Banca de DEFESA: LUANA CAROLINE DE ASSUNCAO CORTEZ CORREA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : LUANA CAROLINE DE ASSUNCAO CORTEZ CORREA
DATE: 11/09/2024
TIME: 08:30
LOCAL: Remoto
TITLE:

Intrinsic Capacity and Disability in Older Population Samples: Gender Differences, Socioeconomic Factors, and Biomarkers Influences

KEY WORDS:

Gender Differences, Sex Differences, Aging, Disability, Socioeconomic Factores, Aging, Intrinsic Capacity.

PAGES: 120
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

INTRODUCTION: Disability is a dynamic process that represents the decline in functionality in the physical and mental domains of individuals. In turn, Intrinsic Capacity (IC), according to the World Health Organization, is a composite of an individual's physical and mental abilities that can estimate healthy aging in elderly populations. Both concepts can be influenced by the sociocultural environment, differences between men and women, and inflammatory processes present in the aging process. This thesis aims to assess the associations between levels of functional disability and intrinsic capacity in elderly populations with different socioeconomic profiles of aging.

OBJECTIVES: #Paper 01: To estimate IC levels in a community-dwelling elderly population and identify factors associated with the decline in IC in both genders. #Paper 02: To investigate whether the cross-sectional and longitudinal associations between blood biomarkers related to inflammation and neurodegeneration and IC differ by sex. #Paper 03: To determine whether the associations between socioeconomic status (SES) and late-life disability differ by gender in a multicultural sample.

METHODS: This thesis is composed of three Papers. #Paper 01 and #Paper 03 used cross-sectional data from the third wave of the International Mobility and Aging Study (IMIAS), collected in 2016. Specifically, #Paper 01 analyzed data from 1,484 older adults. Based on a reflective methodology, four functions were selected from the IMIAS database to assess IC domains: i. locomotion (Short Physical Performance Battery), ii. cognition (Leganes Cognitive Test), iii. vitality (Handgrip Strength), and iv. psychological well-being (Center for Epidemiologic Studies Depression). A composite IC score was calculated (ranging from 0 to 100; higher is better). Socioeconomic and health-related factors included: age, marital status (single, married, divorced/widowed), educational level (low, medium, and high), income sufficiency (not/not very well, reasonably well, very well), occupation (manual and non-manual), number of chronic conditions (≤1, 2-3, and ≥4), body mass index (underweight/normal weight, overweight, obesity), and history of falls in the last year (yes and no). Multiple linear regression analyses were used to investigate factors associated with the decline in IC in both genders. #Paper 03 assessed late-life disability in 1,362 older adults using the frequency and limitation components of the Late-Life Function Disability Instrument (LLFDI). SES was collected through self-report using the following variables: i. educational level (elementary, secondary, higher education), ii. income sufficiency (not/not very well, reasonably well, very well), and iii. occupation (manual and non-manual). Multiple linear regression models were used to examine gender-specific associations between late-life disability (frequency and limitation subscales) and SES. Finally, #Paper 02 used longitudinal data from 1,117 older adults (<70 years, 63.8% female) from the Multidomain Alzheimer Preventive Trial (MAPT). IC domains were operationalized using the following functions: i. cognition (Mini-Mental State Examination), ii. locomotion (Short Physical Performance Battery), iii. vitality (Handgrip Strength), and iv. psychological well-being (Geriatric Depression Scale), each scaled from 0 (worst possible IC) to 100 (best possible IC). Biomarkers related to inflammation and neurodegeneration included: i. Interleukin 6 (IL-6, pg/mL), ii. Growth Differentiation Factor 15 (GDF15, pg/mL), iii. Tumor Necrosis Factor Receptor 1 (TNFR1, pg/mL), iv. Neurofilament Light Chain (NfL, pg/mL), v. Progranulin (PGRN, ng/mL), and vi. Beta-Amyloid protein (Aβ42/40). Linear mixed models were conducted to examine whether sex modified the cross-sectional and longitudinal association between biomarkers and IC.

RESULTS: The results of #Paper 01 indicated that women exhibited significantly lower IC scores compared to men (M = 77.43, SD = 9.06 vs. M = 72.26, SD = 9.31, p < 0.001). Age, study sites, marital status, multiple chronic conditions, and history of falls were negatively associated with IC scores in both genders. Additionally, insufficient income (B = -2.130, p = 0.043) and obesity (B = -1.645, p = 0.039) were negatively associated with IC scores in women, while low educational level (B = -2.124, p = 0.012) was negatively associated with IC scores in men. For #Paper 02, no significant interaction effect was observed at baseline. Longitudinal analyses revealed a significant interaction between sex and IL-6 (p = 0.005), such that higher levels of IL-6 tended to be associated with a faster decline in IC score for men (B = -0.385; p = 0.055; 95% CI = -0.778; 0.008), but not for women (B = 0.287; p = 0.041; 95% CI = 0.011; 0.563). In #Paper 03, low educational level (B = −3.11 [95% CI −4.70; −1.53]) and manual occupation (B = −1.79 [95% CI −3.40; −0.18]) were associated with a decrease in participation frequency for men, while insufficient income (B = −3.55 [95% CI −5.57; −1.52]) and manual occupation (B = −2.25 [95% CI −3.89; −0.61]) played a negative role in participation frequency for women. For both men (B = −2.39 [95% CI −4.68; −0.10]) and women (B = −3.39 [95% CI −5.77; −1.02]), insufficient income was the only factor associated with greater perceived limitation during daily tasks.

CONCLUSIONS: It is concluded that: #Paper 01: Women exhibited lower IC scores compared to men. Age, study sites, multiple chronic conditions, and history of falls were factors associated with the reduction in IC in both genders. Educational level seems to particularly influence IC in men, while insufficient income and obesity are more significant factors for women. These findings highlight the need for gender-specific strategies to address the distinct determinants of IC, aiming to promote healthier aging in older adults. #Paper 02: Among all biomarkers, only IL-6 showed sex-dependent associations; over 4 years, it tended to be associated with a rapid decline in IC in men, but not in women. A possible sex-dependent effect of inflammatory status on IC should be further investigated. #Paper 03: Men and women experienced different late-life disability trajectories. For men, occupation and education were associated with a decrease in participation frequency, while for women, this reduction was associated with income and occupation. Income was associated with perceived limitation during daily tasks for both genders.

COMMITTEE MEMBERS:
Externa ao Programa - 1195933 - ANA CAROLINA PATRICIO DE ALBUQUERQUE SOUSA - nullExterno à Instituição - ETIENE OLIVEIRA DA SILVA FITTIPALDI - UFPE
Externa à Instituição - JULIANA MARTINS PINTO
Presidente - 350637 - RICARDO OLIVEIRA GUERRA
Interna - 3885543 - SAIONARA MARIA AIRES DA CAMARA