The availability of care among frail older adults: impacts on care management in a crisis context — the Fibra Study

Torres, Juliana Lustosa; Lustosa, Lygia Paccini

doi:10.1590/1414-462X202432010201

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ORIGINAL ARTICLE • Cad. Saúde. Colet. 32 (1) • 2024 • https://doi.org/10.1590/1414-462X202432010201 copy

The availability of care among frail older adults: impacts on care management in a crisis context — the Fibra Study

Disponibilidade de cuidado em pessoas idosas frágeis: impactos na gestão do cuidado em um contexto de crise — Estudo Fibra

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

In Brazil, most of the care provided is informal, but its availability remains relatively little explored in the context of frailty.

Objective:

The objective of this study was to describe the availability of care among older adults from Belo Horizonte, Brazil, and its association with frailty.

Method:

This is a cross-sectional study based on 598 older adults from the Fibra-BH Study (2008/09). Frailty was defined using the 5-item of physical frailty phenotype. The availability of care included subjective and objective measures. Adjusting variables were age, sex, education, and self-rated health. Statistical analyses were based on a Poisson regression model with a robust error variance.

Results:

The prevalence of frailty was 11.4% and pre-frailty was 56.4%. The availability of care was slightly lower among frail than pre-frail and non-frail, where 17% lived alone, 14% had nobody to rely on, and 13% were childless. An association was observed between a lack of availability of care and frailty only among men, regarding living alone and having nobody to rely on.

Conclusion:

Only a small part of older adults have a lack of availability of care, but it is slightly higher among frail older adults. Focus on male older adults with a lack of availability of care is necessary due to a higher probability of having frailty or pre-frailty.

Keywords:
frailty; long-term care; social environment; social support

Variables	Total	Frailty/pre-frailty		p-value
Variables	Total	No	Yes	p-value
Female sex, (%)	66.5	20.4	46.0	0.397^a a Based on Pearson’s χ2 test with Rao-Scott correction;
Age, mean (SD)	74.3 (6.4)	72.2 (5.5)	75.3 (6.6)	<0.001^b b Based on the t-test;
Years of education, (%)				0.012^a a Based on Pearson’s χ2 test with Rao-Scott correction;
<4	27.8	6.7	21.1
4–8	46.8	14.6	32.2
9+	25.4	10.9	14.5
Self-rated health, (%)				<0.001^a a Based on Pearson’s χ2 test with Rao-Scott correction;
Very good/good	61.3	78.5	53.1
Fair/bad/very bad	38.7	21.5	46.9
Number of children, mean (SD)	3.9 (2.7)	3.9 (2.6)	4.0 (2.8)	0.723^b b Based on the t-test;
Living arrangement, (%)				0.539^a a Based on Pearson’s χ2 test with Rao-Scott correction;
Living alone	14.7	11.9	16.1
Living with a partner or children	40.7	42.0	40.2
Other arrangements	44.6	46.2	43.8
Expectation for care, (%)				0.059^a a Based on Pearson’s χ2 test with Rao-Scott correction;
Somebody to rely on	88.7	97,6	91.0
Nobody to rely on	11.3	2.4	9.0
Total (N)value^# # Total sample without sampling parameters.	598	182	416

Variables	Overall (men and women)			Men			Women
Variables	Expected probability of frailty/pre-frailty¹ 1 Adjusting for age, sex, years of education, and self-rated health; (%)	Frailty/pre-frailty		Expected probability of frailty/pre-frailty² 2 Adjusting for age, years of education, and self-rated health, stratifying by sex for men and women; (%)	Frailty/pre-frailty		Expected probability of frailty/pre-frailty² 2 Adjusting for age, years of education, and self-rated health, stratifying by sex for men and women; (%)	Frailty/pre-frailty
Overall		PR	95%CI		PR	95%CI		PR	95%CI
Number of children	71.2 (childless)	0.99	0.97–1.01	68.4 (childless)	0.99	0.94–1.04	72.2 (childless)	0.99	0.96–1.01
Living arrangement
Living alone	72.0	1.00		89.5	1.00		69.9	1.00
Living with a partner or children	67.8	0.93	0.77– 1.20	58.3	0.65	0.49–0.86^* * p<0.05.	72.6	1.04	0.83–1.31
Other arrangements	67.1	0.93	0.77–1.13	64.9	0.72	0.55–0.96^* * p<0.05.	65.9	0.94	0.74–1.19
Expectation for care
Somebody to rely on	66.8	1.00		63.3	1.00		68.4	1.00
Nobody to rely on	74.3	1.11	0.98–1.29	78.2	1.24	1.01–1.52^* * p<0.05.	73.2	1.07	0.88–1.30

Instituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de Janeiro Avenida Horácio Macedo, S/N, CEP: 21941-598, Tel.: (55 21) 3938 9494 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@iesc.ufrj.br

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[1] Correspondence:Juliana Lustosa Torres. E-mail: jlt.fisioufmg@hotmail.com