Determinantes sociais da mobilidade funcional e quedas em idosos do município de São Paulo: uma análise multinível

Abstract

Introduction: Recent studies show that falls are the most important external cause of death in elders, leading to hospitalization, injuries, dependency, and to increased costs of health and social care services. Functional mobility impairment is a risk factor for falling, but social, environmental and behavioral aspects may also affect this event. Objective: To identify the socioeconomics and contextual aspects associated with functional mobility and falls in elderly residents of the Municipality of Sao Paulo, Brazil. Methods: We used data from Health, Wellbeing and Aging (SABE) Study, a representative study of individuals aged 60 and older of the Municipality of Sao Paulo in 2010. The dependent variables of interest were the occurrence of any fall in the last year and functional mobility impairment, assessed by the Timed Up and Go (TUG) test. Individual (marital status, race, years of schooling and perception of income sufficiency) and contextual (Gini coefficient, green areas per capita, and homicide rate) factors were analyzed by multilevel logistic models. Results: From the sample of 1,190 elderly individuals, 29% reported a fall in the last year and 46% had mobility impairment. The socioeconomic individual factors were not significantly associated with falling, but having eight or more years of schooling was a protective factor for mobility impairment for every model (OR: 0.56). Living in a neighborhood with a moderate homicide rate was associated with higher odds of falling (OR: 1.51, 95%CI: 1.09-2.07). Neighborhoods with moderate greens spaces were associated with higher odds of falling for individuals 80 years old and older (OR: 2.63, 95%CI: 1.23-5.60). Conclusion: Our findings support the concern that neighborhood characteristics are associated with falls and mobility impairment for the elderly. Strategies to prevent falls and mobility impairment in developing countries should consider public environment and social aspects. Descriptors: Falls, elderly, functional mobility, multilevel analysis