title: Disability in instrumental activities of daily living among older adults: gender differences.
abstract: OBJECTIVE To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults. METHODS The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE - Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome. RESULTS The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women. CONCLUSIONS The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.
authors.affiliation: Departamento de Gerontologia, Universidade Federal de São Carlos, São Carlos, SP, Brasil.
authors.forename: Tiago da Silva
authors.initials: Tda S
authors.lastname: Alexandre
authors.affiliation: Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Ligiana Pires
authors.initials: LP
authors.lastname: Corona
authors.affiliation: Departamento de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Daniella Pires
authors.initials: DP
authors.lastname: Nunes
authors.affiliation: Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: Jair Lício Ferreira
authors.initials: JL
authors.lastname: Santos
authors.affiliation: Departamento de Enfermagem Médico Cirúrgica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Yeda Aparecida de Oliveira
authors.initials: YA
authors.lastname: Duarte
authors.affiliation: Departamento de Gerontologia, Universidade Federal de São Carlos, São Carlos, SP, Brasil.
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Lebrão
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors