Disability relating to instrumental activities of daily living in the elderly with rheumatic diseases

Abstract Objective: to characterize the sociodemographic profile of elderly persons with arthritis/rheumatism in relation to gender, as well as to estimate the prevalence and factors associated with functional disability for the performance of instrumental activities of daily living (IADL). Method: a cross-sectional population-based study with a sample of 1,136 elderly persons (≥65 years old) from seven Brazilian municipal regions was carried out. Functional capacity was assessed by the self-reports of the elderly in terms of the performance of IADL, using the Lawton Scale. Differences between the genders, according to sociodemographic variables, were verified by the chi-squared test (p<0.05). The prevalence of inability to perform IADL was calculated and the independent associations were verified through multiple logistic regression. Results: the mean age was 72.4 years, 79.1% of the sample were women, and 45.9% of the elderly with arthritis/rheumatism were dependent for the performance of IADL. Differences were observed between the genders in relation to age, marital status, income and household arrangements (p<0.05). A higher prevalence of disability was observed among older elderly persons, those with no schooling and lower incomes, who lived in multigenerational households and who were frail. In the evaluation of the performance of specific activities, elderly persons with arthritis/rheumatism had greater difficulty taking medication (OR: 1,90; CI 95%: 1.19 - 3.06), after adjusting for gender and age. Conclusion: associations were found between functional disability and sociodemographic variables and frailty. Independence in daily activities such as those evaluated in this study is one of the primary conditions for the well-being of the elderly, even in conditions of frailty or chronic diseases.

研究目的：本研究旨在明确伴有关节炎/风湿病的老年人按性别划分的社会人口学特征，并估算其在完成工具性日常生活活动（instrumental activities of daily living, IADL）时出现功能障碍的患病率及相关影响因素。
研究方法：本研究为基于人群的横断面研究，共纳入巴西7个城市区域的1136名年龄≥65岁的老年人作为研究对象。采用劳顿量表（Lawton Scale），通过受试者的自我报告评估其工具性日常生活活动完成能力。依据社会人口学变量，采用卡方检验（chi-squared test，p<0.05）分析不同性别间的差异。计算无法完成工具性日常生活活动的患病率，并通过多因素logistic回归（multiple logistic regression）验证独立关联因素。
研究结果：本研究结果显示，受试者平均年龄为72.4岁，其中79.1%为女性；45.9%的伴有关节炎/风湿病的老年人在完成工具性日常生活活动时存在功能依赖。按社会人口学变量分析发现，不同性别受试者在年龄、婚姻状况、收入及家庭居住安排方面存在显著统计学差异（p<0.05）。高龄、未接受过教育、低收入、多代同堂家庭居住以及衰弱的老年人，其工具性日常生活活动功能障碍患病率更高。在针对特定活动完成情况的评估中，经性别与年龄校正后，伴有关节炎/风湿病的老年人在服药环节面临更大困难（优势比[OR]=1.90；95%置信区间[CI]：1.19~3.06）。
研究结论：本研究发现功能障碍与社会人口学变量及衰弱状态存在关联。如本研究中所评估的日常活动独立性，是老年人福祉的核心条件之一，即便老年人处于衰弱或罹患慢性疾病状态亦是如此。