Functional dependence among older adults: a cross-sectional study with a rural population of southern Brazil

Introduction: Despite the rapid aging process in Brazil, little is known about the occurrence of functional dependency in rural older adults population. The objective of this study was to estimate the prevalence of functional dependency and its associated factors among community%u2010dwelling older adults in the rural area of the municipality of Rio Grande, Rio Grande do Sul state, Brazil.
Methods: cross-sectional population-based study. A systematic random sampling of households was used. It was selected 80% of rural households in which we found 1131 older adults. The outcome analyzed in this study was functional dependency and was measured by the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). The data were collected using the Katz Index for ADL and Lawton & Brody’s Scale for IADL. Descriptive analysis was used to estimate the prevalence of functional dependency in ADL and IADL and to describe the sample. Crude and adjusted analysis was performed by Poisson regression with robust adjustment of variance. Prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were reported.
Results: 1029 older adults took part in this study, corresponding to 8.9% rate of losses and refusals. Prevalence of functional dependency in ADL was 8.1% (95% CI 6.4-9.7), while prevalence of functional dependency in IADL was 32.4% (95% CI 29.5-35.2). The occurrence of functional dependency in one or more ADL or IADL was 6.7% (95% CI 5.2-8.2). Female sex (PR=1.70; 95% CI 1.10-2.62), age group 80 or over (PR=3.68; 95% CI 2.20-6.16), reporting none (PR= 2.49; 95% CI 1.28-4.84) or 1-4 years of schooling (PR= 2.61; 95% CI 1.26-5.37), having diabetes (PR= 1.85; 95% CI 1.21-2.83), depression in the last year (PR= 1.90; 95% CI 1.09-3.31), urinary incontinence (PR= 3.26; 95% CI 2.06-5.16), history of stroke (PR= 2.26; 95% CI 1.35-3.76) and poor/very poor self-rated health (PR= 2.36; 95% CI 1.29-4.32), were associated with functional dependency in ADL. Female sex (PR = 1.40; 95% CI 1.19-1.65), the 70–79 and 80 or more age ranges (PR=3.80; 95% CI 3.07-4.72), none and 1-4 years of schooling (PR=1.87; 95% CI 1.46-2.41), medical diagnosis of diabetes (PR=1.33; 95% CI 1.10-1.60), urinary incontinence (PR=1.40; 95% CI 1.17-1.68), history of stroke (PR=1.41; 95% CI 1.10-1.81) and regular or poor/very poor self-rated health (PR=1.80; 95% CI 1.41-2.30) were associated with functional dependency in IADL.
Conclusion: Older adults in rural areas have a high prevalence of functional dependency. Knowledge of functional dependence and associated factors in rural populations is necessary for the planning and developing actions, especially in the routine of primary care, which promote health and prevent or postpone the decline in functional capacity.