A decade of difference: cross-continental patterns of functional performance in Brazil and Europe within the WHO ICOPE framework.

Abstract

Global aging patterns are highly heterogeneous, especially in diverse socioeconomic contexts. We aimed to analyze the determinants of functional performance within the WHO's Integrated Care for Older People (ICOPE) framework. Functional performance was evaluated using basic and instrumental activities of daily living (BADL/IADL) from ELSI-Brasil and SHARE cohorts. Sociodemographic characteristics and the clinical domains of intrinsic capacity (mobility, vitality, cognition, psychological, and sensory functions) were also assessed. The final sample consisted of 4,825 participants from ELSI-Brasil and 25,978 from SHARE. Functional risks diverged significantly based on intrinsic capacity domains: i) mobility: handgrip strength was a stronger protective factor in Europe, while the walking speed was a unique BADL risk factor in Brazil (OR 1.16); ii) vitality: weight loss showed a significant BADL risk for Europeans (OR 1.18); iii) cognition: low self-perceived memory showed similar risk for IADL across both cohorts (SHARE OR 1.23 vs. ELSI-Brasil OR 1.22); iv) psychological: depression posed a higher independent risk in Europe (OR 1.67-1.71) than in Brazil (OR 1.26-1.53), while poor self-rated health reflected higher risk in the Brazilian context (BADL OR 2.72 vs. 2.07 in Europe); v) sensory function: hearing impairment was a stronger IADL risk in Brazil (OR 1.27), while vision was significant only in Europe (OR 1.32). Functional decline begins a decade earlier in Brazil than in Europe, reflecting socioeconomic disparities across intrinsic capacity domains. ICOPE strategies should be tailored to each societal context to promote equitable healthy aging.