Introduction: Access is considered one of the necessary conditions for achieving effectiveness and quality in health services. However, it represents a complex construct, with several interpretations, and which can be understood as the ease or degree of difficulty with which people obtain effective and timely care. Barriers to access can be related to individual characteristics and those of health systems and services. Regarding the elderly living in rural riverine localities, these limitations are exacerbated due to the territorial dispersion of households and the difficulty of obtaining the necessary care near their homes. The aim of this study was to describe and test the association of sarcopenia and physical performance with primary health care attributes and the use of health services by elderly people living in rural riverside areas in the Amazon, Brazil.
Methods: This is a cross-sectional observational study, carried out in households with individuals aged 60 years or older living in nine communities located on the left bank of the Negro River, in the rural riverside area of the municipality of Manaus, Amazonas, Brazil. The study evaluated socioeconomic and demographic conditions, health services utilization and the primary care attributes related to the use and access to services, assessed by components of the Primary Care Assessment Tool instrument (PCATool-Brazil), a reduced version validated for Brazilian adult users. Physical performance was assessed using the Short Physical Performance Battery scale, and hand grip strength was also assessed according to a dynamometer. The Sarcopenia Formulary (SARC-F) and calf circumference (CC) were used to assess sarcopenia (SARC-CalF). The association of sarcopenia and the physical performance with the study outcomes was evaluated using hierarchical logistic regression for the health services utilization (having had a medical consultation in the last year), and hierarchical linear regression for the continuous outcomes of the PCATool-Brazil (total score and each of the domains). In Model 1 the sociodemographic variables were inserted and in Model 2 the clinical variables. Variables with p<0.20 were kept in the models.
Results: A total of 98 elderly (55.1% men; mean age = 70±7.4 years) were included in the study. Low physical performance and suggestive signs of sarcopenia were observed in 52.5% and 28.9% of the study participants, respectively. Elderly with better physical performance reported more health services utilization (OR=1.37; 95%CI=1.03-1.81) and higher scores in the affiliation (β=1.67; 95%CI=0.37-2.98), utilization (β=1.19; 95%CI=0.06-2.33) and longitudinality (β =0.99; 95%CI=0.09-1.90) domains of the PCATool-Brazil.
Conclusions: The study findings showed high prevalence of impairment in physical performance and suggestive signs of sarcopenia in elderly people living in the studied rural riverside localities. Better physical performance was associated with use of health services in the last year and with better evaluation of some primary care attributes.
Keywords: Health Services Accessibility; Health Care Utilization; Aging; Physical Performance; Sarcopenia.