Incapacidade funcional de mulheres e homens idosos com catarata residentes na macrorregião de saúde do triângulo sul: análise de modelagem de equações estruturais.

Abstract

Population aging is a relevant phenomenon of the 21st century and generates a demographic situation of greater vulnerability to the emergence of morbidities, such as cataracts, an important factor associated with functional disability among older women and men. Thus, the objective was to analyze functional disability and its associated factors among older women and men with cataracts residing in the Health Macro-region of the Southern Triangle. This is a cross-sectional and analytical study with a quantitative approach, carried out among 444 elderly people with self-reported cataracts living in the urban area of the Macroregion of Health in the Southern Triangle, Minas Gerais, who were divided into two groups: female (n=302) and male (n=142). Data collection was carried out in households through the application of instruments validated in Brazil. Descriptive and trajectory analysis (p<0.05) were performed using structural equation modeling. Regardless of sex, functional decline occurred in a hierarchical way. In each group, older women and men, predominated respectively: age 70├80 years (46.0% and 47.9%), 1├5 years of study (56.0% and 60.6%), individual monthly income of one minimum wage (55.6% and 47.2%), presence of 5 or more morbidities (91.7% and 71.1%), absence of indicative of depressive symptoms (68.2% and 84 .5%), and pre-frailty (44.7% and 54.2%). However, regarding physical performance (39.7% moderate and 44.4% good) and self-rated health (44.7% fair and 43.0% good), there were divergences between the groups. As for functional incapacity, older women and men presented, respectively: 8.6% and 9.2% dependence for Basic Activities of Daily Living; 73.5% and 74.6% partial dependence for Instrumental; and 29.1% and 21.8% lower participation in Advanced. Lower cognitive ability (p<0.001; p=0.001) and a higher number of compromised components of the frailty phenotype (p<0.001; p<0.001) were, respectively, directly associated with functional disability among older women and men with cataracts. Moreover, in the group of older women, there were direct associations, with the outcome, of the worse physical performance (p<0.001) and more sedentary behavior (p<0.001); and, among elderly men, of the greater number of depressive symptoms (p<0.001). In both groups, there were indirect associations between lower education, mediated by lower cognitive capacity, with functional disability (p<0.001). Among the older women, the worse physical performance, the higher number of compromised components of the frailty phenotype and the higher sedentary behavior mediated the associations of the higher age (p<0.001) and the higher number of depressive symptoms (p<0.001) with the outcome. Among older men, worse physical performance, mediated by lower cognitive capacity (p<0.001), and by the greater number of compromised components of the frailty phenotype (p<0.001) was indirectly associated with functional disability; as were the greater number of of morbidities, mediated by the greater number of depressive symptoms (p<0.001), which also mediated the association with older age (p<0.001). It is concluded that, regardless of gender, among older people with cataracts, functional decline occurs in a hierarchical manner and is associated with cognitive capacity and the frailty syndrome; specifically among older women with this disease, functional disability was associated with physical and behavioral conditions; and among men, with the presence of depressive symptoms.