Disability met needs for older adults in Brazil, ELSI-2019

As the Brazilian population ages, the number of older adults with chronic illness, multimorbidity, cognitive impairment, and disability has increased (Giacomin et al., 2018). The high prevalence of health conditions in older Brazilian puts a strain on families that dedicate time and effort to caregiving (Lima-Costa et al., 2017). Caregivers may assist with specific chores, such as feeding and transferring, or other substantial assistance throughout the day, depending on the needs of older adults. The unmet needs occur when older people have difficulty receiving necessary care or are concerned about whether sufficient care is delivered (Kalánková et al., 2021). These unmet needs will further lead to a variety of severe negative consequences for the older adult, including physical discomfort, dehydration, falls, psychological distress, lower self-rated health, poor quality of life, increasing risks of institutionalization, hospitalization, and even mortality.

The causes and associated factors of old age’s unmet ADL and IADL needs are complex. A recent systematic review, primarily based on studies from developed countries, identified that a variety of demographic, social, and psychological factors, such as age, gender, household income, educational attainment, disability severity and type, race, expectations, structural barriers, and living arrangement, to be associated with unmet needs (Kalánková et al., 2021). As more older adults develop needs in performing daily activities, understanding the unmet care needs and its contributing factors becomes a significant research topic, especially when the unmet needs will have broad effects on their quality of life and health. This study identified four research questions: a) what are the prevalence and characteristics of the ADL, IADL related unmet needs among Brazilian adults ages 50 and over? b) what are the associations between characteristics and unmet needs for ADL and IADL? c) who provides care in Brazil? d) what are the consequences of unmet needs for the adult population? To do so, we use recently collected nationally representative data from Brazilian Longitudinal Study of Aging (ELSI-Brazil) conducted in 2019.

Methods

Data

Data from the second wave of the ELSI-Brazil study conducted in 2019 was used in the analysis. ELSI-Brazil is a cohort study with a representative sample of the Brazilian population aged 50 years and over. The final sample is restricted to 9,882 persons aged 50 years and over with complete data in selected variables.

Measures

Difficulty performing ADL and IADL activities – For ADL activities, participants answered six separate questions – getting across a room, dressing, bathing, eating, getting in and out of bed (transferring), and toileting. For IADL, participants answered six questions related to difficulty performing IADL activities – doing personal hygiene, preparing hot meals, transportation, shopping, using the telephone, and taking medication.

Unmet needs – Participants were categorized as 1) met need (answered “yes” for needing help and “yes” for receiving assistance for the activity they have difficulty performing or answered “no” for needing help), and 2) unmet (answered “yes” for needing help and “no” for the receiving help for the activity with they have difficulty performing).

Measures used to address negative consequences of unmet needs include social engagement, doctor’s visits, and the degree to which incontinence interfered in their daily lives.

Additional measures included: demographic, socioeconomic, and health variables.

Statistical methods

First, we estimated the prevalence rates of each ADL and IADL condition and unmet and descriptive statistics calculated for the sample according to the need categories for ADL and IADL help. Second, we used Poisson regression models to assess the associations between living arrangements and unmet needs for ADL and IADL. Third, we examined the consequences of unmet needs. We used Poisson and linear regressions to examine broadly how unmet needs in ADL or IADL affected those outcomes.

Results

Prevalence of ADL, IADL, and unmet needs

The prevalence rate of ADL was 9.9% (95% CI 8.4 – 11.7), and the prevalence of IADL was 18.7% (95% CI 15.7 – 22.2). The three most prevalent ADL limitations were transferring in and out of bed (6.1%), followed by walking from one room to the other (5.2%), and dressing (4.7%). Among IADL limitations, the most frequent ones were transportation (12.2%), shopping (10.1%), and using the telephone (7.4%).  Among those with at least one ADL difficulty, 12.6% (95% CI 9.1 – 17.1) reported having unmet needs. The ADL activities with the highest unmet needs were transferring in and out of bed, dressing, and walking across the room. Among those with IADL difficulties, 8.3% (95% CI 6.0 – 11.5) reported having at least one activity with unmet need. The highest levels of unmet needs were personal hygiene, transportation, and telephone use.