Desenvolvimento de índices relacionados à percepção das características do ambiente da vizinhança e avaliação da sua associação com a Síndrome de Fragilidade em idosos
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2024-02-22
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Universidade Estadual Paulista (Unesp)
Resumo
Os objetivos deste estudo foram desenvolver e validar índices relativos à percepção de pessoas idosas sobre as características do ambiente da vizinhança onde residem e avaliar a associação destes índices com a Síndrome de Fragilidade. Para alcançar estes objetivos foi utilizado o banco de dados do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil) e o método de modelagem de equações estruturais por meio da implementação do algoritmo de quadrados mínimos parciais (PLS-SEM). Primeiramente, foram desenvolvidos dois índices relativos à percepção das características físicas e sociais do ambiente da vizinhança. Em um segundo momento, foi desenvolvido um índice de nível hierárquico superior, relativo ao ambiente da vizinhança como um todo, composto pelos dois índices anteriores. Foram testados diferentes modelos de associação entre os índices relativos ao ambiente da vizinhança e a síndrome de fragilidade, incluindo depressão e nível de atividade física como variáveis mediadoras e, como covariáveis para ajuste de confundimento: idade, sexo, renda, escolaridade, situação conjugal e raça/cor. Para as análises foi utilizada uma subamostra do banco de dados de idosos que participaram da primeira onda do ELSI-Brasil, composta por 3514 de indivíduos com idade igual ou superior a 60 anos, com mediana de idade (Intervalo Interquartil) de 68 (63 a 75) anos e residentes em áreas urbanas. Os modelos de mensuração dos índices desenvolvidos demonstraram propriedades adequadas em termos de validade convergente, ausência de multicolinearidade e, de forma geral, pesos e cargas adequados. No modelo com melhor performance explanatória e preditiva, bem como com melhor ajuste aos dados observados, o índice do ambiente percebido da vizinhança não apresentou associação com a síndrome de fragilidade (β: 0,04, IC95%: 0,00 a 0,08, P=0,06) nem com o nível de atividade física dos participantes. Por outro lado, foi observada associação entre o índice do ambiente da vizinhança e a ocorrência de sintomas depressivos (β: 0,14, IC95%: 0,10 a 0,18, P<0,001) e entre o nível de atividade física e a fragilidade (β: -0,26, IC95%: -0,29 a -0,23, P<0,001). Em conclusão, foram desenvolvidos índices sobre a percepção das pessoas idosas sobre as características da vizinhança onde vivem, e que poderão ser utilizados em pesquisas futuras envolvendo o banco de dados do estudo ELSI-Brasil. A ausência de associações encontradas entre os construtos emergentes relacionados ao ambiente da vizinhança com a prática de atividade física, bem como com a ocorrência da síndrome de fragilidade, chamam atenção para um aspecto pouco estudado da saúde das pessoas idosas no país e sinalizam a necessidade de novos estudos para confirmar estes achados e entender seus motivos subjacentes. A associação observada entre os índices relativos ao ambiente da vizinhança e a ocorrência de depressão entre pessoas idosas residentes na comunidade, a despeito das limitações inerentes aos resultados de estudos transversais, apontam para a possibilidade de abordagens intersetoriais e de cunho coletivo voltadas para a saúde mental dessas populações.
The aims of this study were to develop and validate indices regarding the perception of older adults about the characteristics of the neighborhood environment where they live and to evaluate the association of these indices with the Frailty Syndrome. To achieve these objectives, data from the Longitudinal Study of the Health of Older Brazilians (ELSI-Brazil) and the structural equation modeling method using the Partial Least Squares (PLS-SEM) algorithm were utilized. Initially, two indices regarding the perception of the physical and social characteristics of the neighborhood environment were developed. Subsequently, a higher-level hierarchical index concerning the neighborhood environment as a whole, composed of the two preceding indices, was developed. Different models of association between the neighborhood environment indices and the frailty syndrome were tested, including depression and level of physical activity as mediating variables, and age, sex, income, education, marital status, and race as confounding adjustment covariates. For the analyses, a subsample of elderly individuals who participated in the first wave of ELSI-Brazil was used, comprising 3514 individuals aged 60 years and older, with a median age (Interquartile Range) of 68 (63 to 75) years and residing in urban areas. The measurement models of the developed indices demonstrated appropriate properties in terms of convergent validity, absence of multicollinearity, and overall adequate weights and loadings. In the model with the best explanatory and predictive performance, as well as the best fit to the observed data, the perceived neighborhood environment index showed no association with the frailty syndrome (β: 0.04, 95% CI: -0.00 to 0.08, P=0.06) or with the participants' level of physical activity. On the other hand, an association was observed between the neighborhood environment index and the occurrence of depressive symptoms (β: 0.14, 95% CI: 0.10 to 0.18, P<0.001), and between the level of physical activity and frailty (β: -0.26, IC95%: -0.29 to -0.23, P<0.001). In conclusion, we developed and validated indices regarding the perception of older people about the characteristics of the neighborhood where they live and these indices may be used in future research involving the ELSI-Brazil study database. The absence of associations found between the emerging constructs related to the neighborhood environment and the practice of physical activity, as well as with the occurrence of the frailty syndrome, draws attention to a little-studied aspect of the health of older individuals in the Brazil and signals the need for further studies to confirm these findings and understand their underlying reasons. The observed association between the indices related to the neighborhood environment and the occurrence of depression among older adults residing in the community, despite the inherent limitations of cross-sectional studies, suggests the possibility of intersectoral and collective approaches aimed at the mental health of these populations.
The aims of this study were to develop and validate indices regarding the perception of older adults about the characteristics of the neighborhood environment where they live and to evaluate the association of these indices with the Frailty Syndrome. To achieve these objectives, data from the Longitudinal Study of the Health of Older Brazilians (ELSI-Brazil) and the structural equation modeling method using the Partial Least Squares (PLS-SEM) algorithm were utilized. Initially, two indices regarding the perception of the physical and social characteristics of the neighborhood environment were developed. Subsequently, a higher-level hierarchical index concerning the neighborhood environment as a whole, composed of the two preceding indices, was developed. Different models of association between the neighborhood environment indices and the frailty syndrome were tested, including depression and level of physical activity as mediating variables, and age, sex, income, education, marital status, and race as confounding adjustment covariates. For the analyses, a subsample of elderly individuals who participated in the first wave of ELSI-Brazil was used, comprising 3514 individuals aged 60 years and older, with a median age (Interquartile Range) of 68 (63 to 75) years and residing in urban areas. The measurement models of the developed indices demonstrated appropriate properties in terms of convergent validity, absence of multicollinearity, and overall adequate weights and loadings. In the model with the best explanatory and predictive performance, as well as the best fit to the observed data, the perceived neighborhood environment index showed no association with the frailty syndrome (β: 0.04, 95% CI: -0.00 to 0.08, P=0.06) or with the participants' level of physical activity. On the other hand, an association was observed between the neighborhood environment index and the occurrence of depressive symptoms (β: 0.14, 95% CI: 0.10 to 0.18, P<0.001), and between the level of physical activity and frailty (β: -0.26, IC95%: -0.29 to -0.23, P<0.001). In conclusion, we developed and validated indices regarding the perception of older people about the characteristics of the neighborhood where they live and these indices may be used in future research involving the ELSI-Brazil study database. The absence of associations found between the emerging constructs related to the neighborhood environment and the practice of physical activity, as well as with the occurrence of the frailty syndrome, draws attention to a little-studied aspect of the health of older individuals in the Brazil and signals the need for further studies to confirm these findings and understand their underlying reasons. The observed association between the indices related to the neighborhood environment and the occurrence of depression among older adults residing in the community, despite the inherent limitations of cross-sectional studies, suggests the possibility of intersectoral and collective approaches aimed at the mental health of these populations.
Descrição
Palavras-chave
Pessoa idosa, Ambiente da vizinhança, Síndrome de fragilidade, Atividade física, Depressão, Modelagem por equações estruturais, Aged, Neighborhood characteristics, Frailty, Depression, Structural equation modeling, Partial least squares
Como citar
BENATTI, Leandra Navarro. Desenvolvimento de índices relacionados à percepção das características do ambiente da vizinhança e avaliação da sua associação com a Síndrome de Fragilidade em idosos. Orientador(a): Edison Iglesias de Oliveira Vidal. 2024. Tese (Doutorado em Saúde Coletiva) - Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, 2024.