Is cognitive decline in the elderly associated with contextual income? Results of a population-based study in southern Brazil.

The aim of this study was to estimate the association between contextual income and cognitive decline in the elderly in Florianópolis, a medium-sized city in southern Brazil. A nested cross-sectional study was performed in a cohort of elderly ≥ 60 years (n = 1,197), interviewed in the second wave (2013/2014) of the EpiFloripa cohort. Cognitive decline was assessed with the Mini Mental State Examination (MMSE) and contextual income was measured as the mean monthly income of the heads of households. Individual adjustment variables were sex, age, skin color, per capita household income, years of schooling, and time living in the neighborhood. The data were analyzed using multilevel logistic regression. The odds of cognitive decline were twice as high (OR = 1.99; 95%CI: 1.03; 3.87) in elderly living in census tracts with the lowest income quintile compared to those in the highest quintile, independently of individual characteristics. In conclusion, the socioeconomic environment is related to cognitive decline and should be considered in public policies with a focus on health of the elderly.

[1]  K. Anstey,et al.  Life Expectancy with and without Cognitive Impairment in Seven Latin American and Caribbean Countries , 2015, PloS one.

[2]  Jane Wardle,et al.  Internet use, social engagement and health literacy decline during ageing in a longitudinal cohort of older English adults , 2014, Journal of Epidemiology & Community Health.

[3]  Marta Maria Alves da Silva,et al.  A implementação das prioridades da Política Nacional de Promoção da Saúde, um balanço, 2006 a 2014 , 2014 .

[4]  J. Ayuso-Mateos,et al.  Built Environment and Elderly Population Health: A Comprehensive Literature Review , 2014, Clinical practice and epidemiology in mental health : CP & EMH.

[5]  Y. Duarte,et al.  Correlates of above-average cognitive performance among older adults: the SABE study. , 2014, Cadernos de saude publica.

[6]  C. Brayne,et al.  The association between community environment and cognitive function: a systematic review , 2014, Social Psychiatry and Psychiatric Epidemiology.

[7]  H. Amièva,et al.  Change in leisure and social activities and risk of dementia in elderly cohort , 2014, The journal of nutrition, health & aging.

[8]  Anita Liberalesso Neri,et al.  Metodologia e perfil sociodemográfico, cognitivo e de fragilidade de idosos comunitários de sete cidades brasileiras: Estudo FIBRA , 2013 .

[9]  G. Koh,et al.  Individual and Area Level Socioeconomic Status and Its Association with Cognitive Function and Cognitive Impairment (Low MMSE) among Community-Dwelling Elderly in Singapore , 2012, Dementia and Geriatric Cognitive Disorders Extra.

[10]  J. Antunes,et al.  Is income area level associated with blood pressure in adults regardless of individual-level characteristics? A multilevel approach. , 2012, Health & place.

[11]  M. Silveira,et al.  Cognitive impairment, the Mini-Mental State Examination and socio-demographic and dental variables in the elderly in Brazil. , 2012, Gerodontology.

[12]  C. M. Trentini,et al.  Qualidade de vida, cognição e desempenho nas funções executivas de idosos , 2012 .

[13]  Eleonora D’orsi,et al.  Atividade física e percepção do ambiente em idosos: estudo populacional em Florianópolis , 2012 .

[14]  H. Arrighi,et al.  Mild cognitive impairment: Disparity of incidence and prevalence estimates , 2012, Alzheimer's & Dementia.

[15]  J. Ockene,et al.  Neighborhood socioeconomic status and cognitive function in women. , 2011, American journal of public health.

[16]  Michelle J Ko,et al.  The Urban Neighborhood and Cognitive Functioning in Late Middle Age , 2011, Journal of health and social behavior.

[17]  J. House,et al.  Cognitive function in the community setting: the neighbourhood as a source of ‘cognitive reserve’? , 2011, Journal of Epidemiology & Community Health.

[18]  Iúri Dacosta Leite,et al.  Factores asociados a la incapacidad funcional de los ancianos en Brasil: análisis multinivel , 2010 .

[19]  C. Depp,et al.  Successful aging: focus on cognitive and emotional health. , 2010, Annual review of clinical psychology.

[20]  K. Sheffield,et al.  Neighborhood context and cognitive decline in older Mexican Americans: results from the Hispanic Established Populations for Epidemiologic Studies of the Elderly. , 2009, American journal of epidemiology.

[21]  A. Roux,et al.  Next steps in understanding the multilevel determinants of health , 2008, Journal of Epidemiology & Community Health.

[22]  M. Glymour,et al.  Effects of social integration on preserving memory function in a nationally representative US elderly population. , 2008, American journal of public health.

[23]  D. King.  Neighborhood and individual factors in activity in older adults: results from the neighborhood and senior health study. , 2008, Journal of aging and physical activity.

[24]  C. Brayne,et al.  Community-level socio-economic status and cognitive and functional impairment in the older population. , 2008, European journal of public health.

[25]  D. Melzer,et al.  Neighborhood Deprivation, Individual Socioeconomic Status, and Cognitive Function in Older People: Analyses from the English Longitudinal Study of Ageing , 2008, Journal of the American Geriatrics Society.

[26]  Rosângela Minardi Mitre Cotta,et al.  Avaliação do declínio cognitivo e sua relação com as características socioeconômicas dos idosos em Viçosa-MG , 2007 .

[27]  Dóra Chor,et al.  Associação entre fatores contextuais e auto-avaliação de saúde: uma revisão sistemática de estudos multinível , 2007 .

[28]  D. Fone,et al.  Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis. , 2007, International journal of epidemiology.

[29]  A. D. Diez Roux,et al.  Neighborhoods and health: where are we and were do we go from here? , 2007, Revue d'epidemiologie et de sante publique.

[30]  Renato Peixoto Veras,et al.  Mini-Exame do Estado Mental: caractersticas psicomtricas em idosos ambulatoriais , 2006 .

[31]  T. Seeman,et al.  Urban neighborhood context, educational attainment, and cognitive function among older adults. , 2006, American journal of epidemiology.

[32]  L. Berkman,et al.  Neighborhood contextual influences on depressive symptoms in the elderly. , 2005, American journal of epidemiology.

[33]  Paulo Caramelli,et al.  Sugestões para o uso do mini-exame do estado mental no Brasil , 2003 .

[34]  K. Pickett,et al.  Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review , 2001, Journal of epidemiology and community health.

[35]  S. Robert.  SOCIOECONOMIC POSITION AND HEALTH: The Independent Contribution of Community Socioeconomic Context1 , 1999 .

[36]  O. Almeida.  [Mini mental state examination and the diagnosis of dementia in Brazil]. , 1998, Arquivos de neuro-psiquiatria.

[37]  Sonia Maria Dozzi Brucki,et al.  O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade , 1994 .

[38]  P. Bertolucci,et al.  [The Mini-Mental State Examination in a general population: impact of educational status]. , 1994, Arquivos de neuro-psiquiatria.

[39]  S. Folstein,et al.  “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician , 1975 .

[40]  I. Schneider,et al.  Socioeconomic profile of the elderly in Florianópolis: comparative analysis studies Perfil do Idoso 2002 and EpiFloripa Idoso 2009. , 2014, Revista brasileira de epidemiologia = Brazilian journal of epidemiology.

[41]  M. Haan,et al.  Original Contribution Neighborhood Socioeconomic Context and Cognitive Decline Among Older Mexican Americans: Results From the Sacramento Area Latino Study on Aging , 2011 .

[42]  R. A. Rodrigues,et al.  Características sociodemográficas, capacidade funcional e morbidades entre idosos com e sem declínio cognitivo , 2011 .

[43]  I. Kawachi.  Social cohesion, social capital and health , 2000 .