Relação entre sintomas depressivos e capacidade funcional em idosos de um estudo de base populacional

Abstract

Introduction: Accelerated population aging imposes challenges to the maintenance of autonomy in old age. Mood alterations, such as depression, and functional decline are not normal consequences of aging, but severe aggravating factors to the health of older adults that demand territorial investigation in Primary Health Care. Objectives: To analyze the relationship between depressive symptoms and the functional capacity of community-dwelling older adults, investigating whether the severity of the depressive condition is differentially associated with the level of dependence in Basic (BADL) and Instrumental (IADL) Activities of Daily Living, in addition to identifying the influence of sociodemographic moderating factors. Methodology: A cross-sectional, descriptive, and quantitative epidemiological study conducted in Chapecó (SC), with 138 older adults from Primary Health Care. Between 2023 and 2024, this study employed a sociodemographic questionnaire, the Katz Index (BADL), the Lawton and Brody Scale (IADL), and the Geriatric Depression Scale (GDS-15). Data were analyzed using SPSS software through descriptive statistics, Pearson's Correlation, Binary Logistic Regression (Odds Ratio), and Pearson's Chi- square test. Results: The sample (mean age 72.1 years) was predominantly female (60.1%), white (79.7%), married (55.8%), and residing in urban areas (88.4%). Socioeconomically, the highlights were education up to middle school (39.9%) and income up to 1.5 minimum wages (63.8%). There was a very high prevalence of psychological distress, with 82.6% of the sample presenting depressive symptomatology (69.6% mild and 13% moderate to severe) and strong social withdrawal (74.6%). Functionally, 82.6% were independent for BADLs and 65.3% for IADLs. Pearson's analysis demonstrated that advancing age correlates with an increase in depressive symptoms (r = 0.248; p = 0.003) and with a decline in BADLs (r = -0.351) and IADLs (r = -0.454). Through categorical analysis, the Chi-square revealed a significant association between depression and BADL (p = 0.019; Fisher: p = 0.014), showing that 100% of older adults with basic dependence manifested depressive symptoms. Age group was also strongly associated with the dependence group in BADLs (p = 0.003) and IADLs (p < 0.001). Variables such as income, education, and sex did not demonstrate a significant impact in categorical tests, suggesting socioeconomic homogeneity in the territory. Logistic Regression pointed to autonomy as a protective factor for mental health. Discussion: The divergence between models indicates that essential biological self- care (BADL) remains preserved in the absence of symptoms but completely collapses in depressed individuals. In contrast, the robust negative linear correlation between the GDS-15 and IADLs demonstrates that psychological distress induces early social withdrawal and compromises the volitional initiative necessary to maintain an independent routine. Finally, the lack of impact of income and education variables evidences that the socioeconomic homogeneity and care support of the territory mitigate the polarization of these determinants in the sample. Conclusion: The study evidenced an alarming prevalence of depressive symptoms in the evaluated elderly population, directly associated with the loss of independence in daily activities. It becomes imperative that Primary Health Care adopts preventive strategies for continuous mental health screening coupled with functional assessment, aiming to preserve social participation and the autonomy of older adults in the community.