Factors associated with functional dependence in older adults with disabilities in Brazil: a study based on the 2019 National Health Survey

Abstract

Abstract: This study aimed to analyze factors associated with moderate and severe functional dependence in older adults with sensory or motor disabilities in Brazil. Data from the 2019 Brazilian National Health Survey were used in this cross-sectional study. The sample included 9,856 older adults (aged ≥ 60 years) with hearing, visual, or motor impairment. Functional dependence was chosen as the outcome variable, classified into three levels: independence, moderate functional dependence, and severe functional dependence. Personal and environmental factors were considered in this study. Crude and adjusted prevalence estimates and multinomial logistic regression models were estimated, adopting independence as the reference category. Among the older adults with disabilities, 44.4% lived independently, 33.6% had moderate dependence, and 22% experienced severe dependence. Severe or moderate functional dependence occurred more often in women, older individuals, and those with less schooling. Race/skin-color was only associated with severe functional dependence , with lower odds in Mixed-race individuals than in White ones. Regarding the environmental factors, higher chances of dependence occurred in those who occupied no leadership position in their household, residents of the Brazilian Northeast, and users of assistive technologies. Co-residency, receiving home visits from community health workers, and using regular rehabilitation care were specifically associated with severe functional dependence. The high proportion of older adults with disabilities who live independently challenges ableist conceptions about aging. However, the observed inequalities indicate that social and environmental factors still conditioned the maintenance of functional autonomy.