title: Gender differences in incidence and determinants of disability in activities of daily living among elderly individuals: SABE study.
abstract: Determining the groups that are most susceptible to developing disability is essential to establishing effective prevention and rehabilitation strategies. The aim of the present study was to determine gender differences in the incidence of disability regarding activities of daily living (ADL) and determinants among elderly residents of Sao Paulo, Brazil. In 2000, 1634 elderly with no difficulties regarding ADL (modified Katz Index) were selected. These activities were reassessed in 2006 and disability was the outcome for the analysis of determinants. The following characteristics were analyzed at baseline: socio-demographic, behavioral, health status, medications, falls, hospitalizations, depressive symptoms, cognition, handgrip, mobility and balance. The incidence density was 42.4/1000 women/year and 17.5/1000 men/year. After adjusting for socioeconomic status and health conditions, women with chronic diseases and social vulnerability continued to have a greater incidence of disability. The following were determinants of the incidence of disability: age and depressive symptoms in both genders; stroke and slowness on the sit-and-stand test among men; and osteoarthritis and sedentary lifestyle among women. Better cognitive performance and handgrip strength were protective factors among men and women, respectively. Adverse clinical and social conditions determine differences between genders regarding the incidence of disability. Decreased mobility and balance and health conditions that affect the central nervous system or lead to impaired cognition disable men more, whereas a sedentary lifestyle, reduction in muscle strength and conditions that affect the osteoarticular system disable women more.
authors.affiliation: Public Health School, Epidemiology Department, São Paulo University, Sao Paulo, Sao Paulo, Brazil. tsfisioalex@gmail.com
authors.forename: Tiago da Silva
authors.initials: Tda S
authors.lastname: Alexandre
authors.forename: Ligiana Pires
authors.initials: LP
authors.lastname: Corona
authors.forename: Daniella Pires
authors.initials: DP
authors.lastname: Nunes
authors.forename: Jair Lício Ferreira
authors.initials: JL
authors.lastname: Santos
authors.forename: Yeda Aparecida de Oliveira
authors.initials: YA
authors.lastname: Duarte
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Lebrão
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002908:Chronic Disease; D003072:Cognition Disorders / Q000453:epidemiology; D003858:Dependency, Psychological; D003863:Depression / Q000453:epidemiology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000379:methods; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D018737:Hand Strength; D006801:Humans; D015994:Incidence; D057187:Independent Living / Q000706:statistics & numerical data; D008297:Male; D051346:Mobility Limitation; D010003:Osteoarthritis / Q000150:complications / Q000453:epidemiology; D004856:Postural Balance; D057185:Sedentary Behavior; D012737:Sex Factors