Goals: To evaluate the degree of functional capacity of older people sequellated by leprosy. at the General Hospital Dr. Geraldo da Rocha, Manaus, Amazonas, Brazil

Methods: Cross-sectional qualitative-quantitative approach, using a form of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), complemented with sociodemographic information.

Results: the subjects were 34 older people, 21 women and 13 men. The female gender had a representation of 61.75% and the male of 38.25%. Of these older women, 33.33% were illiterate; in older males, this percentage was 61.54%. Questioned about the civil status, 23.81% of the older women and 23.08% of the older men affirmed to be married; 47.62% of the older women and 46.15% of the older men were widows. About economic situation 52.94% survived with 01 minimum wage. In relation to health status, 57.14% of the older women interviewed considered having good health, despite the sequelae left by leprosy, in contrast, only 38.46% of the older men reported having this same health status. In relation to memory, 61.90% of the older people stated that they had a good memory. Among the older people who participated in the survey 82.35% had a modified independence in relation to all daily activities. The greatest difficulty faced by these older people was to use public transportation for which 92.24 of older women and 100.00% of older men reported some degree of difficulty.

Conclusion: This study provides important basic information on the situation of older people sequellated or affected by leprosy at the Leprosy General Hospital Dr. Geraldo da Rocha and it can serve as a basis for managers at the hospital, municipal and state levels to make the necessary decisions that lead to an improvement in the quality of life of these older people affected by this disease, institutionalized or not, in the same or different health conditions.

Keywords: older people, leprosy, functional capacity

ADLs, activities of daily life; IADLs, instrumental activities of daily life; UEA, universidade do estado do amazonas; TCLE, termo de consentimento livre e esclarecido (free and informed consent form); AM, amazonas; IBGE, instituto brasileiro de geografia e estatística; CEP, comitê de ética em pesquisa (research ethics committee).

The natural process of aging brings with her physiological stress and pathologies, often of a genetic nature, degenerative and chronic diseases.¹ Since aging is a dynamic and progressive process in which there are morphological, functional and biochemical alterations that go altering progressively the organism, making it more susceptible to aggressions.² It is noticed that in the changes related to age are the presence of risk factors and the occurrence of chronic degenerative diseases, which determine for older people a certain degree of dependence, directly related to the loss of autonomy and difficulty to perform the basic activities of daily living, interfering in their quality of life.^3,4

One of the pathologies that leave many sequelae is leprosy and this can be observed mainly in the older people due to the fact that the disease has a slow development. As we know, leprosy is an infectious, degenerative and transmissible disease caused by bacillus Mycobacterium leprae^5,6 (also knew as Hansen´s bacillus). Its nervous manifestations are always present because the peripheral nervous system is the place where the M. Leprae develops, thus causing sensitivity disorders in the affected nerve region and in skin lesions. The most affected nerves are the radial nerve (which when affected prevents the extension of the hand, producing the so-called "fallen hand"), the cubital nerve, the median nerve on the wrist, the external sciatica-popliteal nerve (when affected preclude the foot from remaining in the normal position and makes the gait), the posterior tibial and the upper branch of the vagus nerve,⁷ leading people who suffer from this disease, gradually to the loss of their functional capacity.^8,9

The functional capacity, especially in the motor dimension, is one of the most important markers of a successful aging and quality of life of the older people.¹⁰ The loss of this capacity is associated with prediction of fragility, dependence, institutionalization, increased risk of falls, death and mobility problems, bringing complications over time, and generating long-term care and high cost. It has been found that it is much easier to avoid deaths than to avoid the development of disabilities associated with aging. Each year, about 10% of the adult population, life, such as bathing, dressing, eating and personal hygiene.¹¹

The functional capacity is the independence to perform the activities of daily living.¹² However, the functional capacity goes beyond the performance of daily Activities. This is the ability to maintain the physical and mental skills necessary for an independent life, valuing autonomy and self-determination.¹³ Therefore, from these concepts it can be understood that functional capacity is a set of physical, intellectual and emotional needs that each individual has and must have. The factors most strongly associated with functional capabilities are related to the presence of some diseases, disabilities or medical problems. However, it is observed through some studies that this capacity is influenced by factors such as demographic, socioeconomic, cultural and psychosocial factors.¹⁴

Some researcher as Katz et al.;¹⁴ Lawton e Brody.¹⁵ Paula¹⁶ proposed two scales of functional assessment that classified daily activities in consensus to their level of complexity. The first scale, the activities of daily living (ADLs), is represented by the basic activities that are required in the daily lives of the older people. While the second scale, which concerns about instrumental activities of daily living (IADLs), is represented by more complex tasks that require an adaptation of the individual in the environment. The ADLs and IADLs are activities that, for the older people, have a high degree of complexity, especially for those older people with leprosy sequelae.

Functional capacity is considered a new health paradigm,¹⁷ being of crucial value for prevention and health promotion of the older people. It is thought that of we realized researches in this sense, we will be able, in the future, to diagnose, treat, rehabilitate and avoid in the older people these kinds of complications. In this respect, the study aimed to evaluate the functional capacity and sociodemographic conditions of older people sequellated by leprosy in the Dr. Geraldo da Rocha Hospital, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil.

Type of Study     

This research was a cross-sectional, descriptive study, and from the statistical point of view it had a qualitative-quantitative approach.

Place of study

The research was developed at the Dr. Geraldo da Rocha hospital, located at Tancredo Neves Street - s/n - Tancredo Neves Square - Antônio Aleixo District, Manaus, Amazonas. This hospital was founded in 1978, starting its activities since 1942 with the name of Leprosarium of Aleixo and is specialized in providing bio-psycho-social care to patients and former carriers of leprosy. The hospital has 102 (one hundred and two) operating beds for clinical treatment only.

Population

The research consisted of a census of all the older people sequellated by leprosy residents in the hospital, who, at moment of this research, currently represented a population of 34. Of these, 13 were men and 21 were women.

Inclusion/exclusion criteria

The inclusion criteria considered were: 1) age ≥ 60 years, 2) currently residing at the hospital Dr. Geraldo da Rocha, 3) agreeing to participate in the research, and 4) signing the informed consent form (ICF). The exclusion criteria were: 1) not being 60 years old or older; 2) not residing in the hospital; 3) not agreeing to sign the informed consent form (ICF); 4) although residing in the hospital, not being found during the days of the interview.

Data collection instrument

As instrument for data collection, we used an individual structured interview script (questionnaire), with both open and closed questions. The questionnaire used was adapted from Fonseca¹⁸ and complemented with others.^19,20 It contained questions related to the socio-demographic, economic and epidemiological profile, and on the functional capacity of the older people sequellated by leprosy.

Ethical aspects

This research involving human beings was approved by the Secretaria Municipal de Saúde de Manaus (SEMSA) (Manaus Municipal Health Secretariat) and the Comitê de Ética em Pesquisa (CEP) (Research Ethics Committee) da Escola Superior de Saúde (School of Health Sciences) of Universidade do Estado do Amazonas (UEA) (University of the State of Amazonas) (process number - 052/09, 11/05/09) observing the resolution 196/96, of the Comitê Nacional de Ética em Pesquisa (CONEP) (National Commission for Ethics in Research), regarding the rights of individuals subject to research, related to ethical principles such as: study benefits, privacy, non-maleficence, justice, autonomy and veracity.

Data collection

After approval by Ethics Committee, the study subjects were informed about the objective, necessity and importance of the project. As the subjects agreed, they signed the ICF, consenting with the participation of the research. Interviews and data collection were conducted in the morning and afternoon hours at the hospital Geraldo da Rocha, Colônia Antônio Aleixo, with the collaboration of nurses and other health agents who were willing to collaborate, after a brief presentation of the researchers and the research project to the older people sequellated by leprosy. In cases where the older people for some reason could not respond to the interview, an indirect interview was conducted with the caregiver of them. It is worth mentioning that all interviewees or caregivers interview also had to sign the ICF.

Data analysis

The collected data were organized in a database Microsoft Office Excel v. 2010 for subsequent statistical analysis. Data pertinent to the socio-demographic, economic and epidemiological profile and on the capacity of the older people to perform activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were analyzed using descriptive statistics.^20–25 Data were analyzed with the following softwares: Minitab v.14, SPSS v.20 and Epi Info v.6.

The group of older people studied was thirty-four (34). The female gender had a representation of 61.75% and the male of 38.25%. This result confirms the Brazilian reality with respect to a higher index of older women in relation to older men in the third age.^26–28 Of these older people, illiterate older women were 33.33%; already for older males, this percentage was 61.54% (Table 1). These percentages are compatibles with 11,00% completed primary school obtained by Alves et al.²⁹ in Juiz de Fora, Minas Gerais. While Hurtado-Guerrero et al.²⁸ in Manacapuru, Amazonas, reported that 35.90% had uncompleted primary school.

Questioned about marital status, 23.81% of older women and 23.08% of older men said they were married; 47.62% of older women and 46.15% of older men were widows (Table 2). As confirmed by Ricci et al.^30,31 there is a high prevalence of widowed, divorced or single older people, data also attested by the present study. The fact that an older people does not have a spouse can directly influence their self-care, since the lack and especially the loss of a company can lead to depression and thus the them may become displeased with their physical and physiological needs, thus becoming more vulnerable to various diseases.

In the identification of the professional activities exercised by the older people previously, since 100% of the interviewees were retired, the following ones were found: agriculture was the predominant profession in this group (41.06%) and other such as: domestic works, carpentry, health, car mechanics and general services, represented (58.94%), similar situation found in other studies.^32,33 The main cause why older people getting to be all retired was mutilations, especially in limbs, caused by Hansen's bacillus, thus making retirement wages the only source of income for all them, coinciding with the research of Nogueira et al.³⁴ when it analyzed the functional capacity of the older people with leprosy in Fortaleza. Agriculture appears as a predominant activity exercised by the older people before the sequels left by leprosy, due to the fact that them come from various interior settlements in which one of the most profitable and viable activities is the cultivation of land.

Through the study it was also possible to make an analysis of the economic situation of this older people, being observed that 52.94% of the interviewees received only 01 minimum wage and only 11.76% received 04 minimum wages monthly.

As stated by above percentages, most of the population surveyed has a monthly income of only one minimum wage. Ramos^26,33 affirmed that the financial situation of the older people is directly related to their physical and mental health and is associated with the low functional capacity present mainly in those older people with low income. In conformity with data from IBGE,^27,35 the economic conditions of the interviewees are compatible with those of the older people of the country as a whole, considering that about 50,00% of the them in Brazil have a monthly income lower than or equal to a minimum wage.

This study also sought to identify the social participation of these older people, to know their level of social inclusion, since these older people sequellated by leprosy are constantly targeting of bullying prejudiced attitudes due to their mutilations resulting from the advancement of the disease. It was observed that only 35.29% of these individuals practice some social activity, while 64.71% never participated of such Activities. However, all reported to participate only in religious groups. Several studies have claimed that religion can reduce the fear of death experienced by some older people.^36–40 Through his study^36,39 with older people who had depression, these researchers demonstrated that mental health also improves with religiosity, and these people recovered 70.00% faster than the others.³⁶

With regard to the care of the older people in cases of illness or help, in general, this study found that the caregivers are, in the vast majority of cases, of the family itself, especially represented by sons (44.12%) and grandchildren 23.53%). Others such as: wives, friends, health workers and volunteers (32.35%). The others, concern people who work for them doing household chores, since they have no relatives or friends who could help them. As stated by diverse studies,^41–43 the household arrangement showed that Brazilians older people still live, mostly, sharing the household with children and sometimes with children and grandchildren. This type of household can be called multigenerational and accommodates 50,00% of the older people in this country. For this reason, the data confirm a more intense family support to the them. In contrast, this situation is not experienced in the countries of Europe, since the older people population of these countries lives mostly alone.

The older people also were asked to inform how they classified their state of health and memory. Regarding health status, 57.14% of the older women interviewed considered having good health, despite the sequelae left by leprosy. In contrast, only 38.46% of older men reported having this same health status. In relation to memory, 61.90% of the older women and older men stated that they had a good memory (Table 3). As explained before, most of the them considered themselves to be in good health. And most of them in this study, when analyzing the variables of functional capacity, have some degree of dependence.^4,44 This research confirms a previous study which was found to be at greater risk, for the development of functional disabilities, older people who have a more pessimistic assessment in relation to their health status.^29,45 The aging process is a period of life in which there is the appearance and prevalence of chronic diseases, physical disability, cognitive loss^46,47 and social isolation. The results of this research show that 85.29% of the them self-evaluate their health as good or regular, being compatible with another studies^2,57, in which 60.00% of the interviewed older people declared to have good health and only 6% considered to have a very poor state of it.

When asked about the pain, 89.29% of the older people who responded to the survey reported feeling pain constantly in at least one part of the body (Figure 2). As it is showed, the most affected body segments were: eyes (17.24%), spine (17.24%), legs (13.79%), bones (13.79%) and hands (10.34%). Other health concerns represented (27,6%). In this group studied there is a particularity in relation to eye pain, since they had the loss of visual capacity more pronounced than in the another older people, because the bacillus that causes leprosy affects the anterior segment of the eye being the iris most affected.^48,49 Pain in the limbs and joints are also common in the older people sequellated by leprosy because M. leprae also affects the peripheral nerves causing pain and mutilation.

Figure 1 Income distribution of older people sequellated by leprosy in the hospital Dr. Geraldo da Rocha, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil.
Source: authors.

Figure 2 Body location of pain experienced by the older people sequellated by leprosy in the hospital Dr. Geraldo da Rocha, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil.
Source: authors

The older people who said to have independence to take their medications at the right time represented 88.24% of those surveyed. It was observed that 11.76% of the interviewees needed help to remember that they should take their medications, to take them at the right time or to pick them up. This result is similar to that identified by other studies,^50–52 who in their researches showed that 12.4% of all older people had the same difficulties to take the medications as those of the Hospital Dr. Geraldo da Rocha.

This study sought to identify the older people who make use of self-medication, that is, regarding the purchase of medicine without a prescription, excluding the cases in which them return to purchase a medicine previously prescribed. It was found that among older women this practice is present in 38.10% of the interviewees. This percentage rises to 46.15% to older male, with an average of 41.18% for both older people making use of self-medication. Self-medication is a very common practice adopted by the vast majority of the population. The main causes for its existence are: the great impossibility of a good part of the people to have an access to the medical or odontological attendance either for financial questions or for proper habit to try to solve the problems of ordinary health, besides the high frequency of advertisements through the electronic media that is many times a contributing factor for the self-medication of lay people in the subject.⁵³ Self-medication may result in a drug interaction that is when drugs that are administered concomitantly interact with each other. They can interact in three basic ways: one can potentiate the action of another, can also occur the loss of effects by opposite actions or even the action of a drug altering the absorption, transformation in the organism or the excretion of another drug harming thus the welfare and health mainly of the older people.⁵⁴

Through the instrument of evaluation of the basic activities of daily life (ADLs) and of evaluation of the instrumental activities of daily life (IADLs) it was verified that, in general, only 14.28% of women and 23.08% of men need help to perform these activities (Table 4).

The basic and instrumental activities of daily living proved to be more complex for the older men with leprosy sequelae than for older women with the same conditions, being this result compatible with the study conducted by Lima.⁵⁵ The general autonomy index of leprosy sequelae are similar to that of the older people who participated in the study by Alves,²⁹ in which only 5.9% of them presented a high dependence. Asked about the level of autonomy to perform activities of daily living (ADLs) associated with self-care, it was found that 91.18% of the older people do not report any difficulty to feed themselves, but 8.82% do it only with the help of another person at some point, such as when cutting food. With regard to food preparation, it was observed that 17.65% of the interviewees performed this activity with a small degree of difficulty due to problems in handling the utensils. This study found that 100,00% of the older people are totally independent to take a bath and no difficulty to perform this activity was reported. Already for dressing, a slight difficulty was reported by only 8.82% of people with no difference between genders (Table 5). As in other studies conducted older people, there is not much difficulty in bathing, taking medication, dressing and eating.^8,9

A slight difficulty was observed in the preparation of food, which was also identified in the study by Nogueira,⁹ whose rate of older people in need of assistance was 17.15%, thus being very similar to this research. This study is also compatible with the study conducted by Navarro⁵⁶ in which all the older people had a score compatible with independence in the scale of basic activities of daily living.

Another activity analyzed was the ability of the older people to cut their own nails. A greater difficulty was observed among older women who presented total dependence to cut their nails representing 14.29% (Table 6). This difficulty, reported by them was due to the fact that they have the impairment of the peripheral nerves, thus becoming without strength and/or dexterity to perform there. Another fact cited for this level of difficulty was the absence of some essential fingers for the exercise of this activity.

The ability to control the sphincters showed no difference between the sexes. It was observed that among both older people interviewed, 67.65% had their urinary continence preserved. Considering the control of the fecal sphincter, 64.71% of the them had total control (Figure 3). Among the older people participants in the study, 32.35% of them reported some degree of difficulty in controlling the urinary sphincter. This result was consistent with the study by Nakatani,⁵⁰ in which 28.60% of the older people reported difficulty in controlling the urinary sphincter. Already for fecal sphincter, 35.29% show difficult to control the fecal sphincter, results very different to 6.60% to the above Autor, concluding that the older people have some degree of difficulty in controlling them. When the older people have urinary or fecal incontinence, many times it can go through embarrassing situations, leading them to restrict themselves in their home environment. This condition contributes to diseases such as loneliness, depression and cognitive impairment. It is recommended to the health team to identify and assess the reason for incontinence and create conducts that lead to the recovery of sphincter control.⁵⁰

Figure 3 Degree of control of urinary and fecal sphincters among the older people sequellated by leprosy in the hospital Dr. Geraldo da Rocha, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil.
Source: Authors.
D1, total dependence; D2, need for 75% aid; 3D,need for 50% aid; D4, need for 25%aid; D5, need for supervision; D6, need for minimum aid; D7, indepence.

Asked on the ability of the older people to move, it was found that only 29.41% can walk indoors without help. The percentage of them who considered themselves independent to climb stairs was 32.35%, with no difference between the sexes (Figure 4). The difficulty of locomotion, such as walking indoors and climbing stairs, presented by the vast majority of the older people in this study, has also been mentioned in other studies, such as the studies^9,44,45 but, in particular, in older people who had sequelae left by leprosy, these rates tend to be higher once the Hansen's bacillus reaches the peripheral nerves, deteriorating the sensitivity and functionality of the upper and lower limbs.^7,8,34

Figure 4 Degree of dependence to climb stairs and walk indoors among the older people sequellated by leprosy in the hospital Dr. Geraldo da Rocha, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil.
Source: Authors

D1, total dependence; D2, need for 75% aid; 3D,need for 50% aid; D4, need for 25%aid; D5, need for supervision; D6, need for minimum aid; D7, indepence.

It was found a great difficulty among the older people sequellated by leprosy in using public transportation. There was a prevalence of almost total dependence for this activity among older men reaching the index of 76.92%, while in older women this index was 28.57% (Figure 5).

Figure 5 Degree of dependence for the use of public transportation among the older people sequellated by leprosy in the hospital Dr. Geraldo da Rocha, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil. 

D1, total dependence; D2, need for 75% aid; 3D,need for 50% aid; D4, need for 25%aid; D5, need for supervision; D6, need for minimum aid; D7, indepence.

According to the studies^{8,34,34,44,45} about older people, them were totally independent to use public transportation represented approximately 21.4%. As claimed for these researchers, the older people with sequelae due to leprosy are in a less favorable situation, since they have an enormous difficulty to use public transportation due to several factors, among the main reasons that were reported are: the lack of strength and many times of members to get on, hold and balance in the bus.

In this study, it was found that 28.57% of the older women and 23.07% of the older men had some difficulty standing (Figure 6). In this item, it was observed only the ability of the older people to get up and stand, without taking into account the ability to remain in this position or walk.

Figure 6 Degree of dependence to stand among the older people sequellated by leprosy in the hospital Dr. Geraldo da Rocha, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil.
Source: Authors.

Many of the older people participants in the study have difficulties in walking, since the vast majority have impairment, for example, by amputation of one of the lower limbs making it impossible for them to stand or remain standing. For this reason, they used trolleys that help them to move around, but it becomes difficult with these instruments to climb stairs and use public transportation, thus impairing the ability to come and go of them.

Taking into consideration the ability of these older people to pick up objects on the floor, it was found that there were most older men with difficulties in relation to older women. Among older men, this difficulty, in general, was present in 76,92% while among older women this percentage was 57.14% (Table 7). In total, 64.71% of older men and older women reported difficulties in picking objects from the floor. It was a much higher than that those found by other researchers,^57,58 in which 22.22% of the older people only reported having difficulties in performing this activity. However, all above mentioned situations could be overcome if the institutions to adapt some specific physical and psychological activities that surely will go to improve these conditions.^{14,58,59–62}

In consonance with the Health Ministry,^63,58 the functional dependence of the older people is almost always associated with loss of autonomy. Once an older people demonstrated some degree of dependence to manage their financial resources or to buy food and basic consumer goods, they begin to have their autonomy undermined. As a result, other people will manage their financial assets, they do shop and decide what can or cannot do. The research also showed that about 64.71% of the older people have full autonomy to manage their finances. However, 32.35% reported having some kind of difficulty to properly manage their wages, such as difficulty in going to the bank and receive the money, to make mathematical calculations among others, thus requiring help from the persons who live with them. Only 2.94% need plenty help to manage their finances. The results of this study are similar to another researches,^9,28 in other cities of Brazil, in which the index of independent older people to manage their finances was about 55.00%. A slightly higher autonomy was observed among the older people with leprosy sequelae. When asked about the ability to shop near their homes, 88.24% of them reported having some degree of difficulty to realize this activity.

On the other hand, to use the telephone, the percentage of older people who had difficulty fell to 17.65%, with no significant difference between the sexes (Figure 7).They find it difficult to make purchases due to numerous reasons such as problems to move around, impediments to use the money or inability to carry the purchases. This difficulty can be observed in another study with the older people conducted by Alves^28,29 in which 79.10% of the older people interviewed needed their purchases to be made by their caregivers.

Figure 7 Degree of dependence to make purchases and use the telephone among the older people sequellated by leprosy in the hospital Dr. Geraldo da Rocha, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil. 
D1, total dependence; D2, need for 75% aid; 3D,need for 50% aid; D4, need for 25%aid; D5, need for supervision; D6, need for minimum aid; D7, indepence.

It was found that the percentage of older people who presented some degree of dependence to perform light domestic cleaning, such as washing dishes and cleaning the bed was 55.8%. There was an increase in this percentage to 76.47%, when considering the heavy domestic cleaning, which would be sweeping the house, washing clothes and carrying weight (Figure 8). The inability to perform activities such as domestic cleaning or washing clothes may compromise the proper cleaning of the home and the older people y themselves. It can also lead to feelings of guilt or low self-esteem due to the inability to perform such activities independently.

Figure 8 Degree of dependence, to do household cleaning, found among the older people sequelated by leprosy in the hospital Dr. Geraldo da Rocha, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil.
Source: Authors.
D1, total dependence; D2, need for 75% aid; 3D,need for 50% aid; D4, need for 25%aid; D5, need for supervision; D6, need for minimum aid; D7, indepence.

In accordance with the data presented above, there is a high level of dependence and need for help in IADLs, which are the most complex activities, such as cleaning the house and shopping. Through these indexes can be proven the existence of gradual loss of functions, going from those more detailed and involving coordination and reasoning, to those of more general actions, such as bathing and dressing. This situation can harm the social life of the older people, since they will need more help from caregivers, having to provide more time, more energy and financial resources to overcome the difficulties installed.^8,64–69

Through the application of questionnaires and the observation that was carried out within the General Leprosy Hospital Dr. Geraldo da Rocha during this study, we can know the reality of daily life of older people residents in it, their socioeconomic conditions and also make an analysis of the functional capacity of these people sequellated by leprosy. According to the results obtained in this study, there is a higher incidence of leprosy among farmers older women and older men, and the vast majority of them had income of one minimum wage, married, illiterate, confirming the tendency of this older people in Brazil. Although health and quality of life were reported as good, a significant proportion of them considered that they had serious health problems. A large part of older people had a high degree of dependence on activities of daily living (ADLs), especially with public transportation, climbing stairs, picking up objects from the floor and cutting their toenails. Regarding instrumental activities of daily living (IADLs), the greater difficulties were related to: shop, performing light / heavy domestic cleaning, indicating that it is necessary prevention actions, health promotion and therapeutic interventions by the Health Strategy Teams to delay the continuous decline of the functional capacity of this older people. Leprosy is a serious public health problem in the Northern Region. Thus, this information from the present study can contribute to the planning of actions, to enhance the quality of care, epidemiological surveillance of the mechanism of the disease, and strengthening of the control program in the city of Manaus.

None.

To all leprosy sequellated older people, nurses and other health agents, caregivers and manager of Dr. Geraldo da Rocha hospital. To Universidade do Estado do Amazonas (UEA) and Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM).

The authors declare no conflict of interest.

1. Souza MM de, Silva GB da, Henriques MER de. Significado de ser idoso/Doente de Hanseníase. Rev Eletrônica de Enfermagem. 2005;07(03):327–332.
2. Gontijo RW, Leão MR de C. Effectiveness of a preventive physical therapy program f or the elderly. Rev Med Minas Gerais. 2013;23(2):173–180.
3. Chaimowicz F. The health of elderly Brazilians on the eve of the 21st century: problems, projections and alternatives. 1996.
4. Junior EPP, Silva IT da, Vilela ABA, et al. Functional dependency and associated factor in elderly living with relatives. Cad Saúde Colet. 2016;24(4):404–412.
5. http://bvsms.saude.gov.br/bvs/publicacoes/guia_controle_hanseniase_cab10.pdf.
6. Brazil. ministry of health. health surveillance secretariat. communicable disease surveillance department. Guidelines for surveillance, care and elimination of Hansen's disease as a public health problem: technical-operational manual [electronic resource]/ Ministry of Health, Secretariat of Health Surveillance, department of surveillance of communicable diseases. - Brasília: Ministry of Health, 2016: 58.
7. Eidt LM. Brief history of leprosy: its expansion from the world to the Americas, Brazil and Rio Grande do Sul and its trajectory in Brazilian public health. Saude soc. 2004;13(2):76–88.
8. Santana EMF de, Brito KKG de, Jordana de Almeida Nogueira J de A, et al. Deficiencies and disabilities in leprosy: from the diagnosis to discharge by cure. Rev Eletr Enf. 2018;20:v20a15.
9. Nogueira PSF, Marques MB, Coutinho JFV, et al. Factors associated with the functional capacity of elderly people with leprosy. Rev Bras Enferm. 2017;70(4):711–718.
10. Cordeiro RC, et al. Agreement between observers of a physical therapy assessment protocol in institutionalized elderly women. Rev de Fisioter n. 2002;9:69–77.
11. Guimarães LH de CT, Galdino DCA, Martins FLM, et al. Evaluation of the functional capacity of elderly people undergoing physical therapy treatment. 2004.
12. Gordilho A, Sergio J, Silvestre J, et al. Challenges to be faced in the third millennium by the health sector in comprehensive care for the elderly. Human aging, UNATI, Rio de Janeiro: UERJ, 2000.
13. Rosa TE da C, Benício MHD, Latorre M do RD de O, et al. Fatores determinantes da capacidade funcional entre idosos. Rev Saúde Pública. 2003;37(1).
14. Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–919.
15. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;(9):179–186.
16. Paula JA. Evaluation of the elderly: functional capacity, independence and its relationship with other health indicators. 2007.
17. Wit, NJ de; Schuurmans MJ. Future care for older people in general practice: paradigm shifts are needed. British Journal of General Practice. 2017;67(664):500–501.
18. Fonseca F, Rizzotto MLF. Construction of an instrument for socio-functional evaluation in the elderly. Parana, 2008.
19. Camara F, Gerez G, Miranda ML de J, et al. Capacidade funcional do idoso: formas de avaliação e tendências. São Paulo, 2008.
20. Lima-Costa MF, Firmo, JOA e Uchôa E, et al. The structure of self-rated health among older adults: the Bambuí health and ageing study (BHAS) (A estrutura da autoavaliação da saúde entre idosos: projeto Bambuí). Revista de Saúde Pública Dez. 2004;38(06):1–7.
21. Barbetta PA. Estatística aplicada às ciências sociais. Ed. UFSC, 5ª Edição, 2002.
22. Fowler J, Jarvis P, Chevannes M. Practical statistics for nursing and health care. Wiley & sons, London, 2002:213.
23. Rouquayrol MZ. Epidemiologia & Saúde. 6. Ed. Rio de Janeiro: MEDSI, 2003.
24. Katz DL, Elmore JG, Wild DMG, et al. Jekel’s epidemiology, biostatistics, preventive medicine and public health. Elsevier Saunder. 4th ed, USA, 2014.
25. Medronho RA. Epidemiologia.Atheneu.2nd ed. 2008:676.
26. Ramos LR. Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano. Projeto Epidoso, São Paulo. Caderno de Saúde Pública. 2003:(19)3.
27. http://7a12.ibge.gov.br/vamos-conhecer-o-brasil.
28. Hurtado-Guerrero AF, Lopes EAG, Hurtado–Guerrero JC. Functional capacity and sociodemographic conditions of elderly people in the eliza queiroz maciel living center of mnacapuru, Amazonas, Brazil. Int J of Fam Communi Med. 2019;3(6):253–261.
29. http://www.abep.nepo.unicamp.br/encontro2008/docspdf/ABEP20081534.pdf.
30. http://www.scielo.br/pdf/rsp/v39n4 /25540.pdf.
31. Camarano AA, Kanso S, Fernandes D. Envelhecimento populacional, perda da capacidade laborativa e políticas públicas brasileiras entre 1992 e 2011. 2013.
32. Ferreira JP; Leeson G; Melhado, VR. Cartografias do envelhecimento em contexto rural: notas sobre raça/etnia, gênero, classe e escolaridade. Trab. educ. saúde, Rio de Janeiro. 2019;17(1):e0017612.  
33. Sakamoto CS, Nascimento CA, Maia AG. As famílias pluriativas e não agrícolas no rural brasileiro: condicionantes e diferenciais de renda. Rev Econ Sociol Rural. 2016;54(3):561–582.
34. Nogueira IL. Functional capacity of elderly patients attended in SUS primary healthcare units. UEA, 2007.
35. Brasil. Instituto Brasileiro de Geografia e Estatística. Síntese de indicadores sociais: uma análise das condições de vida da população brasileira, Rio de Janeiro: IBGE, 2017.
36. Soares G. Science proves: Faith helps you live better. Jornal da Ciência, Rio de Janeiro; 2005.
37. Reis LA dos; Menezes TM de O. Religiosity and spirituality in the resilience strategies of the long-lived elderly in daily life. Rev Bras Enferm. 2017;70(4):794–799.
38. Oliveira, RM de, Alves, VP. The quality of life of older people from the influence of religiosity and spirituality: care for the institutionalized elderly in Caetité(BA). Revista Kairós Gerontologia. 2014;17(3):305–327.
39. Neiva RJ; Grisotti M. Representations of leprosy's stigma in the women of the Jequitinhonha Valley-MG. Physis [Internet]. 2019;29(1):e290109.
40. Abdala GA, Kimura M, Duarte YA de O, et al. Religiosity and quality of life related to the health of the elderly. Rev Saúde Pública. 2015;49:55.
41. Melo NCV de, Teixeira KMD, Barbosa TL. Household arrangements of elderly persons in Brazil: analyses based on the national household survey sample (2009). Rev Bras Geriatr Gerontol. 2016;19(1):139–151.
42. Sousa AAAC de, Oliva MTM de, Camargo CL de. Arranjos familiares com pessoas idosas: fatores contributivos. av.enferm. . 2018; 36(3):292–301.
43. Marques JS et al. Atitudes sobre a Velhice: Infância, Adolescência, Avós e a Intergeracionalidade. Revista de Psicologia da IMED. 2019;11(2):147–165.
44. Souza CDF, Fernandes TRM, Matos TS, et al. Grau de incapacidade física na população idosa afetada por hanseníase no estado da Bahia, Brasil. Acta Fisiatr. 2017;24(1):27–32.
45. Viana L da S, Aguiar MIF de, Vasconcelos PF de, et al. Physical aspect and the repercussions on the quality of life and autonomy of elderly people affected by leprosy. Nurse glob. 2017;16(46):336–374.
46. Helene LMF; Rocha MT. Identificação de alguns problemas psicossociais em portadores de hanseníase utilizando para análise os recursos de informática. Rev Esc Enf. 1998;(3):199–207.
47. Matos FS, Jesus CS de, Carneiro JAO, et al. Reduction of functional capacity of elderly residents in the community: a longitudinal study. Collective health science [Internet]. 2018; 23(10):3393–3401.
48. http://www.proec.ufg.br/revistaufg/idoso/perfil.html.
49. Nunes JD, Saes M de O, Nunes BP, et al. Indicadores de incapacidade funcional e fatores associados em idosos: estudo de base populacional em Bagé, Rio Grande do Sul Epidemiol Serv. 2017;26(2):295–304.
50. Nakatani AYK. Functional capacity in elderly in the community and interventions proposed in the team health. Rev Eletr Enf. 2009;11(1):144–150.
51. Arrais PSD; Fernandes, MEP; Pizzol T da S dal. Prevalence of self-medication in Brazil and associated factors. Rev Saúde Pública. 2016;50(supl 2):13s.
52. Garcia AL de F, Madoz KAN, Ferreira EA, et al. Self-medication and adherence to drug treatment: evaluation of participants in the Universidade do Envelhecer program. Rev bras geriatr gerontol. 2018;21(6):691–700.
53. Secoli SR, Marquesini EA, Fabretti S de C, et al. Trend in the practice of self-medication among elderly Brazilians. 2006 e 2010: Estudo SABE. Rev Bras Epidemiol. 2018;21(SUPPL 2): E180007.
54. Rodrigues MCS, Oliveira C. Drug-drug interactions and adverse drug reactions in polypharmacy among older adults: an integrative review. Rev Latino-Am Enfermagem. 2016;24:e2800.
55. Lima M. Perfil da hanseníase no distrito Federal no período de 2000 a 2005. Com. Ciências Saúde. 2008;19(2):163–170.
56. Navarro FM. Convivência familiar e independência para atividades de vida diária entre idosos de um centro dia. Paraná, 2006.
57. Letti FB, Laureano L, DIAS SL de A, et al. Evaluation of the degree of functional capacity of institutionalized elderly. Itajaí, 2004.
58. Brazil. Ministry of Health. secretariat of health surveillance. department of epidemiological surveillance. self-care in leprosy: face, hands and feet / ministry of health, department of health surveillance, Department of Epidemiological Surveillance - Brasília: Publisher of the Ministry of Health, 2010: 72
59. http://seer.upf.br/index.php/rbceh/article/view/10/32.
60. Maciel MG. Physical activity and functionality of the elderly. Motriz Rio Claro. 2010;16(4):1024–1032.
61. Okimura-Kerr T; Okuma SS. Critical attitude of the elderly about physical activity. Rev bras Educ Fís Esporte. 2012;26(4):717–729.
62. http://www.inicepg.univap.br/cd/INIC_2004/trabalhos/inic/pdf/IC4-26R.pdf.
63. http://bvsms.saude.gov.br/bvs/saudelegis/gm/2006/prt2528_19_10_2006.html.
64. Padovani C; Lopes MC de L, Higahashi IH, et al. Being a caregiver for people with Parkinson's Disease: experienced situations. Rev Bras Enferm. 2018;71:2628–2634.
65. Santos KCB dos, TB Cavalcante. MES Lima Leprosy in the elderly: integrative review. Enciclopedia Biosféra. 2019;16(29):2043.
66. Silva DDB da, Tavares CM, Gomes NMC, et al. A hanseníase na população idosa de Alagoas. Rev bras geriatr. gerontol. 2018;21(5):553–561.
67. Farías-Antúnez S. Incapacidade funcional para atividades básicas e instrumentais da vida diária: um estudo de base populacional com idosos de Pelotas. Epidemiologia e Serviços de Saúde [online]. 2018;27(2):e2017290.
68. Teixeira CSS, Medeiros DS de, Alencar CH, et al. Nutritional aspects of people affected by leprosy, between 2001 and 2014, in municipalities in the Brazilian semiarid region. Ciênc. saúde coletiva. 2019;24(7):2431–2441.
69. Lima CA. Functional dependence and risk of falls in the elderly in the home environment and associated factors. C&D-Revista Eletrônica da FAINOR. 2019;12(3):687–704.