Individual- and state-level factors associated with functional limitation prevalence among Colombian elderly: a multilevel analysis

Abstract

This study aimed to identify the main regional factors associated with variations in the prevalence of functional limitation on the older adult in Colombia adjusted by individual characteristics. This multilevel study used cross-sectional data from 23,694 adults over 60 years of age in the SABE, Colombia nationwide survey. State-level factors (poverty, development, inequity, violence, health coverage, and access to improved water sources), as well as individual health related, socioeconomic and demographic characteristics, were analyzed. The overall prevalence of functional impairment for the basic activities of daily living (ADL) was 22%. The presence of comorbidities, low educational level, physical inactivity, no participation in social groups, mistreatment and being over 75 years old were associated with functional limitation. At the group level, the analysis showed significant differences in the functional limitation prevalence across states, particularly regarding the socioeconomic status measured according to the Human Development Index (median OR = 1.22; 95%CI: 1.13-1.30; p = 0.011). This study provides evidence on the impact of socioeconomic variation across states on FL prevalence in the Colombian elderly once adjusted for individual characteristics. The findings of this study, through a multilevel approach methodology, provide information to effectively address the conditions that affect the functionality in this population through the identification and prioritization of public health care in groups with economic and health vulnerability.

Healthy aging determinants and disability among older adults: SABE Colombia

“…Furthermore, a significant association between disability and intermediary determinants was found; these determinants included factors of intrinsic capacity that have previously been related to developing disabilities in elderly individuals, such as multimorbidity, low grip strength, sedentary lifestyle, early childhood economic adversity, hospitalization in the previous year, and no social support or networks ( 3 , 7 , 14 , 18 , 25 ). Our results reinforce the role of inequities in Latin America; for example, in Brazil, several studies have had similar findings concerning the demographic, socioeconomic, and health factors associated with disability ( 32 , 33 ).…”

“…Our results also indicate disability differences between rich and poor populations. Recently, with the same SABE Colombia sample, significant differences in limitation prevalence across national states due to socioeconomic status and demographic characteristics have been demonstrated ( 14 ). Furthermore, the subsidized health insurance scheme has been found to be associated with all measures of disability.…”

“…Our results suggest possible effects of cumulative exposures since childhood, especially economic hardship and hunger during the first 14 years. It is probable that early childhood economic adversity affects muscle strength, especially in women, predisposing them to frailty and disability in older age ( 14 ). The results of this study indicated, as emphasized in other reports, that more economically disadvantaged locations provide less access and few options of services to the local community, few opportunities to perform leisure activities and socialize with friends, and less social interaction and support between individuals and thus contribute to the development of disabilities ( 27 ).…”

“…Recent studies have also shown that inequalities and inequities have grown among Colombian older adults ( 8 – 17 ). Significant associations have been found between indicators of health and SDH, including age and gender ( 8 , 9 ), skin color ( 10 ), chronic conditions ( 11 ), frailty ( 12 , 13 ), functional limitations ( 14 ), health care utilization ( 15 ), use of psychotropic drugs ( 16 ), and social capital ( 17 ). All of these factors, together with other SDH, are relevant to understanding the health status of older adults as part of the processes of exclusion and discrimination that have consequences for health inequities in the region.…”

Vulnerabilidade clínica e funcional de idosos cuidadores de idosos com doença de Alzheimer

“…Functionality is defined as the ability of people to adjust to adversities in daily life, including acting in society, even if they present some social, physical or mental restriction (6) . Thus, based on the premise that to develop care safely and effectively, the elderly caregiver needs to present preserved functionality, frequent assessments of health conditions can guide team decision making and prevent negative outcomes.…”