Prevalência de sarcopenia e sobrevida de idosos expostos ao efeito do comportamento de movimento e custos do sistema de saúde

Abstract

Following the global trend of population aging, Brazil has a significant number of elderly people, a group that experiences more health adversities. Assuming multifactorial characteristics, the increase in age impacts the burden of diseases and consequently results in daily limitations, reduced physical activity, contributing to the increase in sedentary behavior, and probably to the decline in muscle mass and increased prevalence of sarcopenia. Thus, the general objective of this study was to estimate the prevalence of sarcopenia in the elderly and to verify its interrelation with physical activity, sedentary behavior and mortality. Thus, the general objective of this study was to estimate the prevalence of sarcopenia in the elderly and to verify its interrelation with physical activity, sedentary behavior and mortality. In this way, four distinct studies were developed, being: 1) a systematic review with meta-analysis to estimate the prevalence of sarcopenia in community-dwelling elderly Brazilians; 2) a population-based longitudinal study to identify the prevalence of and factors associated with sarcopenia, and the incidence of death and survival after 10 years of follow-up due to sarcopenia and sedentary behavior and possible associated mediators; 3) a time-series study to analyze the costs of hospitalizations for chronic noncommunicable diseases attributable to physical inactivity. For the systematic review study, the literature search was conducted in the electronic databases Medline (via PubMed), SciELO and Scopus, listing studies conducted in Brazil with the elderly. The prevalence of sarcopenia was measured by meta-analysis using a random effect model. The cross-sectional study was carried out with elderly individuals registered with the Family Health Strategy and residing in the urban area of the municipality of Uberaba, MG. The population comprised 622 elderly individuals, of both genders, aged ≥60 years. The participants answered a questionnaire in the form of an individual interview, with sociodemographic and health information, anthropometric measurements, functional capacity, and habitual physical activity. Sarcopenia was determined using the algorithm proposed by European Working Group on Sarcopenia in Older People, and vital status was measured by telephone contact and National Register of Deceased Persons. For data analysis, descriptive statistical techniques and Chi-square test were applied to verify differences in the frequency distributions of sociodemographic, health and behavioral variables, according to sarcopenia; and finally the survival analysis was performed by the Kaplan-Meier method and the associated factors by Cox regression. The cost analysis study used the population attributable fractions associated with physical inactivity for colon cancer, diabetes mellitus, cerebrovascular disease, and coronary heart disease, in addition to the costs attributable to each cause of hospitalization. The prevalence of sarcopenia for community-dwelling Brazilian elderly was 17.0% (IC95%: 13.0 - 21.0; I² = 95.9%), while the cross-sectional study indicated a prevalence of 22.1% (IC95%: 18.3-26.0) for sarcopenia in the elderly in Uberaba, MG, and more prevalent in females 69.6%. Survival analysis showed that 63.8% of participants remained alive within 10 years, and the mean survival time was 4.7 years; with negative outcomes in those elderly who were sarcopenic and insufficiently active. Regarding health costs for hospital admissions in Uberaba, there were 11,510 hospitalizations due to the evaluated chronic diseases in the last 10 years; and we estimated that physical inactivity is responsible for 10.9% of the value of hospitalizations; being this more expressive in coronary diseases. This study generated subsidies for the understanding of the interrelation between sarcopenia and high periods of time in sedentary behavior in mortality in a period of ten years; besides signaling the impact on health, in which the reduction of physical inactivity would bring to the city an economy of over 5 million Reais for the evaluated diseases. It is recommended the development of research that aims not only to clarify the relationship of sarcopenia and physical inactivity with mortality, but also strategies for the population, providing aging with quality and autonomy.