Association between the degree of physical impairment from leprosy and dependence in activities of daily living among the elderly in a health unit in the State of Minas Gerais

Introduction In addition to the common alterations and diseases inherent in the aging process, elderly persons with a history of leprosy are particularly vulnerable to dependence because of disease-related impairments. Objective determine whether physical impairment from leprosy is associated with dependence among the elderly. Methods An analytical cross-sectional study of elderly individuals with a history of leprosy and no signs of cognitive impairment was conducted using a database from a former leprosy colony-hospital. The patients were evaluated for dependence in the basic activities of daily living (BADL) and instrumental activities of daily living (IADL), respectively) and subjected to standard leprosy physical disability grading. Subsequently, descriptive and univariate analyses were conducted, the latter using Pearson's chi-squared test. Results A total of 186 elderly persons were included in the study. Of these individuals, 53.8% were women, 49.5% were older than 75 years of age, 93% had four or less years of formal education, 24.2% lived in an institution for the long-term care of the elderly (ILTC), and 18.3% had lower limb amputations. Among those evaluated, 79.8% had visible physical impairments from leprosy (grade 2), 83.3% were independent in BADL, and 10.2% were independent in IADL. There was a higher impairment grade among those patients who were IADL dependent (p=0.038). Conclusion s: The leprosy physical impairment grade is associated with dependence for IADL, creating the need for greater social support and systematic monitoring by a multidisciplinary team. The results highlight the importance of early diagnosis and treatment of leprosy to prevent physical impairment and dependence in later years.

引言：除衰老过程中固有的常见生理改变与疾病外，有麻风病史的老年受试者因疾病相关躯体功能损害，更易出现依赖状态。
研究目的：明确麻风病所致躯体功能损害与老年人群依赖状态的相关性。
研究方法：本研究依托某既往麻风病康复村医院的数据库，针对有麻风病史且无认知损害迹象的老年人群开展分析性横断面研究。对受试者分别评估其基础性日常生活活动（Basic Activities of Daily Living, BADL）与工具性日常生活活动（Instrumental Activities of Daily Living, IADL）依赖情况，并采用标准麻风病躯体残疾分级进行评定。随后开展描述性分析与单因素分析，单因素分析采用皮尔逊卡方检验。
研究结果：本研究共纳入186名老年受试者。其中女性占比53.8%，49.5%的受试者年龄超过75岁，93%的受试者接受过不超过4年的正规教育，24.2%居住于老年长期照护机构（Institution for Long-term Care of the Elderly, ILTC），18.3%存在下肢截肢史。经评估，79.8%的受试者存在明确的麻风病相关躯体功能损害（2级），83.3%的受试者可独立完成基础性日常生活活动（BADL），仅10.2%的受试者可独立完成工具性日常生活活动（IADL）。存在IADL依赖的受试者，其躯体损害分级更高（p=0.038）。
结论：麻风病躯体损害分级与IADL依赖存在相关性，提示需为该人群提供更充分的社会支持，并由多学科团队开展系统性监测。本研究结果凸显了早期诊断与治疗麻风病，以预防晚年出现躯体功能损害与依赖状态的重要性。