Risk of dependence associated with health, social support, and lifestyle

Alcañiz, Manuela; Brugulat, Pilar; Guillén, Montserrat; Medina-Bustos, Antonia; Mompart-Penina, Anna; Solé-Auró, Aïda

doi:10.1590/S0034-8910.2015049005585

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Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005585 copy

Risk of dependence associated with health, social support, and lifestyle

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze the prevalence of individuals at risk of dependence and its associated factors.

METHODS

The study was based on data from the Catalan Health Survey, Spain conducted in 2010 and 2011. Logistic regression models from a random sample of 3,842 individuals aged ≥ 15 years were used to classify individuals according to the state of their personal autonomy. Predictive models were proposed to identify indicators that helped distinguish dependent individuals from those at risk of dependence. Variables on health status, social support, and lifestyles were considered.

RESULTS

We found that 18.6% of the population presented a risk of dependence, especially after age 65. Compared with this group, individuals who reported dependence (11.0%) had difficulties performing activities of daily living and had to receive support to perform them. Habits such as smoking, excessive alcohol consumption, and being sedentary were associated with a higher probability of dependence, particularly for women.

CONCLUSIONS

Difficulties in carrying out activities of daily living precede the onset of dependence. Preserving personal autonomy and function without receiving support appear to be a preventive factor. Adopting an active and healthy lifestyle helps reduce the risk of dependence.

Dependence; Risk Factors; Personal Autonomy; Lifestyle; Activities of Daily Living; Aging; Logistic Models

Variable	Men		Women
Variable	Prevalence	95%CI	Prevalence	95%CI
Dependent	7.7	6.6;8.9	14.1	12.3;15.8
Age group (years)
15 to 44	4.2	2.9;5.5	3.8	2.3;5.4
45 to 64	6.4	4.4;8.5	11.2	8.3;14.2
65 to 74	10.2	5.6;14.7	21.2	15.2;27.1
75 to 84	26.9	18.8;35.0	45.5	37.0;53.9
85 and older	59.8	49.7;69.9	76.9	69.2;84.5
Education level
Elementary or no education	17.6	14.2;21.0	30.5	26.8;34.2
Secondary school	4.9	3.6;6.2	8.2	6.3;10.0
University education	4.5	2.1;6.9	5.9	3.2;8.6
Use of healthcare services
Emergency care
Yes	11.0	8.5;13.6	20.0	16.9;23.1
No	6.3	5.1;7.5	10.6	9.0;12.3
Hospitalization
Yes	27.4	20.2;34.6	28.0	22.5;33.5
No	6.1	5.0;7.2	12.5	10.8;14.3
Use of medication
Yes	11.5	9.7;13.3	17.8	15.7;20.0
No	3.0	1.8;4.2	2.2	0.8;3.5
EQ-5D dimensions
Walking problems
Some/Many problems	43.3	36.4;50.1	57.9	52.9;62.9
No problems	3.4	2.6;4.3	4.5	3.3;5.6
Problems washing/Dressing
Some/Many problems	80.5	71.6;89.3	85.1	80.4;89.8
No problems	4.8	3.8;5.7	8.9	7.4;10.3
Problems in activities of daily living
Some/Many problems	63.2	56.0;70.4	72.5	66.9;78.0
No problems	3.1	2.3;4.0	4.7	3.5;5.8
Pain or discomfort
Moderate/Intense	21.1	17.4;24.9	30.0	26.6;33.4
None	3.8	2.9;4.8	3.4	2.5;4.4
Anxiety or depression
Moderate/Intense	22.9	17.9;27.9	35.3	31.0;39.6
None	5.3	4.2;6.3	7.1	5.8;8.3
Self-evaluated chronic disorder
Yes	15.6	12.7;18.5	28.8	25.5;32.1
No	3.8	2.8;4.8	4.0	2.9;5.1
Affective social support
Low	27.1	14.7;39.5	23.4	14.4;32.4
Normal	7.2	6.1;8.3	13.7	12.0;15.4
Confidential social support
Low	27.2	20.5;33.9	25.8	18.0;33.6
Normal	6.5	5.5;7.6	13.2	11.5;15.0
Support for activities of daily living
Receive help	85.3	78.1;92.6	89.6	84.6;94.5
Do not receive/Do not need help	4.7	3.7;5.7	6.5	5.3;7.7
Risk factors
Tobacco consumption
Smoker	4.7	3.0;6.3	6.6	4.0;9.2
Ex-smoker/Non-smoker	7.4	5.9;8.9	13.9	11.9;15.9
Alcohol consumption
Risk-level drinker	4.1	0.4;7.7	12.5	1.4;23.6
Non-drinker/Moderate	6.7	5.5;7.8	12.1	10.5;13.8
Sedentary lifestyle
Yes	18.2	14.6;21.7	29.0	24.7;33.2
No	3.0	2.1;3.8	5.7	4.4;7.1
Sample size, N	1,918	–	1,924	–

Variable	Men	Women
Age group (years)
15 to 44	–	–
45 to 64	1.1	3.0^a
65 to 74	1.1	5.2^a
75 to 84	2.9^a	13.1^a
85 and older	12.7^a	55.4^a
Education level
Elementary and no education	–	–
Secondary	0.4^a	0.6^b
University education	0.3^a	0.6^c
Emergencies	1.2	2.2^a
Hospitalization	3.5^a	2.3^a
Use of medication	2.2^a	3.5^a

N	1,917	1,923
LR p-value	< 0.001	< 0.001
% correct classification	80.9	83.3

Variable		Dependent		Not dependent but at risk		Not dependent and not at risk

		N	%	N	%	N	%
15 to 64 years old	Men	131	5.0	275	10.4	2,225	84.6
	Women	166	6.6	217	8.6	2,144	84.8
	Total	297	5.8	492	9.5	4,369	84.7

≥ 65 years old	Men	114	21.4	282	52.9	137	25.7
	Women	291	40.0	420	57.8	16	2.2
	Total	405	32.1	702	55.7	153	12.2

Total	Men	245	7.7	557	17.6	2,362	74.7
	Women	457	14.1	637	19.6	2,160	66.4
	Total	702	11.0	1,194	18.6	4,522	70.4

Variable	15 to 64 years old		≥ 65 years old		Total

	Men	Women	Men	Women	Men	Women
Problems
Walking	3.7^b	0.8	1.1	2.9^b	1.3	1.3
Washing and dressing	2.0	0.2	5.1^b	2.0	3.7^b	1.2
Activities of daily living	0.6	6.9^a	5.0^b	2.0^c	2.7^b	3.2^a
Pain or discomfort	2.0^c	2.4^c	0.7	1.2	1.2	1.6^c
Anxiety or depression	1.4	1.4	1.7	2.0^c	1.3	2.0^b
Self-reported chronic disorder	1.2	0.8	2.7^c	0.7	1.7^c	0.8
Affective social support	0.8^b	1.1	0.9	1.1	0.9^c	1.1^c
Confidential social support	1.1	1.0	0.9	0.9^b	1.0	0.9^c
Support for activities of daily living	–^d	–^d	14.5^a	11.5^a	11.7^a	11.3^a
Risk factors
Smoking	0.6	1.7	0.7	1.8	1.0	2.2^b
Alcohol consumption	0.6	24.4^a	0.1	0.7	0.5	12.2^a
Sedentary lifestyle	1.9^c	2.0	1.3	5.1^a	1.3	3.4^a

N	250	233	307	413	557	646
LR p-value	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
% correct classification	82.2	83.2	91.6	84.9	86.1	83.8

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[1] Correspondence
: Manuela Alcañiz. Departamento de Econometría, Estadística y Economía Española Universitat de Barcelona Diagonal, 690 08034 Barcelona, España. E-mail: malcaniz@ub.edu