Desempenho físico: mudanças e associação com parâmetros de saúde em até seis anos entre idosos de uma coorte do sul do Brasil

Abstract

The decline in physical performance (PP) has been associated with the risk of adverse outcomes among older adults. However, to date, there are few longitudinal studies evaluating multiple outcomes such as negative health self perception (NHSP), high number of health consultations, physical disability, falls and hospitalizations. This thesis aimed to describe changes in PP evaluated by different criteria and their respective associated factors, in addition to the relationship between low PP and the occurrence of five health outcomes observed in up to six years of follow-up among community-dwelling older adults. The study used data from a cohort of 1451 older adults included in a population based cross-sectional study named “COMO VAI?”, living in the urban area of Pelotas, RS, Brazil, with baseline assessment conducted in 2014 and reassessment in 2019-2020. PP assessments included Gait Speed (GS) and Timed Up and Go (TUG) tests. Self-perception of health, number of health consultations, occurrence of falls and hospitalizations were determined through reports from the participants in the 2019-20 follow-up, while physical disability was measured using the scale proposed by Katz. Associations between change in GS and TUG (2014 to 2019-20) and variables of interest were evaluated using mixed linear models, adjusting for confounders. The association between low PP and health outcomes was estimated using Poisson regression with robust variance. A total of 478 older adults with PP tests at both moments were included. Approximately 68% of the participants showed a decline in GS and TUG; 20% had no significant change in GS and 9% in TUG time (sustained PP); and 12% and 23% improved PP through GS and TUG, respectively. Being male, living without a partner/being separated, higher education, and alcohol consumption in the prior month were associated with decreased GS, while older age, lower socioeconomic status, physical inactivity, and being overweight were associated with worsened PP through TUG. The results of the physical tests were not associated with NSPH nor with number of health consultations. However, low PP at baseline (TUG and GS) was associated with physical disability at follow-up. Low TUG performance at baseline was also associated with subsequent falls (PR=1.57, 95%IC 1.13; 2.18). The decline in GS was associated with hospitalization (PR=1.86, 95%IC 1.05; 3.31). In this study, most participants showed a decline in PP, and the most strongly associated factors are non modifiable (gender and age). In addition, low PP was associated with disability, falls, and hospitalization over a five to six-year period. Thus, consecutive assessments of the PP should indicate preventive measures aimed at older people, preventing the incidence of adverse health outcomes.