Habilidade funcional em pessoas idosas na atenção primária à saúde: construção de um escore integrado e análise de fatores associados

Abstract

Introduction: Functional ability is defined as the process of developing and maintaining capacities that enable well-being in old age. More specifically, the World Health Organization (WHO) describes it as the set of health-related attributes that enable older people to "be and do what they have reason to value." Objective: To measure the functional ability of older people followed up in Primary Health Care Units (PHCUs) using a standardized composite score, integrating physical-instrumental, social, and environmental dimensions of functioning, and to analyze their associated factors. Methods: A cross-sectional study was conducted with older people (≥60 years) registered in Primary Health Care Units, capable of traveling to the data collection site. Individuals with severe frailty or severe cognitive impairment were excluded. Functional ability was assessed using an integrated score composed of three dimensions: physical-instrumental, social, and environmental. The physical-instrumental dimension was obtained from standardized scores (0–100) of the Barthel Index, the Lawton and Brody Scale, and the sit-to-stand test, while the social dimension was measured by the social relations domain of the WHOQOL-BREF, and the environmental dimension by the environment domain of the WHOQOL-BREF, also standardized. The overall score resulted from the weighted combination of these dimensions, with greater weight given to the physical-instrumental dimension. The analyses sought to describe the sample profile, construct the overall score, and examine its associations with associated sociodemographic, clinical, behavioral, and functional variables, adopting a significance level of 5%. Results: the sample (n = 826; 65.3% women; mean age 70 years) presented a mean functional ability score of 82.4 points, with 33.3% of the elderly at a low level. Confirmatory factor analysis revealed distinct contributions from physical-instrumental, social, and environmental components to the composition of functional ability, reinforcing its multidimensional nature. Regression analysis demonstrated that low levels of functional ability are associated with poorer health perception, lower levels of physical activity, a greater number of comorbidities and falls, as well as a higher risk of sarcopenia. Among sociodemographic variables, low levels of functional ability were associated with fewer years of schooling and lower income. Conclusion: functional ability is predominantly influenced by modifiable clinical and behavioral factors, with emphasis on self-perception of health and level of physical activity, in addition to being positively impacted by better education and income. These findings highlight the relationship between functional ability and modifiable variables. This reinforces the need for public policies aimed at mitigating socio-structural inequalities and integrated strategies in Primary Care to monitor and optimize healthy aging trajectories.