. A clear graded relationship existed between the number of risk factors and subsequent mortality. Wealth gradients in mortality were apparent in both cohorts after full adjustment, especially among men aged 60-74 in ELSA. A different pattern was found among older women, especially in SIGa-Bagé. These findings call attention for the challenge to health systems to prevent and modify the major risk factors related to non-communicable diseases, especially physical inactivity and smoking. Furthermore, wealth inequalities in mortality persist among older adults. Non-communicable diseases (NCDs) are the main cause of death worldwide, killing 41 million people annually, equivalent to 71% of all deaths globally 1. The main groups of NCDs are cardiovascular diseases (17.9 million deaths), cancers (9.0 million deaths), respiratory diseases (3.9 million deaths), and diabetes (1.6 million deaths) 1. NCDs are often associated with deaths at older age, but evidence shows that a considerable percentage of deaths due to NCDs are premature (before 70 years) 1. The four NCDs listed above cause over 80% of premature deaths, with over 85% occurring in low-and middle-income countries 1. NCD-related health and lifestyle behaviours typically follow the social gradient: people who are disadvantaged in terms of socioeconomic position (SEP) have worse health-and live shorter lives-than those more advantaged 2. Inequalities in social conditions have long-lasting effects during a lifetime that contribute to high levels of NCD-related risk factors 3,4. Socioeconomically disadvantaged persons are at greater risk of being exposed to harmful products, such as tobacco, or of having unhealthy diets, and typically they have lower levels of access to healthcare services 1. Having an unhealthy diet, being physically inactive, and being a cigarette smoker may result in raised blood pressure, increased blood glucose, elevated blood...

Objective: to verify the influence of social relations on the survival of older adults living in southern Brazil. Method: a cohort study (2008 and 2016/17), conducted with 1,593 individuals aged 60 years old or over, in individual interviews. The outcomes of social relations and survival were verified by Multiple Correspondence Analysis, which guided the proposal of an explanatory matrix for social relations, the analysis of survival by Kaplan-Meier, and the multivariate analysis by Cox regression to verify the association between the independent variables. Results: follow-up was carried out with 82.5% (n=1,314), with 46.1% being followed up in 2016/17 (n=735) and 579 deaths (36.4%). The older adults who went out of their homes daily had a 39% reduction in mortality, and going to parties kept the protective effect of 17% for survival. The lower risk of death for women is modified when the older adults live in households with two or more people, in this case women have an 89% higher risk of death than men. Conclusion: strengthened social relationships play a mediating role in survival. The findings made it possible to verify the importance of going out of the house as a marker of protection for survival.

Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.