Aging
Double Risk: How Diabetes and Hypertension Impact Disability in Non- Institutionalized Brazilian Older Adults – Evidence from Two Population-Based Studies Rafaela Gonçalves Ribeiro Lucas* Rafaela Gonçalves Ribeiro Lucas Bárbara Niegia Garcia de Goulart Patricia Klarmann Ziegelmann
Introduction: Diabetes and hypertension are prevalent global comorbidities, particularly among older populations in low- to middle-income countries. Their complications increase mortality and impair quality of life and functional capacity, significantly affecting basic (ADL) and instrumental (IADL) activities of daily living. This study examines the impact of these conditions on moderate and severe disability among Brazilian older adults, using data from the 2013 and 2019 National Health Surveys.
Methods: Individuals aged ≥60 years were analyzed using Poisson regression with robust variance, adjusted for sampling design and confounding factors. Disability was assessed with the Katz and Lawton scales, categorized as moderate or severe. Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated separately for ADL and IADL.
Results: In 2013 and 2019, participant characteristics are: age 60–80 years (86.6%; 86.7%), women (59.3%; 55.1%), black/brown ethnicity (51.0%; 54.8%), and incomplete elementary education (69.2%; 65.4%). The prevalences were: severe ADL (5.3; 7.0) and IADL (17.7; 23.3); moderate ADL (10.3, 13.6) and IADL (14.0; 64.5). In 2013, diabetes and hypertension increased moderate ADL (PR=1.9; CI 1.4–2.6) and severe ADL disability (PR=2.0; CI 1.4–2.7). By 2019, the impact on moderate ADL disability decreased (PR=1.6; CI 1.4–1.8) but remained similar for severe ADL (PR=1.9; CI 1.7–2.3). In IADL, these conditions were associated with severe disability in 2013 (PR=1.4; CI 1.2–1.7) and with the moderate (PR=1.2; CI 1.19–1.22) and severe disability (PR=1.66; CI 1.6–1.7) in 2019.
Conclusion: From 2013 to 2019, the coexistence of diabetes and hypertension significantly impacted moderate and severe disability, particularly in IADL, with progression linked to aging. These findings emphasize the need for public policies targeting disease management and functional support for older adults, especially in the Americas.