Aging and Urbanization: The Neighborhood Perception and Functional Performance of Elderly Persons in Belo Horizonte Metropolitan Area-Brazil

Abstract

Currently, half of the world population resides in cities. The percentage of world population that is elderly is expected to double from 11% to 22% by 2050 and will be concentrated in urban areas of developing countries. The purpose of this study was to evaluate the functional status of elderly who live in the Belo Horizonte Metropolitan Area, Minas Gerais State, Brazil. The International Classification of Functioning, Disability and Health (ICF) was employed as the theoretical model. Probabilistic sampling was used to select 1,611 elderly persons (defined as >/=60 years) for the study. The response variable "functional performance" was developed by counting the number of basic and instrumental activities of daily living (ADL) that subjects found difficult to carry out. A zero-inflated negative binomial (ZINB) regression model was fitted to the data. The prevalence of disability was 47.1%. Neighborhood self-perception revealed that 84.0% of the elderly were satisfied with their neighborhood, although only 18.4% trusted people around them. Concerns about walking around the neighborhood were: fear of being robbed (78.0%) and fear of falling due to sidewalk defects (48.2%), which caused a 62% increase in the number of ADL carried out with difficulty. It is well known that there is a continuous tendency for functional results to improve as the frequency of walking increases. Thus, urban infrastructure interventions, such as improving public sidewalks, might influence the frequency of elderlies walking in their neighborhoods. Making walking possible-or even pleasant-could increase their social participation and use of services.

FIGURE 1

Theoretical model of the relation among different domains included in the study. Adapted from the 2001 International Classification of Functioning, Disability and Health (World Health Organization).

FIGURE 2

Assessing model fit, difference in observed proportion and mean predictive probability using Poisson (PRM), negative binomial (NBRM), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) models. The ZINB model is the best fitting model with fewer points above and below zero on the y-axis.

FIGURE 3

Distribution of the response variable “functional performance” base on counting the number of basic and instrumental activities of daily living (ADL) that elderly subjects found difficult to carry out. Fifteen ADL were taken into account.